IMPORTANT ADDENDUM # 2. RFP # Printing and Mailing Services. Addendum Date: October 28, 2015

Transcription

1 3200 Atlantic Avenue Raleigh, NC Phone: Fax: IMPORTANT ADDENDUM # 2 RFP # Printing and Mailing Services Addendum Date: October 28, 2015 Proposals Opening Date & Time: November 5, :00pm., EST 1

2 Vendor Questions and Answers RFP # Printing and Mailing Services 1. Referring to page 47 of document pdf would UV coating be acceptable in place of Aqueous Coating? A: Yes, that is acceptable. 2. Referring to page 39 of the document pdf for project performance purposes will it be fine to assist the Plan in securing a bulk mail permit at mail facilities currently not utilized? A: Yes 3. I d like to make a request of samples of the Plan s past projects too please. A: A : See Exhibit C attached 4. Can you provide samples for us to evaluate? A: A: See Exhibit C attached 5. Can you send us PDF files from previous printing for the brochures, postcard, and newsletter? A: See Exhibit C attached 6. Who is your current vendor and what is their pricing? A: R. R. Donnelley. The Plan has paid the vendor the following amounts: Calendar year 2014: $147, January 2015 to date: $246,

3 7. Who is the incumbent contractor? A: See response to question Who is the vendor that was awarded this contract from the previous awarded contract? A: See response to question 6 9. What was the bid price from the previous awarded contract? A: See response to question Are you satisfied with them? Why is this out for RFP? A: The current contract ends December 31, Do you require your vendor to be a USPS full service vendor? A: We do not require certification. We require the vendor to meet the minimum requirement stated in #3. Offeror must have knowledge of all regulations regarding mass mailings via the United States Postal Service for first class and bulk mailings and experience with working with Centralize Accounting Processing Systems (CAPs) accounts. 12. Can we mail from out of state? A: This would only be acceptable if the targeted in house delivery date can be met. 13. How should we include postage? Should we give you a range of postage rates or would you prefer a total for your estimated postage? A: It isn t necessary to include postage as those rates are set by the USPS. 3

4 14. Can you provide the bid results from the previous time this contract was bid? A: The contract was awarded to R.R. Donnelley. 15. How much was billed for these services over the last 12 months? A: See Exhibit B attached 16. Can you provide history of the print orders for the last 12 months? We want to see how much of each product was ordered. A: See Exhibits A and B. attached 17. Are there any spikes in order volumes during the year? If so, what time of the year? A: Yes, August through October are higher volume months as the State Health Plan is sending Annual Enrollment materials to members. 18. In reference to a fixed cost for quantities below 100,000 what quantities would you like quoted under 100,000? Do you want a per thousand rate broken out per a quantity of 10,000 or 50,000 or 75,000? A: Quote in quantities of ten thousand so 10,000, 20,000, 30,000, etc. 19. In reference to inks (Full Color) a) Does the 9x6 postcard print 4-color process 2-sides 4/4 b) Does the brochure print in 4-color process 2-sides 4/4 c) Does the newsletter print in 4-color process 2-sides 4/4 d) Is there bleeds on the brochures, postcards or newsletters? A: a) Yes, it is 4 color process front and back. b) Yes, it is 4 color process front and back. c) Yes. d) Yes 20. Can you send us PDF files from previous printing for the brochures, postcard, and newsletter? A: Yes, see Exhibit C. 21. Is the self-mailer for the brochure -- one tab only? A: Yes 22. We are in the process of becoming HIPAA certified and expect the process to be completed by January. Should we submit a bid - or not? A: Offeror must be HIPAA compliant at the time the bid is submitted.

5 23. Item #3: Specs describe brochure that is not a tri-fold. Instead becomes an 8 page brochure. Is material 80# matte text or cover? Text would fold better. A: Item # 3 should be 80# matte text 4

6 EXHIBIT A: PRINTING SUMMARY EXHIBIT A: State Health Plan Printing Summary Month Number of Pieces Description Jan Mar 15-May 15-Jul 15-Jul 15-Aug 15-Aug 15-Sep 15-Sep 15-Oct 2,244 One page letter in envelope 23, 506 Two page letter in envelope 499,961 Tri-fold Brochure 486,646 9x 6 Postcards 342,386 4x6 Postcards 145, pg booklet 631,869 Tri-fold Brochure 501,409 Postcards 493, pg booklet 498,683 Postcards 5

7 EXHIBIT B: ORDER VOLUMES DATE AMOUNT 2/23/ , /28/ , /25/2013 3, /31/2013 1, /8/ , /8/ /25/ , /25/ /9/2013 2, /9/2013 1, /9/ , /9/ , /9/ /16/2013 3, /16/2013 1, /6/2013 3, /20/ , /20/2013 7, /20/ , /19/ , /14/2014 2, /4/ /4/2014 5, /16/2014 2, /13/ , /17/2014 1, /22/2013 2, Total 547,

