Health Plans We Do Not Regulate

State Health Plan for Teachers and State Employees

State Health Plan for Teachers and State Employees

The state of North Carolina provides to its employees a "self-funded" plan arrangement. Self-funded plan sponsors contract with insurance companies or third-party administrators (TPAs) to provide administrative services only. This is the only service that Blue Cross Blue Shield of NC provides to the state employees of North Carolina. It is the employer, The State of North Carolina that is responsible for coverage and premium amounts as well as seeing that claims are paid in accordance with plan provisions. For more information concerning the State Health Plan contact them at:

State Health Benefits Office
3200 Atlantic Ave
Raleigh, NC 27604
Phone: 855-859-0966 or 800-422-4658

https://www.shpnc.org/

State of North Carolina Health Choice for Children / CHIP (Child Health Insurance Program)

State of North Carolina Health Choice for Children / CHIP (Child Health Insurance Program)

State of North Carolina Children's Health Insurance Program is a program funded by the federal and state governments. A child with no health insurance under the age of 19 who lives in the State of North Carolina may be covered depending on how much income his or her family earns a year. To obtain more information about this program, contact the North Carolina Division of Medical Assistance at:

North Carolina Division of Medical Assistance
1985 Umstead Drive
Raleigh, NC 27603-2001
Phone 919-733-4261
Toll-free phone: 800-367-2229
TTY: 877-452-2514

 

Medicaid

Medicaid

Medicaid provides medical assistance to low-income families and individuals of all ages participating in-cash assistance programs. The federal and state governments jointly finance Medicaid. Medicaid programs are governed by federal guidelines but vary in eligibility criteria and covered services. In North Carolina, each county determines eligibility for Medicaid benefits. To obtain more information about this program, contact the North Carolina Division of Medical Assistance at:

North Carolina Division of Medical Assistance
1985 Umstead Drive
Raleigh, NC 27603-2001
Phone 919-733-4261
Toll-free phone: 800-367-2229
TTY: 877-452-2514

Self-Funded Employee Health Benefit Plans

Self-Funded Employee Health Benefit Plans

In a self-funded plan, the employer or group collects premiums itself and uses those funds to pay for claims. While an insurance company or other company may be responsible for administering the plan (provider network, claims processing, customer service, etc.), the employer retains responsibility for making sure that there are enough funds to pay claims. Send complaints to the plan administrator, the employer’s human resources department, and/or the U.S. Department of Labor, Employee Benefits and Security Administration (EBSA).

USDOL, EBSA
Atlanta Federal Center
61 Forsyth St. SW; Suite 7B54
Atlanta, GA 30303
Toll-free phone: 866-487-2365

Federal Employees Health Benefits (FEHB) Program

Federal Employees Health Benefits (FEHB) Program

The U.S. Office of Personnel Management (OPM) directs human resources and employee management services, administers retirement benefits, manages healthcare and insurance programs for Federal employees. If you have questions or want to know your rights as a Federal employee, you may contact OPM at:

U.S. Office of Personnel Management
Federal Employees Health Benefits Program, Room 3443
1900 E Street, NW
Washington, DC 20415-0001
Email: fehb@opm.gov
Phone: 888-767-6738 or 202-606-1800

Medicare

Medicare

Medicare is a federal health insurance program for people age 65 years or older, certain people with disabilities and people with permanent kidney failure treated with dialysis or a transplant. For more information concerning Medicare and Medicare supplements, contact our Seniors' Health Insurance Information Program (SHIIP) toll-free at 1-855-408-1212 or https://www.medicare.gov/ 1-800-MEDICARE (1-800-633-4227)

Part A Claims & Provider Problems
Palmetto GBA – Medicare Part A
800 S Duke St.
P.O. Box 3824
Durham, NC 27702

Toll free phone: 877-567-9249

Part B Claims & Provider Problems
CIGNA – Medicare Part B
4135 Mendenhall Oaks Parkway, Suite 101
Attn: Public Relations
High Point, NC 27265
Phone: 336-882-4562

Workers Compensation Claims Questions

Workers Compensation Claims Questions

If you need help with an injury on the job claim, have a workers’ compensation question, or want to know your rights as an employee, you may contact the Workers’ Compensation Information Specialists Section of the N.C. Industrial Commission at:

 

North Carolina Industrial Commission

1233 Mail Service Center
Raleigh, NC 27699-1233
Phone: 800-688-8349 or 919-807-2501

Provider Licensure and Ethics

Provider Licensure and Ethics

Complaints regarding Providers are accepted by the North Carolina Medical Board from patients, family members and other members of the public, as well as from medical professionals and health care organizations such as hospitals, pharmacies, insurance companies, health care agencies or other entities.

North Carolina Medical Board
PO Box 20007
Raleigh, NC 27619
Phone: 800-253-9653 or 919-326-1100