NC state workers’ problems persist with State Health Plan

jfrank@newsobserver.comJanuary 6, 2014 

Months after problems plagued enrollment in the State Health Plan, thousands of current and retired state workers continue to face obstacles.

The new coverage year began Jan. 1, but state officials acknowledged Thursday that 105,000 state employees, mostly those who work at government agencies, do not have insurance cards used to obtain medical care.

State Treasurer Janet Cowell’s office oversees the insurance plan, which covers 660,000 state workers and retirees. The office says the cards are being processed and will be mailed soon.

For thousands of state retirees, a billing glitch left confusion and questions at the end of December, when health insurance coverage was not deducted from pension checks. Schorr Johnson, a Cowell spokesman, said the problem mostly affected retirees with dependents and did not affect coverage.

The state is sending a letter explaining the snafu and a bill for the amount owed to those affected. Johnson said he could not provide specific numbers about how many retirees received incorrect pension checks.

The troubles come after thousands of state workers and retirees faced long delays in signing up for health coverage in October in a situation that drew parallels to the federal health care debacle. State Health Plan officials were forced to extend the enrollment deadline to November after more than half of state workers and retirees hadn’t chosen coverage.

The plan’s administrators initially downplayed the problem but sought fixes under pressure from the State Employees Association of North Carolina and complaints from workers. As for the new problems, Johnson said officials are working to remedy the issues.

“For the largest open enrollment the State Health Plan has ever had ... the plan was always aware there were going to be some issues,” Johnson said Thursday.

For some, the enrollment issues persist.

Theresa Raphael-Grimm, an associate professor of nursing and medicine at UNC-Chapel Hill, said a computer glitch put her in the wrong plan, the basic 70/30 option, when she thought she enrolled in an 80/20 plan that provides more robust coverage.

“Given that I provide mental health care to citizens of North Carolina and my husband provides medical care, I think it is especially ironic that I cannot obtain the very health care benefits for which I qualify, and all because of a well-documented system glitch with the vendor who operates the State Health Plan enrollment process,” Raphael-Grimm said, adding that she has heard many others experience related issues.

Raphael-Grimm said she appealed to the university benefit coordinators who supported her petition, but it was rejected by the State Health Plan.

Johnson said about 1,600 active and retired state employees have completed the process to get an exception, but technical issues were not a factor. He said the state is continuing to press Benefitfocus, the South Carolina-based company that manages components of the plan, to resolve lingering issues.

Raphael-Grimm said she’s not satisfied. With the federal health care law, she said, the Obama administration took responsibility, but the state is not doing so. She said the problems with enrollment should lead to leniency for those who had problems.

“I am particularly distressed that glitches in the enrollment process were documented, recorded and communicated to the State Health Plan administrators, yet still they take no responsibility or demonstrate no measures to allow people like me to have their situation corrected,” she said.

Frank: 919-829-4698

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