Table of Contents
- Reminder: DIPNC and State Health Plan Benefits
- Reminder: Employer Reimbursement for Short-Term Benefits
- State Health Plan Eligibility Audit Under Way!
Reminder: DIPNC and State Health Plan Benefits
Under current law, an employee or member who is receiving Disability Income Plan of North Carolina (DIPNC) benefits may be eligible for medical coverage through the State Health Plan. If a member has five or more years of Teachers’ and State Employees’ Retirement System (TSERS) or Optional Retirement Program (ORP) membership service, the state will pay for their individual State Health Plan (SHP) coverage under the non-contributory plan (currently 70/30 or Medicare Advantage Base). If members have less than five years of TSERS or ORP membership service, they may choose to enroll in SHP coverage, but will have to pay the entire cost. In all cases, the full cost of dependent coverage, if elected, must be paid by the member.
To ensure timely enrollment in SHP coverage for eligible members and their dependents, please encourage and assist your employees with applying for DIPNC benefits as soon as possible, or at least 90 days prior to the benefit effective date.
For more information about DIPNC benefits, visit the Disability Benefits page on our website.
Reminder: Employer Reimbursement for Short-Term Benefits
Employers may request reimbursement of short-term disability benefits paid during the second six months of the short-term period. Employers must submit all documents required for reimbursement, including a copy of every Form 703, Reporting Earnings for Short-Term Disability Benefits and Medical Report for Eligibility Review, found in ORBIT. Failure to submit all forms may cause a delay in processing.
State Health Plan Eligibility Audit Under Way!
The State Health Plan is conducting a Dependent Eligibility Verification Audit to protect plan benefits and reduce waste, fraud and abuse.
Allowing ineligible dependents to participate in the Plan increases the overall cost of our Plan to members and taxpayers. Every dollar going to those who are ineligible is a dollar out of members’ pockets. As an important step towards reducing costs and eliminating waste, this audit impacts all dependents under age 75 covered by the Plan as of April 19, 2017. Please share with employees as appropriate.
Plan members should have already received a letter in the mail with a request for documentation of dependents, which will need to be provided by July 31, 2017. Members should not wait until the last minute to submit documents! For full details, click here.