8 EXHIBIT C: PRINT SAMPLES (This page intentionally left blank) 78187_SHP120.indd 1 9/29/15 5:23 PM

9 2016 STATE HEALTH PLAN ANNUAL ENROLLMENT ISHAPPENINGNOW! ENR DLINE: NOVEMBER 18, 2015 As you think about choosing the best 2016 health plan option for you and your family,rememberthatthingsaredifferentthisyear.ourfocusfor2016 and beyond is offering simple steps that can lead to better health for you, and lower costs for you and the State Health Plan. Make the choice to learn more, and then take action! FOR ACTIVE EMPLOYEES & NON-MEDICARE RETIREES 78187_SHP120.indd 2 9/29/15 5:23 PM

10 THE STATE HEALTH PLAN FOR 2016 AND BEYOND: SIMPLE STEPS TO BETTER HEALTH AND LOWER COSTS PRSRT STD U.S. POSTAGE PAID Durham, NC Permit No. 785 Consumer-Directed Health Plan (CDHP) with HRA Enhanced 80/20 Plan Traditional 70/30 Plan Reduction in monthly premiumfor completing all of these Wellness Activities by November 18, 2015 $80/month premium reduction for: Being tobaccofree or enrolling in QuitlineNC; $90/month premium reduction for: Being tobaccofree or enrolling in QuitlineNC; Nopremium reduction available Choosing a Primary Care Provider and watching a Patient-Centered Medical Homes video; and Taking (or updating) your Health Assessment, including biometrics Choosing a Primary Care Provider and watching a Patient-Centered Medical Homes video; and Taking (or updating) your Health Assessment, including biometrics TOTAL monthly employee-only premium $0 $14.20 $0 Visitwww.shpnc.org for moreinformation aboutyour 2016 health planoptions. Complete your wellness activities and make your 2016 health plan choice by November 18, Visitwww.shpnc.organdclick EnrollNow or call , Monday Friday, 8 a.m. 8 p.m. SHP _SHP120.indd 2 10/1/15 2:36 PM

11 NEW DATES FOR ANNUAL ENROLLMENT: OCTOBER 15 NOVEMBER 18, 2015 IS THE CONSUMER-DIRECTED HEALTH PLAN RIGHT FOR YOU? look inside to fi d out! Telephone town hall enrollment meetings are coming in September. Reserve your spot now by going to the State Health Plan website! Snap this code using your smartphone or visit Visit for more information. FOR ACTIVES & NON-MEDICARE RETIREES

12 myth or fact? Test what you know about the Consumer-Directed Health Plan (CDHP). You could be surprised to learn that the CDHP might be the right plan for you! MYTH: The CDHP is only for young, healthy people who hardly ever go to the doctor. FACT: No matter your age or need for medical care, the CDHP gives you more control over your health care dollars. When you or your covered dependents need care, you can pay for it by using the State Health Plan-provided funds in your Health Reimbursement Account (HRA) before paying any money from your wallet. MYTH: The CDHP will cost more than the other plans. FACT: It s true that the CDHP s annual deductible is higher than the deductibles under your other plan options. However, the CDHP s deductible includes amounts you pay for prescription drugs something the other two plans don t include. Plus, the monthly premiums for the CDHP are lower than the premiums for the other plans. So, the CDHP could save you money. MYTH: The State Health Plan offers the CDHP just to save money. FACT: The State Health Plan continually looks for ways to offer you valuable, affordable health coverage. The CDHP is a good example. It offers you lower premiums, a State Health Plan-funded HRA and opportunities to earn more in your HRA. More in your HRA means you pay less when you need care. Depending on how you use it, the CDHP may be the most valuable option the State Health Plan offers. M YTH: I have to contribute my own funds to my HRA. FACT: The State Health Plan contributes 100% of the funds in your HRA. You don t and can t contribute to your HRA. 1

13 HOW THE CONSUMER-DIRECTED HEALTH PLAN WORKS The CDHP works very simply. Here s how: Step 1 Step 2 Step 3 Get FREE Affordable Care Act (ACA) preventive care services and medications. Your annual check-up and age-/gender-specific ACA vaccinations, prescriptions and exams are covered 100% when you see an in-network provider. Use your State Health Plan-funded Health Reimbursement Account (HRA) to pay for covered expenses. The State Health Plan contributes to your HRA each year, based on the coverage level you choose (see page 3). Use your HRA to help pay your annual deductible and prescription drug expenses. Earn additional HRA contributions by completing wellness activities and participating in the CDHP s Health Engagement Program (see page 4). Meet your annual deductible. Continue using your HRA to meet your annual deductible. If you use all your HRA funds, you pay any remaining amount toward your annual deductible from your wallet. Step 4 Pay coinsurance. After meeting the annual deductible, you pay 15% coinsurance in-network or 30% out-of-network for each covered expense. After reaching the annual coinsurance limit, the Plan pays 100% of covered expenses for the rest of the Plan Year. Your HRA balance rolls over. If you don t use your entire HRA in 2016 and you remain covered under the CDHP for 2017, the balance is added to the amount the State Health Plan will contribute to your HRA in NEW CDHP PHARMACY DEBIT CARD You ll receive a pharmacy debit card when you enroll in the CDHP for Use this card like a regular debit card when paying for prescriptions at your local pharmacy. Most retail pharmacies accept the card be sure to ask your pharmacy if it does. Your payment will be deducted from your Health Reimbursement Account automatically. By using the card, you won t need to pay the full cost of a prescription when it s filled and then wait for reimbursement. 2

