Employee Open Enrollment 2026 - Health Insurance Benefits

Open Enrollment Resources

Dear Lee County Schools Employees,

Open Enrollment for the State Health Plan will take place October 13–31, 2025. During this time, all employees should log in to review their coverage, make any necessary changes, and confirm their selections for the 2026 plan year.

Please note that the State of North Carolina has made several important changes to the plan structure and premiums for the upcoming year:

·  Salary-Based Premiums: Premiums for the Standard PPO and Plus PPO are now tied to income. Employees with lower salaries will see smaller increases.

·  Higher Deductibles: Deductibles will increase to $3,000 (single) and $9,000 (family).

·  Lower Premiums for Children: The cost to add children to a plan has been reduced for many employees.

·  New PPO Options: The 80/20 Enhanced PPO and 70/30 Base PPO are being replaced with the Standard PPO and Plus PPO.

·  Prescription Changes: The out-of-pocket maximum for pharmacy costs will increase by $100.

·  Completing a tobacco attestation is no longer required to lower your monthly premium.

2026 Premiums:
Premiums for the upcoming year are outlined below.

**Please note that any changes in monthly insurance premiums will be reflected in paychecks issued in December 2025.**

 Additional details about the new plan options and premiums can be found on the State Health Plan website:

https://www.shpnc.gov/2026-open-enrollment-information

If you have any questions, please contact the SHPNC Support Center at 855-859-0966.

Employee Insurance Premiums for 2026

Important Notes About Your 2026 Benefits

  • There have been increases to copays and out-of-pocket costs.

  • The Plan will be implementing salary-based premiums for 2026. Rates will be based on your current, total salary and will only apply to the subscriber-only rate.

  • Your subscriber-only rate will remain the same for 2026 regardless of salary adjustments unless a salary change occurs in the 1st quarter of 2026. If a change occurs during that time, your premium may change. Completing a tobacco attestation is no longer required to lower your monthly premium.

  • The Clear Pricing Project is ending Dec. 31, 2025. In 2026, the Plan is introducing Preferred Providers. These providers have been identified by the Plan as providers who are committed to improved access to high-quality, affordable health care. When you select and see one of these providers in 2026, you will pay the lowest copay for an office visit.

  • If you would like to change your selected Primary Care Provider (PCP) to a Preferred Provider, you will need to wait until after Jan. 1, 2026, to make that change. If your selected PCP is already noted as a Preferred Provider, you do not need to take any action. As a reminder, PCPs can be changed anytime, and ID cards typically arrive 7-10 days after the change is made.

  • The Plan is excited to be partnering with Lantern, a trusted provider that helps connect Plan members to a high-quality, carefully selected surgeon when you need a planned, non-emergency procedure. There will be no cost ($0) for the surgery for members who use a Lantern provider —no deductibles and no copays. Members will be getting more information directly from Lantern on this benefit. Medicare Primary members are not eligible.

  • The formulary (drug list), which determines what medications are covered and what tier they fall under, changes on a quarterly basis, so there is a possibility that you will have changes in your prescription coverage in 2026.

  • Preferred and non-preferred insulin continues to have a $0 copay for a 30-day supply.

  • Preventive Services remain covered at 100% – no copay or deductible – on either plan.