Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its affiliated companies are not responsible or liable for the content, accuracy or privacy practices of linked sites, or for products or services described on these sites.
Proud to serve North Carolina
We’re excited to serve North Carolina State Health members beginning January 1, 2025. In the meantime, we’re here to help you prepare for your new health plan. On this page you’ll find the latest information on quality Aetna® health care providers and answers to your questions.
To those that teach, protect and serve — we welcome you
As a native North Carolinian, I am honored to welcome you — the people who teach, protect and serve our great state — to Aetna. While we won’t begin administering your health plan until January 1, 2025 — two years from now — it’s never too early to start connecting with you.
My sole mission — along with the hundreds of North Carolina-based Aetna employees dedicated to this relationship — is to make this transition seamless for members of the State Health Plan. To do so, we will embark on an extensive outreach campaign over the next two years to help you live healthier lives.
Today, you will find a comprehensive frequently asked questions feature and information about Aetna’s extensive statewide network of primary care doctors, mental health professionals, specialists, and general care hospitals that North Carolinians know and trust.
Using Aetna’s 170 years of expertise and experience, we will provide greater value for State Health Plan members by connecting you to the services and support you need for every type of health care moment, simply and affordably.
I look forward to serving you because healthier happens together™.
Jim Bostian
North Carolina Market President, Aetna
Doctors, specialists and hospitals you know and trust
We’re making it easy for North Carolinians to connect to primary care providers, mental health providers, specialists, hospitals and more. For the quality care you need, in the neighborhoods where you live and work.
Our national health care network reaches every corner of the United States. But our local health care network in North Carolina is where it really counts. Aetna has nearly 170 years of expertise and experience. And we’re ready to serve State Health Plan members through our comprehensive, local health care network.
Some things to know:
- We’re present in all 100 North Carolina counties.
- Every general care hospital in North Carolina is part of our extensive statewide health care network.
- More than 98% of the claims paid by the current administrator, Blue Cross Blue Shield of North Carolina, were paid to health care providers currently in the Aetna network.
Best of all: You’ll likely be able to see the same health care providers you know and trust today.
Frequently asked questions
On January 1, 2025, Aetna will officially become the third-party administrator (TPA) for the North Carolina State Health Plan. We’re excited about this new opportunity to serve those who serve North Carolina. But administering health benefits is not new to us. Aetna has been in business for 170 years because we hold a long-term view on value, relationships and service.
How will this transition impact provider options? How will it impact premiums and copays? What is a third-party administrator? You’ll find answers to those questions, and more, below.
-
A third-party administrator or “TPA” is an entity that receives and processes claims on behalf of another organization. Aetna will manage the operations of the State Health Plan. This includes claims processing, health care provider contracts, customer service and more. However, all decisions about premiums, copays and benefits will still be made by the State Health Plan Board of Trustees, not Aetna.
For more information, visit the North Carolina State Health Plan website.
-
The third-party administrator works to ensure the State Health Plan operationally runs smoothly and affordably, while responding to the needs of members.
The third-party administrator also:
- Decides which health care providers (i.e., doctors, specialists, hospitals, etc.) are in network
- Provides disease and care management services
- Ensures superior customer service for plan members, and much more.
-
All decisions about copays, premiums and benefits will still be made by the State Health Plan Board of Trustees, not Aetna. Our commitment is to deliver affordable and high-quality health benefits to those who teach, protect and serve the great state of North Carolina.
-
Funding for State Health Plan members’ medical claims comes from member premiums and from taxpayer dollars appropriated by the North Carolina General Assembly.
-
As part of the application process, we provided data to analyze the millions of State Health Plan claims submitted over an entire year and compared those claims to our current network.
The result? 98% of claims were paid to a health care provider that’s in our current network.
Even with that very high match rate, we have already begun communicating with additional doctors and specialists to add them to the network before the January 1, 2025 transition.
-
Yes, every general care hospital in North Carolina is in our network.
-
If your current doctor or specialist is in network for you right now, but is not in our network, we will contact them to begin the process of adding them.
If your doctor or specialist is not in our health care network, they can request to join our network. -
Prior to Aetna taking over as the new third-party administrator for the State Health Plan on January 1, 2025, all members of the State Health Plan will receive new ID cards. They’ll also receive all the information they need to understand their benefits.
-
There will be no change to the benefit plans currently offered by the State Health Plan. The State Health Plan Board of Trustees makes all decisions regarding the plan. They have indicated there will be no changes.
-
All pre-existing conditions are covered under the State Health Plan.
Media inquiries
If you have a media inquiry or are a member of the press, email the Aetna Lead Communications Director.
Legal notices
Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna).
Health benefits and health insurance plans contain exclusions and limitations.