14 STATE HEALTH PLAN CONTRIBUTIONS TO YOUR HEALTH REIMBURSEMENT ACCOUNT A great advantage to enrolling in the CDHP is the Health Reimbursement Account (HRA) that comes with it. For 2016, the State Health Plan contributions to your HRA will increase, as shown below. If you were enrolled in the CDHP previously and have funds remaining in your HRA, those funds will roll over and be added to the amounts below. COVERAGE LEVEL Employee 2016 STATE HEALTH PLAN-PROVIDED HRA CONTRIBUTION $600 Employee +1 $1,200 Employee +2 or more $1,800 It s great to use the HRA to pay my medical expenses! ADDITIONAL OPPORTUNITIES TO EARN MORE HRA CONTRIBUTIONS When you enroll in the CDHP, you can increase the funds that the State Health Plan contributes to your HRA by doing the following: WHAT YOU CAN DO See the Primary Care Provider (PCP) listed on your medical plan ID card (or see another provider in your PCP s practice) ADDITIONAL STATE HEALTH PLAN CONTRIBUTIONS TO YOUR HRA $25 See a Blue Options Designated Specialist $20 Use a Blue Options Designated Hospital $200 3

15 THE CDHP S NEW HEALTH ENGAGEMENT PROGRAM When you enroll in the CDHP, you have the opportunity to participate in a new Health Engagement Program and earn more State Health Plan-provided contributions to your HRA. FOR ALL CDHP MEMBERS Starting in 2016, if you re enrolled in the CDHP, you will have the opportunity to earn additional HRA contributions by working with an NC HealthSmart lifestyle coach and by tracking your daily physical activity and/or nutrition. You can work with an NC HealthSmart lifestyle coach by phone and track your physical activity and nutrition through the Personal Health Portal. You can do this by using a wearable device (e.g., Fitbit, Garmin) or using a free app (e.g., MapMyFitness, MyFitnessPal). FOR CDHP MEMBERS WITH CHRONIC CONDITIONS If you have a chronic health condition, you can earn additional HRA contributions while obtaining the regular care you need to manage your condition. Chronic conditions include diabetes, asthma, high cholesterol, chronic obstructive pulmonary disease (COPD), high blood pressure (hypertension), coronary heart disease, and congestive heart disease. Here are the things you can do to earn additional HRA contributions: Complete a call with an NC HealthSmart nurse coach every 6 months See your Primary Care Provider (PCP) and have a 6-month follow-up visit Complete the clinically recommended lab work (e.g., a blood lipid test) for your condition Complete recommended treatments and education for your condition. If you enroll in the CDHP, you ll receive more information about the Health Engagement Program in your home mailbox. The information contained herein is a brief summary of State Health Plan benefi Refer to the applicable plan benefi booklet, which will be available on the State Health Plan s website in October 2015, for a full description of benefi In the event of a discrepancy between the information in this newsletter and the plan benefi booklet, the information provided in the plan benefi booklet will govern. facebook.com/shpnc 4

16 PRESORTED FIRST-CLASS MAIL U.S. POSTAGE PAID Durham, NC Permit No. 786 State Health Plan Eligibility and Support Center P.O. Box 1484 Lincolnshire, IL get ready for 2016 Annual Enrollment TAKE SIMPLE STEPS TO IMPROVE YOUR HEALTH AND SAVE ON PREMIUMS! Watch your mail for the State Health Plan Enrollment Decision Guide to help you determine if the CDHP is the right 2016 health plan choice for you. Visit the State Health Plan website ( to watch videos, listen to podcasts, and more. NEW DATES FOR ANNUAL ENROLLMENT: OCTOBER 15 NOVEMBER 18, 2015 Please note: You may have inadvertently received a postcard about Annual Enrollment that was intended for a different group of State Health Plan members. If so, we apologize for the error and any confusion it may have caused. You will receive an Enrollment Decision Guide in your home mailbox in September that will include more information about Annual Enrollment and applicable wellness credits. Please visit for more information. SHP105

17 welcome to 2016 Annual Enrollment! OCTOBER 15 NOVEMBER 18, 2015 Annual Enrollment is your chance to review your health plan choices, make changes, and complete wellness activities to earn wellness premium credits for Visit for State Health Plan information. FOR ACTIVE EMPLOYEES

