The State Health Plan (Plan) Board of Trustees took action today to keep the Plan solvent through the remainder of 2026. This vote came after the Board examined the Plan’s financial outlook which had higher costs than anticipated for the year.
To close the gap, the Board approved a financial adjustment from the Retiree Health Benefit Fund contribution to the Plan. Similar action has been taken by the Board in previous years and is intended to help address the Plan’s immediate cash needs.
The Plan’s financial report showed that losses accelerated from July through September 2026, depleting reserves faster than projected. If current trends continue, the Plan could run out of cash by the end of 2026. The Plan’s new provider tiering system along with approved 2027 premiums and benefit changes are expected to produce a slight cash gain next year, though additional actions will still be needed to rebuild the Plan’s target stabilization reserve.
“Today’s discussion underscores the serious financial pressures facing the Plan and why the changes being implemented in 2027 are necessary as we work to protect the Plan’s ability to pay members’ claims,” said Treasurer Brad Briner, who chairs the Board. “The approved action will help address the immediate cash challenge as the Plan continues its work toward a more sustainable financial path.”
The meeting comes at the same time the Plan and Atrium Health announced a new contract to keep Atrium Health as an Access tier provider in the Plan.
The Plan’s new the Medical Policy Advisory Committee recommended adding to the benefit for members who suffer from vein conditions like varicose veins. The Board voted to remove the “one procedure, per limb, per lifetime” for various veins from the Plan’s current benefit limitations.
The Board also received a report from its actuarial consultant on the health of active members and non-Medicare retirees. Members with chronic conditions accounted for 63% of the Plan’s medical costs in 2025. Cancer and oncology, diabetes and other metabolic conditions, and cardiovascular conditions were among the leading contributors to increased medical risk. The report will help guide the Plan’s efforts to target health support and care programs.
The Board also received an Open Enrollment update. Open Enrollment for 2027 coverage runs through November 6, 2026.
State Health Plan Board of Trustees meeting materials are available at shpnc.gov.