In light of a judge’s initial ruling allowing Atrium Health’s Affordability Program (Program) to continue, the State Health Plan (Plan) is now building upon Atrium’s commitment to Plan members and enhancing its impact. Beginning Jan. 1, 2027, Atrium Health will move to the out-of-network tier for the Plan, except for the previously agreed to "access" level facilities. This action will save the Plan hundreds of millions of dollars and, if Atrium Health keeps its commitment, will not impact member cost.
Members who choose Atrium Health providers and facilities are held harmless under this action, assuming Atrium follows through with its program. When Atrium introduced the Program last week, it stated “...regardless of how Atrium Health is categorized under the State Health Plan's new structure, the new Atrium Health Affordability Protection Program is designed to ensure members can continue receiving care from Atrium Health at the lowest cost-sharing available under the State Health Plan." The Plan is taking Atrium at its word that its “…sole purpose is to make healthcare more affordable for North Carolina's dedicated public servants and their families.” The only way to accomplish this is by not dismantling the new four-tiered provider network, which was created as the key way to avoid insolvency of the Plan.
“We understand that this back and forth is unsettling for our members, but this is all behind the scenes bookkeeping. Members should expect to have the same coverage as set by the plan over the summer,” said Treasurer Brad Briner, who chairs the State Health Plan Board of Trustees. “One of my duties is to keep the State Health Plan financially solvent so it can continue as an incentive for teachers and state employees. I will not let one hospital system destroy the Plan, raise premiums on every teacher and state employee and send us into overwhelming debt.”
Thousands of members have told us they don’t want their premiums to increase and benefits to be cut. If we failed to take today’s action, Atrium would continue to charge the Plan higher rates into 2027. So, even if members pay less out of pocket on the front end, the Plan estimates the resulting cost impact could quickly reach a quarter of a billion dollars. This is an amount the Plan is not in a financial position to absorb.
The Plan is a publicly funded benefit program—not a private insurance company. Policies and rates must be governed by the Plan’s agreements and the responsibilities entrusted to the Treasurer and the State Health Plan Board of Trustees, not dictated by private entities through 'creative' programs that conflict with those agreements.
“The Plan’s new provider tier network created competition and resulted in providers like UNC Health, Novant Health and Duke stepping up and providing us with deeper discounts for high-quality care. This approach was solely to place the Plan on a better financial path and to avoid placing any additional burden on Plan members in the form of increased copays and premiums” said Tom Friedman, Executive Administrator of the State Health Plan.
While we stand firmly in saying that Atrium providers are high-quality providers, the decision by their executive level leaders will place the Plan in the red. By moving Atrium to the out-of-network tier, the Plan has little to no financial responsibility to Atrium Health and, if Atrium keeps its promise, our members will still pay the reduced costs outlined by the Program. The action we’re taking today simply shifts the cost burden to Atrium, not the Plan.
This is not a fight over your health care choices today. Plan members can continue to make the choices that are right for them. This is a fight to protect the Plan’s ability to serve members now and tomorrow.
Note to members: The State Health Plan is conducting Open Enrollment Oct. 12-Nov. 6. Plan members are reminded that Primary Care Provider copays remain the same. The following services are also not applicable to the new tiered network: Behavioral Health, Speech, Occupational, Chiropractor and Physical Therapy and Urgent Care.
In an emergency, members should seek care at the nearest emergency room. All emergency room copays are at Access Tier level regardless of the hospital's network tier, including your hospital stay if admitted. Members are encouraged to visit the Plan’s website for more information regarding Open Enrollment.