18 let s get started! This guide will help you take a closer look at the three health plan options available to you and decide which one to choose for 2016 your best choice for 2016 may be different than the coverage you have now. IMPORTANT: If you do nothing during Annual Enrollment, you may pay more than you should in 2016! The choices you make during Annual Enrollment are for benefits from January 1, 2016 through December 31, Once you choose your benefi plan, you may not elect to switch plans until the next enrollment period. The coverage type you select (for example, employee only) will remain in effect until the next benefi plan year, unless you experience a qualifying life event. A list of qualifying life events is available in the applicable benefi booklet, which will be available on the State Health Plan website in October 2015 ( WHAT YOU NEED TO DO: Visit and use the Health Benefi Cost Estimator to compare how much you may pay under each plan in It s easy and quick. Just answer a few questions about your health care needs and you ll instantly get your estimated annual health care expenses: your premium and how much you ll pay at the time of service when you need care. Select a health plan. Your best choice for 2016 may be different than the coverage you have now. Complete the wellness activities applicable to the plan you choose. Be sure to read about our new Health Engagement Program for Consumer-Directed Health Plan (CDHP) members! Make plan changes any time between October 15 and November 18, Go to the State Health Plan website ( See How to Enroll/Complete Wellness Activities (page 5). Note that all members must log in to during Annual Enrollment to verify that personal and enrollment information is correct for 2016! Earning wellness premium credits adds up to big savings for you! WHAT S INSIDE the Consumer-Directed Health Plan (CDHP)....1 the Enhanced 80/20 Plan the Traditional 70/30 Plan how to enroll/complete wellness activities State Health Plan comparison monthly premiums NCFlex state insurance plans

19 a look at your options For 2016, the State Health Plan will continue offering three Preferred Provider Organization (PPO) plans through Blue Cross and Blue Shield of North Carolina (BCBSNC): The Consumer-Directed Health Plan (CDHP) with a Health Reimbursement Account (HRA); The Enhanced 80/20 Plan; and The Traditional 70/30 Plan. These PPO plans allow you the fl xibility to visit any provider in or out of the PPO network and receive benefi Generally, you pay less when you visit an in-network PPO provider. All three plans offer comprehensive coverage and a large provider network. the Consumer-Directed Health Plan (CDHP) IMPORTANT 2016 CHANGE ABOUT OUT-OF-NETWORK LABS Effective January 1, 2016, if your provider sends your lab work to an outof-network lab for processing, your claims will not be paid at the in-network coinsurance level; instead, they will be paid at the appropriate out-of-network coinsurance level. This may result in you paying more for out-of-network lab work. Talk to your provider to ensure they are using Blue Cross and Blue Shield of North Carolina in-network labs. WHAT S NEW UNDER THE CDHP FOR 2016? The State Health Plan s contributions to your Health Reimbursement Account will increase. The out-of-pocket maximum will increase by $500 for employee-only coverage, and $1,500 for family coverage. A new Health Engagement Program will give you the opportunity to earn more State Health Plan contributions to your HRA. A new prescription drug debit card will let you pay for prescriptions at a retail pharmacy directly from your HRA, without having to pay up front and wait for reimbursement. (See page 3.) HOW THE CDHP WORKS When you enroll in the CDHP, the State Health Plan sets up an HRA in your name. This account starts with a balance provided by the State Health Plan. Your HRA is used to help you meet the deductible and pay other out-of-pocket covered medical expenses. The State Health Plan s contribution to your HRA in 2016 depends on how many people you enroll in your plan, as shown below. If you are enrolled in the CDHP now and have funds remaining in your HRA, those funds will roll over and be added to the amounts below. Yourself only: $600; or Yourself and one dependent: $1,200; or Yourself and two or more dependents: $1,800. 1

20 NEW HEALTH ENGAGEMENT PROGRAM! In 2016, if you re enrolled in the CDHP, you will have the opportunity to earn additional HRA contributions by working with an NC HealthSmart lifestyle coach and by tracking your daily physical activity and/or nutrition. You can work with an NC HealthSmart lifestyle coach by phone and track your physical activity and nutrition through the Personal Health Portal. You can do this by using a wearable device (e.g., Fitbit, Garmin) or by using a free app (e.g., MapMyFitness, MyFitnessPal). If You Have a Chronic Health Condition If you have a chronic health condition, you can earn additional HRA contributions while obtaining the regular care you need to manage your condition. Chronic conditions include diabetes, asthma, high cholesterol, chronic obstructive pulmonary disease (COPD), high blood pressure (hypertension), coronary heart disease, and congestive heart disease. Here are the things you can do to earn additional HRA contributions: Complete a call with an NC HealthSmart nurse coach every 6 months. See your Primary Care Provider (PCP) and have a 6-month follow-up visit. Complete the clinically recommended lab work (e.g., a blood lipid test) for your condition. Complete recommended treatments and education for your condition. GREATER HRA WELLNESS INCENTIVES FOR 2016 As in past years, you can earn additional HRA contributions when you choose high-quality provider options, as shown below. These smart choices can earn you more in your HRA in SMART CHOICE ADDITIONAL HRA CONTRIBUTION See your selected Primary Care Provider (or see another provider in your PCP s offi e) $25 See a Blue Options Designated specialist $20 Use a Blue Options Designated hospital for an inpatient stay $200 FINDING A BLUE OPTIONS DESIGNATED PROVIDER, SPECIALIST OR HOSPITAL Blue Options Designated providers have been designated because they provide high quality and cost effective services. To fi d a Blue Options Designated provider, specialist or hospital, visit the State Health Plan website ( and click on Member Login to access Blue Connect. Then, select Find a Doctor or Facility. Or, call Blue Cross and Blue Shield of North Carolina (BCBSNC) at Visit to use the Health Benefi Cost Estimator and compare what you may pay under the health plans. 2

