North Carolina State Health Plan
COMPARISON CHART OF RATES AND BENEFITS FOR INDEMNITY AND PPO PLANS FOR BENEFIT YEARS 2007-2009
The rate increases are effective October 1, 2007
All benefit changes are retroactively effective to July 1, 2007 except for the specialist copayment for chiropractic care on the PPO plans is effective October 1, 2007
| PPO Basic Plan 70/30 | PPO Standard Plan 80/20 | PPO Plus Plan 90/10 | Indemnity Plan | |
|---|---|---|---|---|
| Premium Increase | 11.2% | 11.2% | 11.2% | 11.4% |
| Office Visit Copayment | Primary Care $25 Specialist $50 |
Primary Care $20 Specialist $40 |
Primary Care $15 Specialist $30 |
Primary Care $25 Specialist $25 |
| Physical Occupational and Speech Therapies | Unlimited Visits | Unlimited Visits | Unlimited Visits | Unlimited Visits |
| Chiropractic | 30 Visits Per Benefit Year Specialist Copayment $50* |
30 Visits Per Benefit Year Specialist Copayment $40* |
30 Visits Per Benefit Year Specialist Copayment $30* |
$2,000 benefit year max. $25 Copayment plus 20% Coinsurance after Deductible |
| Benefit Year Deductible | $600 Individual $1,800 Family |
$300 Individual $900 Family |
$150 Individual $450 Family |
$450 Individual $1,350 Family |
| Mental Health and Chemical Dependency | · Unlimited Visits $200 Inpatient Copay plus 30% Coinsurance after Deductible |
Unlimited Visits $150 Inpatient Copay plus 20% Coinsurance after Deductible |
Unlimited Visits $100 Inpatient Copay plus 10% Coinsurance after Deductible |
Unlimited Visits $150 Inpatient Copay plus 20% Coinsurance after Deductible |
| Generic | · $10 Rx Copay | · $10 Rx Copay | · $10 Rx Copay | · $10 Rx Copay |
| Preferred-No Generic Equivalent | · $30 Rx Copay | · $30 Rx Copay | · $30 Rx Copay | · $30 Rx Copay |
| Equivalent Preferred-Generic | · $40 Rx Copay | · $40 Rx Copay | · $40 Rx Copay | · $40 Rx Copay |
| Equivalent Non-Preferred | · $50 Rx Copay | · $50 Rx Copay | · $50 Rx Copay | · $50 Rx Copay |
Please visit the State Health Plan website at http://statehealthplan.state.nc.us or contact:
| NC SmartChoiceSM Blue OptionsSM PPO Questions For questions about the PPO offering, entitled NC SmartChoiceSM Blue OptionsSM e-mail ppo.inquiries@shpnc.org |
Customer Services PO Box 30085 Durham, NC 27702 Phone: 1-888-234-2416 |
| Indemnity Plan Questions For questions about the Indemnity Plan, e-mail indemnity.inquiries@shpnc.org |
Customer Services PO Box 30111 Durham, NC 27702-3111 Phone: 1-800-422-4658 Fax: 919-765-7080 |