Benefit Information - STATE OPTION
Just like most traditional employer-sponsored health plans, Inclusive Health covers a broad range of services, including preventive care, urgent care, outpatient services, a prescription drug benefit and other common health care services.
Inclusive Health offers several plan options, so you can choose the plan that best meets your individual medical and financial needs.
Benefits Policies, Summaries and Schedules
- PPO 1000:
NCHIRP Policy and Benefits Summary | Benefit Schedule
- PPO 2500:
NCHIRP Policy and Benefits Summary | Benefit Schedule
- PPO 3500:
NCHIRP Policy and Benefits Summary | Benefit Schedule
- High Deductible Health Plan 5000 (HDHP):
NCHIRP Policy and Benefits Summary | Benefit Schedule
Click here to download a comparison of Benefits between the State and Federal Options.
Copay Information for Prescription Drugs under the
PPO 1000, PPO 2500 and PPO 3500 plans:
$10 for Generic Drugs
$40 for Brand Drugs
20% or $250 copay for Specialty Drugs with an annual maximum of $100,000 per calendar year.
Please note: The copays only apply to the PPO1000, PPO2500 and the PPO3500 plans. If you selected the HDHP 5000 High deductible plan, prescriptions will not be reimbursed until you have satisfied your entire $5000 deductible. You will pay the Inclusive Health negotiated price for a prescription until you have reached the $5000 deductible, then all services are covered at 100%.
All deductibles are calculated on a calendar year basis. A new deductible will begin each January.
Provider Network
The PPO plans (PPO 1000, PPO 2500 and PPO 3500) and the use of a network provider feature lower out of pocket expenses when using a network provider. You may use a provider that is not in the Inclusive Health network, but you will have a higher out of pocket expense. Please see your policy for the specific benefits.
Please note:
North Carolina providers are forbidden under state law from balance billing you for any amounts above the Inclusive Health allowed/negotiated rate. For services received from providers outside of North Carolina, however, you may be subject to being balance billed for charges in excess of the Inclusive Health allowed/negotiated rate.
- PPO 1000:
NCHIRP Policy and Benefits Summary | Benefit Schedule
- PPO 2500:
NCHIRP Policy and Benefits Summary | Benefit Schedule
- PPO 3500:
NCHIRP Policy and Benefits Summary | Benefit Schedule
- High Deductible Health Plan 5000 (HDHP):
NCHIRP Policy and Benefits Summary | Benefit Schedule
Click here to download a comparison of Benefits between the State and Federal Options.
Copay Information for Prescription Drugs under the
PPO 1000, PPO 2500 and PPO 3500 plans:
$10 for Generic Drugs
$40 for Brand Drugs
20% or $250 copay for Specialty Drugs with an annual maximum of $100,000 per calendar year.
Please note: The copays only apply to the PPO1000, PPO2500 and the PPO3500 plans. If you selected the HDHP 5000 High deductible plan, prescriptions will not be reimbursed until you have satisfied your entire $5000 deductible. You will pay the Inclusive Health negotiated price for a prescription until you have reached the $5000 deductible, then all services are covered at 100%.
All deductibles are calculated on a calendar year basis. A new deductible will begin each January.
Provider Network
The PPO plans (PPO 1000, PPO 2500 and PPO 3500) and the use of a network provider feature lower out of pocket expenses when using a network provider. You may use a provider that is not in the Inclusive Health network, but you will have a higher out of pocket expense. Please see your policy for the specific benefits.
Please note: North Carolina providers are forbidden under state law from balance billing you for any amounts above the Inclusive Health allowed/negotiated rate. For services received from providers outside of North Carolina, however, you may be subject to being balance billed for charges in excess of the Inclusive Health allowed/negotiated rate.