21 SIMPLE STEPS TO REDUCING YOUR CDHP MONTHLY PREMIUM You can lower your monthly premium for the CDHP by completing the wellness activities shown below to earn wellness premium credits. Wellness premium credits apply only to the employee premium. IF YOU COMPLETE THE FOLLOWING WELLNESS ACTIVITIES FOR THE CDHP BY NOVEMBER 18, 2015 BY DOING THE FOLLOWING YOUR MONTHLY PREMIUM WILL BE REDUCED BY Attest that you and (if applicable) your enrolled spouse are tobacco-free or enroll in the QuitlineNC multiple-call tobaccocessation program Responding to the attestation question on eenroll as part of the enrollment process. Even if you attested during last year s Annual Enrollment, you will need to re-attest (and attest for your spouse, if you are enrolling him/her). If either of you is a tobacco user, you must enroll in the QuitlineNC tobacco-cessation program to receive the wellness credit. You can enroll in QuitlineNC s program any time between now and November 18, 2015, to receive the credit. $40 Select a Primary Care Provider (PCP) for you and all covered dependents and watch a short PCMH (Patient-Centered Medical Homes) video Signing into eenroll, selecting a PCP (if you haven t already selected one) AND watching the PCMH video (video available beginning October 15). $20 Take (or update) your Health Assessment and provide your biometric numbers Visiting the State Health Plan website ( clicking on Personal Health Portal and entering your information. If you have updated or completed your Health Assessment between November 1, 2014 and November 18, 2015, you will earn this wellness premium credit for You may also update or take your assessment by phone: $20 TOTAL MONTHLY SAVINGS: $80 TOTAL MONTHLY EMPLOYEE-ONLY PREMIUM: $0 NEW CDHP PHARMACY DEBIT CARD You ll receive a pharmacy debit card when you enroll in the CDHP for Use this card like a regular debit card when paying for prescriptions at your local pharmacy. Most retail pharmacies accept the card be sure to ask your pharmacy if it does. Your payment will be deducted from your Health Reimbursement Account automatically. By using the card, you won t need to pay the full cost of a prescription when it s fi and then wait for reimbursement. If you enroll in the CDHP, you ll receive more information about the Health Engagement Program in your home mailbox. 3

22 the Enhanced 80/20 Plan WHAT S NEW FOR 2016? The Enhanced 80/20 Plan remains the same for 2016, with one exception: The prescription drug coinsurance maximum for Tier 5 (non-specialty) medications will increase slightly. See the 2016 State Health Plan Comparison on page 6. WELLNESS INCENTIVES FOR 2016 As in past years, you can reduce your copays when you choose high quality provider options, as shown below. These smart choices can save you more in copay reductions in SMART CHOICE See your selected Primary Care Provider (or see another provider in your PCP s offi e) $15 See a Blue Options Designated specialist $10 Use a Blue Options Designated hospital for an inpatient stay COPAY REDUCTION Copay not applied SIMPLE STEPS TO REDUCING YOUR ENHANCED 80/20 PLAN MONTHLY PREMIUM You can lower your monthly premium for the Enhanced 80/20 Plan by completing the wellness activities shown below to earn wellness premium credits. Wellness premium credits apply only to the employee premium. IF YOU COMPLETE THE FOLLOWING WELLNESS ACTIVITIES FOR THE ENHANCED 80/20 PLAN BY NOVEMBER 18, 2015 Attest that you and (if applicable) your enrolled spouse are tobacco-free or enroll in the QuitlineNC multiple-call tobaccocessation program Select a Primary Care Provider (PCP) for you and all covered dependents and watch a short PCMH (Patient-Centered Medical Homes) video BY DOING THE FOLLOWING Responding to the attestation question on eenroll as part of the enrollment process. Even if you attested during last year s Annual Enrollment, you will need to re-attest (and attest for your spouse, if you are enrolling him/her). If either of you is a tobacco user, you must enroll in the QuitlineNC tobaccocessation program to receive the wellness credit. You can enroll in QuitlineNC s program any time between now and November 18, 2015, to receive the credit. Signing into eenroll, selecting a PCP (if you haven t already selected one) AND watching the PCMH video (video available beginning October 15). YOUR MONTHLY PREMIUM WILL BE REDUCED BY $40 $25 Take (or update) your Health Assessment and provide your biometric numbers Visiting the State Health Plan website ( clicking on Personal Health Portal and entering your information. If you have updated or completed your Health Assessment between November 1, 2014 and November 18, 2015, you will earn this wellness premium credit for You may also update or take your assessment by phone: $25 TOTAL MONTHLY SAVINGS: $90 TOTAL MONTHLY EMPLOYEE-ONLY PREMIUM: $

