NC State Health Plan Approves 5% Premium Increase and New Hospital Tiers
The NC State Health Plan board approved a 5% premium increase for 2027 and a new four-tier provider network featuring preferred hospital partners.
Planned Premium Adjustments
Members of the NC State Health Plan board have authorized a flat 5% premium increase set to take effect in 2027. This adjustment will apply to the majority of the organization's existing plans to account for rising healthcare costs.
The decision marks a significant shift in the plan's financial structure as it prepares for the 2027 coverage year. The board's move aims to stabilize the plan's long-term funding while navigating evolving market conditions.
Implementation of Four-Tier Network
In addition to the premium adjustments, the health plan is transitioning to a structured four-tier network model. This new system will categorize medical providers based on specific criteria to manage costs and influence member selection.
Under this tiered framework, certain healthcare providers will be designated as preferred. This structure allows the plan to steer members toward high-value providers while managing overall expenditure.
Preferred Healthcare Providers
The plan has officially identified major healthcare systems to serve as preferred providers within the new network. Specifically, Novant Health and UNC Health will occupy preferred positions in the tiered hierarchy.
By designating these large systems as preferred, the plan expects to consolidate care within networks that meet specific quality and cost metrics. This change will impact how members select specialists and hospital facilities for their medical needs.
Impact on Plan Members
The combination of increased premiums and a tiered network structure will require members to adjust their healthcare utilization strategies. While the 5% increase is scheduled for 2027, the introduction of preferred providers may influence cost-sharing responsibilities and out-of-pocket expenses depending on the tier chosen.
Members should prepare for the following changes:
- A standard 5% increase in premiums for most plans starting in 2027.
- A new four-tier provider classification system.
- Preferential status for Novant Health and UNC Health facilities.
