It’s almost time to review and renew your NC state health insurance plan for 2016. One of North Carolina’s biggest health insurance providers is Blue Cross/Blue Shield (BCBSNC), and three of their core insurance products cover thousands of state workers and teachers through the North Carolina State Health Plan.
Renewing your insurance in October ensures that you continue to receive your benefits without interruption. Whether you are a returning client or a new one, here are all the best reasons why you should review and renew:
#1: Not all State Plans are Equal
If you are on one of Blue Cross/Blue Shield’s health plans for teachers and state employees, open enrollment runs through October 31, 2015. During open enrollment, you have the opportunity to select a health plan that will give you access to benefits mandated by the Affordable Care Act (ACA), also known as Obamacare. However, not all State Health Plans are created equally when it comes to covering preventive care like obesity prevention, health coaching, and nutrition services.
#2: Prevention is Free
In the past, preventive services like obesity screening, nutritional counseling, and health coaching were excluded from many NC state health insurance plans. However, ACA-compliant plans are required to cover preventive care 100% with a $0 copay and $0 deductible. As more and more plans comply with the ACA, it is becoming easier to get help controlling your weight, developing healthy eating habits, and staying physically active.
#3: ACA Compliance Helps
The Affordable Care Act is a raft of legislation that is intended to get all Americans enrolled in health insurance plans. Additionally, ACA addressed gaps in health care insurance coverage so that people can get access to critical health care services, like screening for high blood pressure, routine check-ups, and behavior intervention and counseling for obesity.
Here are a few of the preventive services that ACA requires health plans to provide 100% free of charge:
- Obesity screening and counseling for children and adults
- Blood pressure screening
- Type 2 Diabetes screening for adults with high blood pressure
- Cholesterol screening for increased-risk adults
- Gestational diabetes screening for pregnant women
#4: Obesity Is an Epidemic
In 2012, the U.S. Preventive Services Task Force recommended that all obese Americans be given access to intensive counseling and behavioral intervention to reduce body weight, prevent Type 2 Diabetes, and develop healthy living habits. The Task Force noted that weight management counseling for obesity is most effective when it is intensive and ongoing; with patients receiving behavioral intervention and weight loss support over 12 to 26 sessions.
1 in 3 American adults are obese, and the long-term negative consequences and costs of excess body weight are astronomical. In June 2013, the American Medical Association formally recognized obesity as a disease, and noted that treating and preventing obesity require a full range of medical interventions. Being overweight or obese is a risk factor for many life-threatening or fatal health conditions, such as hypertension, Type 2 Diabetes, gestational diabetes during pregnancy, cardiovascular disease, heart attacks, stroke, and other grave health problems.
The Plan: What You Need to Know
If you are a member of the North Carolina State Health Plan, what is covered and what is excluded by your insurer can be confusing, especially because not all of BCBSNC’s plans for state workers are ACA-compliant.
Here is a run-down of what you need to know about ACA’s preventive coverage mandates and the plans offered by Blue Cross/Blue Shield for teachers and state employees.
Traditional 70/30 Plan
The Traditional 70/30 Plan is Blue Cross/Blue Shield’s most basic health insurance plan. For major medical care like hospital stays, this plan covers 70% of expenses and the enrollee is responsible for 30% of costs after the $933 individual deductible ($2,799 for families) is reached. This plan is considered “grandfathered” by Blue Cross/Blue Shield, so it does not provide enrollees with completely free preventive services that are required by ACA. 70/30 enrollees with diabetes can have 6 nutritional counseling visits per year with an in-network provider, and those sessions are 100% covered. For people with other nutrition-related health diagnoses, the 70/30 plan covers 4 nutritional counseling visits per year covered at 100% in-network with a $35 copay.
Enhanced 80/20 Plan
The Enhanced 80/20 Plan covers 80% of major medical expenses once the enrollee satisfies the plan’s deductible of $700 for individuals or $2,100 for families. This plan is considered “grandfathered” by BCBSNC, so it does not comply with all elements of the ACA. However, most preventive services are covered, and that includes nutritional counseling. As long as your provider is in the BCBS network and you have a medical situation that indicates that preventive or wellness services are warranted, nutritional counseling is covered 100% with no out-of-pocket expense to you. Diabetes treatment and management services are also covered.
Consumer-Driven Health Plan (CDHP)
The Consumer-Driven Health Plan is Blue Cross/Blue Shield’s newest offering in the NC State Health Plan. It is compliant with the preventive services mandate of the ACA. Therefore, all preventive services for nutrition, diet and weight management, diabetes prevention and care, and other critical wellness services are all 100% free with no copay due at the time of your visit with a medical provider.
Where to Get Preventive Care
If you are insured by one of Blue Cross/Blue Shield’s health plans for teachers and state employees, you can get help preventing and treating many serious health conditions at LifeStyle Medical Center in Durham. The interdisciplinary team at LifeStyle Medical Center works with patients to create personalized, evidence-based treatment plans to help you combat high blood pressure, diabetes, obesity or excess body weight, high cholesterol, gestational diabetes, and other nutrition-related health issues. LifeStyle Medical Center employs strategies like diet and nutritional counseling, exercise planning, and medical evaluations to help you eat right, get the physical exercise you need to get and stay healthy, and manage your wellness.
Contact LifeStyle Medical Center today and learn how our expert team uses nutritional counseling, lifestyle modification, and clinical outcomes to develop realistic and individualized health goals for our patients.