23 the Traditional 70/30 Plan WHAT S NEW FOR 2016? The Plan s annual deductible, copays, and other out-of-pocket expenses are increasing for See the 2016 State Health Plan Comparison on page 6. Please note the State Health Plan of North Carolina s Board of Trustees has decided to delay offering a wellness credit for this plan for A previous communication that was mailed to you had included information about a credit for Choose the plan that s right for you and your family! HOW TO ENROLL/COMPLETE WELLNESS ACTIVITIES: 1. To enroll in or change your plan, or to complete wellness activities, visit the State Health Plan website ( and click Enroll Now to log into the eenroll system. You may be required to create an account if you are a fi time eenroll user. 2. Review your dependent information and make changes, if needed. 3. Attest to and complete the applicable wellness activities, to reduce your monthly premium. 4. Review the benefits you ve selected. If you are OK with your elections, you will be prompted to save your enrollment. 5. The fi al step is printing your confi ation statement for your records. Visit to use the Health Benefi Cost Estimator and compare what you may pay under the health plans. 5

24 2016 State Health Plan comparison PLAN DESIGN FEATURES HRA Starting Balance Annual Deductible Coinsurance Coinsurance Maximum* Out-of-Pocket Maximum** Rx Out-of- Pocket Maximum Preventive Care Offi Inpatient Hospital Visits CONSUMER-DIRECTED HEALTH PLAN (CDHP) ENHANCED 80/20 PLAN TRADITIONAL 70/30 PLAN In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network $600 Employee $1,200 Employee + 1 $1,800 Employee + 2 or more $1,500 Individual $4,500 Family 15% of eligible expenses after deductible N/A $3,500 Individual $10,500 Family $3,000 Individual $9,000 Family 35% of eligible expenses after deductible and the difference between the allowed amount and the charge N/A $7,000 Individual $21,000 Family Included in total out-of-pocket maximum $0 (covered at 100%) 15% after deductible; $25 added to HRA if you use PCP on ID; $20 added to HRA if you use Blue Options Designated specialist 15% after deductible; $200 added to HRA if you use Blue Options Designated hospital N/A 35% after deductible 35% after deductible $700 Individual $2,100 Family 20% of eligible expenses after deductible $3,210 Individual $9,630 Family N/A $1,400 Individual $4,200 Family 40% of eligible expenses after deductible and the difference between the allowed amount and the charge $6,420 Individual $19,260 Family $1,054 Individual $3,162 Family 30% of eligible expenses after deductible $4,282 Individual $12,846 Family N/A N/A N/A N/A N/A $0 (covered at 100%) $30 for primary doctor; $15 if you use PCP on ID card $70 for specialist; $60 if you use Blue Options Designated specialist $233 copay, then 20% after deductible; copay not applied if you use a Blue Options Designated hospital $2,500 $3,294 N/A PRESCRIPTION DRUGS 40% after deductible $233 copay, then 40% after deductible $39 for primary doctor; $92 for specialist $39 for primary doctor; $92 for specialist $329 copay, then 30% after deductible $2,108 Individual $6,324 Family 50% of eligible expenses after deductible and the difference between the allowed amount and the charge $8,564 Individual $25,692 Family Only certain services are covered 50% after deductible $329 copay, then 50% after deductible Tier 1 $12 copay per 30-day supply $15 copay per 30-day supply Tier 2 Tier 3 Tier 4 15% after deductible 35% after deductible $40 copay per 30-day supply $64 copay per 30-day supply 25% up to $100 per 30-day supply Applicable copay and the difference between the allowed amount and the charge $46 copay per 30-day supply $72 copay per 30-day supply 25% up to $100 per 30-day supply Applicable copay and the difference between the allowed amount and the charge Tier 5 25% up to $132 per 30-day supply 25% up to $132 per 30-day supply ACA Preventive Medications $0 (covered at 100%) $0 (covered at 100%) $0 (covered at 100%) $0 (covered at 100%) N/A N/A CDHP Preventive Medications 15%, no deductible 15%, no deductible N/A N/A N/A N/A Note: For the Enhanced 80/20 and Traditional 70/30 Plans, for non-specialty brand-name drugs for which a generic is available, you will pay the generic copay plus the difference between the plan s cost for the brand-name drug and the generic drug, up to $100 per 30-day supply for the brand-name drug. * Excludes deductible. ** Includes deductible. 6

25 2016 monthly premiums Note that the monthly premiums below apply only to Active members. Monthly premiums for all plans can be found on the State Health Plan website: CONSUMER-DIRECTED HEALTH PLAN (CDHP) WITH HEALTH REIMBURSEMENT ACCOUNT (HRA) COVERAGE TYPE EMPLOYEE MONTHLY PREMIUM MONTHLY WELLNESS PREMIUM CREDIT NET MONTHLY PREMIUM Employee $80.00 ($80.00) $0.00* Employee + Child(ren) $ ($80.00) $189.82* Employee + Spouse $ ($80.00) $489.14* TRADITIONAL 70/30 PLAN Employee + Family $ ($80.00) $520.96* COVERAGE TYPE EMPLOYEE MONTHLY PREMIUM ENHANCED 80/20 PLAN Employee $0.00 Employee + Child(ren) $ COVERAGE TYPE EMPLOYEE MONTHLY PREMIUM MONTHLY EMPLOYEE MONTHLY PREMIUM NET MONTHLY PREMIUM Employee + Spouse $ Employee + Family $ Employee $ ($90.00) $14.20* Employee + Child(ren) $ ($90.00) $294.72* Employee + Spouse $ ($90.00) $660.52* Employee + Family $ ($90.00) $699.42* *Assumes completion of all wellness activities. Visit to use the Health Benefi Cost Estimator and compare what you may pay under the health plans. 7

26 NCFlex benefi are available to employees of state agencies, the university system, select community colleges, or select charter schools. You must work 20 hours or more a week in a permanent, probationary, or time-limited position to participate. To see full rates, visit DENTAL We offer two affordable plan options to fit your health and budget needs: RATE TIER HIGH OPTION LOW OPTION Employee Only $36.88 $21.22 Employee & Spouse $73.96 $42.78 Employee & 1 Child $70.96 $41.04 Employee & 2+ Children $89.70 $52.28 Employee & Family $ $73.22 You choose your dentist: in-network or out-of-network. VISION We offer a choice of three plans with comprehensive eye exams and materials: COST BY PLAN EMPLOYEE ONLY EMPLOYEE & FAMILY Core Wellness No cost N/A Basic $5.56 $15.46 Enhanced $8.58 $22.88 SPENDING ACCOUNTS HEALTH CARE SPENDING ACCOUNT The Health Care Flexible Spending Account (HCFSA) is a special account you put money into that you use to pay for certain out-of-pocket health care costs. You can use an NCFlex Convenience Card, which works like a credit card or debit card when paying for these expenses. You may contribute as little as $120 per plan year or as much as $2,550 per plan year. DEPENDENT DAY CARE SPENDING ACCOUNT Similar to the Health Care Spending Account, you may contribute pre-tax funds to be used for Child Care and Adult Day Care. You may contribute up to $5,000 per household per plan year. GROUP TERM LIFE INSURNACE This plan pays a benefi to your benefi ary(ies) if you die while covered under the policy. Please note that this is strictly a Term Life Policy with no cash value. Rates are based on the employee s age. For example, if you are years old and elect $20,000 in coverage, your monthly premium is $2. CORE ACCIDENTAL DEATH & DISMEMBERMENT This insurance plan pays a benefi if you suffer a loss as the result of a covered accident. You are eligible for up to $10,000 for you or your beneficiary. It also pays a benefit if you suffer certain disabling injuries while covered. VOLUNTARY ACCIDENTAL DEATH & DISMEMBERMENT This insurance plan pays a benefi if you suffer a loss or certain disabling injuries as a result of a covered accident. CANCER INSURANCE You can choose among three plan options depending on your cancer insurance needs and specified diseases. The rates for the Low, High, and Premium Options are below: COST BY PLAN EMPLOYEE ONLY EMPLOYEE & FAMILY Low Option $6.38 $10.56 High Option $15.18 $25.16 Premium Option $20.28 $33.54 This benefi pays an annual wellness benefi for you and your family. The benefi amount depends on the type of coverage selected. CRITICAL ILLNESS This insurance pays a benefi for critial illnesses, such as heart attack, stroke, cancer, and more. The coverage pays a lump sum benefit of up to $15,000 per diagnosis. You can use your benefi as you see fi Rates are based on employee s age. For example, if you are years old, your monthly premium is $7.40 and your spouse s premium will also be the same price regardless of his/her age. Dependent children are no cost. TRICARE SUPPLEMENT PLAN If you currently have TRICARE Standard/Extra, Prime, or TRS benefits offered through the Military Community, you may be eligible for this plan, which pays a benefit for costs not covered by TRICARE. TRICARE and the TRICARE Supplement Plan work together to maximize your benefits and minimize your out-of-pocket expenses. RATE TIER COST Employee Only $60.50 Employee & Child(ren) $ Employee & Spouse $ Employee & Family $ Starting September 1, 2015, ALEX will be available to help you with your benefi decisions. ALEX is an online benefi counselor that interacts with you to help you understand your benefi needs. Start the conversation with ALEX at ncflex.org. 8

27 LEGAL NOTICES Notice Regarding Wellness Incentives Your health plan is committed to helping you achieve your best health. Rewards for participating in a wellness program are available to all employees. A reasonable alternative to tobacco use status (participation in a tobacco-cessation program) has been provided to you. If your physician recommends a different alternative because he or she believes the program we make available is not medically appropriate, that recommendation may be accommodated to enable you to achieve the reward. Contact us at to make an accommodation request. Notice of Grandfather Status The State Health Plan believes the Traditional 70/30 and the Enhanced 80/20 Plans are grandfathered health plans under the Patient Protection and Affordable Care Act (the Affordable Care Act). As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted. Being a grandfathered health plan means that your plan may not include certain consumer protections of the Affordable Care Act that apply to other plans, for example, the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act, for example, the elimination of lifetime limits on benefi Questions regarding which protections apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health plan status can be directed to Customer Service at You may also contact the U.S. Department of Health and Human Services at As a plan grandfathered under the Affordable Care Act, cost sharing for preventive benefi may continue as it does currently and be based on the location where the service is provided. Enrollment in the Flexible Benefi Plan (under IRS Section 125) for the State Health Plan If you are an active employee, you are eligible to participate in the Flexible Benefi Plan and have your health benefi plan premium payments deducted on a before-tax basis. Retirees and members with COBRA continuation coverage are not eligible to participate because they must have current payroll earnings from which the premium payments can be deducted. The Flexible Benefi Plan allows any premiums you pay for health benefit coverage to be deducted from your paycheck before Federal, State, and FICA taxes are withheld. By participating, you will be able to lower your taxable income and lower your taxable liability, thereby in effect, lowering the net cost of your health plan coverage. The Flexible Benefit Plan is designed so that your participation will be automatic unless you decline. If you wish to decline participation and have your contributions paid on an after-tax basis, you must do so in the eenroll system. You will have the opportunity to change your participation election during each Annual Enrollment period. The Flexible Benefi Plan offered by the State is for the payment of health benefi plan premiums on a before-tax basis only and is separate and distinct from NCFlex, which is administered by the Office of State Human Resources. Your health benefit coverage can only be changed (dependents added or dropped) during the Annual Enrollment period or mid-year, when you experience one of the qualifying events listed in your Benefi Booklet (available online at In all cases, the requested change in coverage must be consistent with the status change event that you experienced (e.g., add new dependent to coverage due to birth). Your request for a change in coverage due to a status change event must be completed online within 30 days of the event. If you do not process the request within 30 days, you must wait until the next Annual Enrollment to make the coverage change (unless you experience another status change event during the year). Employees who terminate a dependent s coverage mid-year may only re-enroll their dependent during that year if another status change event occurs mid-year, or at the next Annual Enrollment. Notice to Members of the State Health Plan for Teachers and State Employees Regarding Your Mental Health Benefi Under a Federal law known as the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Public Law , as amended, group health plans must generally comply with the requirements listed below. However, the law also permits State and local government employers that sponsor health plans to elect to exempt a plan from certain of these requirements for the part of the plan that is self-funded by the employer, rather than provided through an insurance policy. The State of North Carolina has elected to exempt the State Health Plan for Teachers and State Employees (State Health Plan) from the following requirements: The requirement calling for parity in the application of certain limits to mental health benefi That requirement states that group health plans (of employers that employ more than 50 employees) that provide both medical and surgical benefi and mental health or substance abuse disorder benefi must ensure that fi ancial requirements and treatment limitations applicable to mental health or substance abuse benefi are no more restrictive than the predominant fi ancial requirements and treatment limitations applicable to substantially all medical and surgical benefi covered by the plan. State law, under N.C.G.S (4), requires that the Plan provide benefi for the treatment of mental illness and chemical dependency and that the benefi provided have the same deductibles, durational limits and co-insurance factors as the benefi for physical illness generally. The current mental health benefi are in compliance with state law. The exemption from these Federal requirements will be in effect for the 2016 plan year, beginning January 1, 2016, and ending December 31, The election may be renewed for subsequent plan years. What does this mean for you? Please note that you will not lose your health coverage as a result of these elections, and your mental health benefits are not changing. The State Health Plan s mental health benefi are established under North Carolina statutes and Plan policy. Members pay a copayment for in-network offi e services; after 26 mental health offi e visits per benefi year, members must seek authorization for additional visits to verify medical necessity. It is also the member s responsibility to ensure that all out-of-network inpatient and outpatient hospital services are authorized prior to services being rendered and that out-of-network emergency admissions are authorized as soon as reasonably possible following admission. Services performed in an outpatient hospital setting are subject to the deductible and coinsurance, and inpatient services are subject to an inpatient copayment, the deductible and coinsurance. For additional information, read your Benefits Booklet, or go to select My Medical Benefi and review the Plan Comparison Chart. Notice Regarding Mastectomy-Related Services As required by the Women s Health and Cancer Rights Act of 1998, benefi are provided for mastectomy-related services including all stages of reconstruction and surgery to achieve symmetry between the breasts, prostheses, and complications resulting from a mastectomy, including lymphedema. For more information, contact Customer Service at

28 State Health Plan Eligibility and Support Center 100 Benefitfocus Way Charleston, SC FIRST CLASS MAIL PRESORTED U.S. POSTAGE PAID Raleigh, NC Permit No. 786 YOUR ENROLLMENT DECISION GUIDE FOR 2016 STATE HEALTH PLAN ANNUAL ENROLLMENT! ANNUAL ENROLLMENT: OCTOBER 15 NOVEMBER 18, 2015 CONTACT US eenroll questions: Express Scripts (pharmacy questions): Blue Cross and Blue Shield of NC (benefits & claims): NC HealthSmart: SHP108

29 Let us know how we re doing Your opinion matters and so does your satisfaction with the North Carolina State Health Plan. That s why we re asking you to let us know about your experience with the Plan. As an active or retired member, both you and your covered spouse (if applicable) are welcome to participate in our quick, online survey. Taking the survey is fast and easy: Go to by August 31, 2015 Click on the survey link Take the survey Thank you in advance for your valuable feedback. It helps us learn what s working well and what might need improvement to ensure an excellent member experience for you and your family.

30 North Carolina State Health Plan PO Box 1484 Lincolnshire, IL Share your experience with us Take a quick online survey from the State Health Plan, and help us ensure the best member experience for you and your family. Be sure to take the survey by August 31, Go to now.