NC State Health Plan Open Enrollment 2027: Premiums, Tiers and Which Plan to Pick

Open enrollment for the North Carolina State Health Plan runs from October 12 to November 6, 2026, for coverage that starts January 1, 2027. This year matters more than most. Premiums are rising again, the plans have new names, and a new four-tier provider network means what you pay will depend on which hospital system you use. Every member will be moved into the Standard PPO automatically unless they choose otherwise. This guide covers the 2027 premiums, what each plan costs at each tier, which health systems landed where, and how to decide between the two plans.

What Is Changing for 2027

The State Health Plan covers about 770,000 people, including teachers, state employees, university staff, retirees, and their families. Three changes affect almost all active members.

Open Enrollment Dates and the Default Plan

Open enrollment runs October 12 through November 6, 2026, through the eBenefits portal. All members are enrolled in the Standard PPO automatically. If you want the Plus PPO, or need to add or remove a dependent, you must make that choice during open enrollment. The plans were renamed: the Standard PPO is the former 70/30 plan and the Plus PPO is the former 80/20 plan. Some employers set earlier internal deadlines, so check with your benefits office.

A New Four-Tier Provider Network

Starting January 1, 2027, doctors and hospitals fall into four tiers: Preferred, Access, Non-Preferred, and Out-of-Network. Your deductible, out-of-pocket maximum, and many copays now depend on the tier of the provider you use. Preferred providers cost the least. Access providers cost about what in-network care costs in 2026. Non-Preferred providers are still in the network but cost substantially more.

Premiums Rise About 5%

The plan's Board of Trustees approved an average increase of about 5% for 2027, the second increase in two years. For employee-only coverage the increase is less than $2 to about $8 a month, depending on salary and plan. For family coverage it is about $29 to $42 a month. The plan cited a projected deficit and said the state's budget contribution kept the increase smaller than it would otherwise have been.

2027 Monthly Premiums

The rate for employee-only coverage depends on your base salary. Rates for coverage that includes dependents are flat amounts added on top. Bonuses, longevity pay, and overtime do not count toward your salary band, and the rate set at open enrollment stays the same all year even if your salary changes. If you work for a private employer instead, our workplace open enrollment guide covers choosing a plan, FSAs, and HSAs.

Standard PPO (Formerly 70/30)

Plus PPO (Formerly 80/20)

Monthly rates for active employees of state agencies, universities, and school systems, January 1 through December 31, 2027. Source: State Health Plan 2027 rate sheet. Local government employers set their own rates.

What the State Pays

Your employer contributes $745.44 a month toward each active employee's coverage, which is far more than most employees pay themselves. Spouse and family coverage cost the same, so once you are covering a spouse, adding children costs nothing extra. Covering only your children is much cheaper than covering a spouse.

Deductibles, Out-of-Pocket Limits, and Copays by Tier

The tier of the provider you use now matters as much as the plan you pick. These are the 2027 figures for active and non-Medicare members.

Deductibles and Out-of-Pocket Maximums

Individual / family amounts. Spending at in-network tiers counts toward each other's deductible and out-of-pocket maximum. Pharmacy costs count toward the Access tier amounts. Source: State Health Plan 2027 Plan Comparison.

Common Copays

In-network copays shown. Emergency room copays are waived if you are admitted.

Prescriptions

Prescription copays for a 30-day supply are $25 for Tier 1 and $75 for Tier 2 on the Standard PPO, and $15 and $55 on the Plus PPO. Tier 4 drugs cost $200 or $100, and Tier 5 drugs $600 or $500. Tiers 3 and 6 are subject to the deductible and coinsurance. Insulin, both preferred and non-preferred, and preventive medications cost $0 on both plans.

Which Health Systems Are in Which Tier

Where your doctors and nearest hospital land is the single biggest factor in what you will pay in 2027. Check every provider you use in the plan's 2027 Find a Doctor tool before you choose.

Preferred

UNC Health, Novant Health, and Iredell Health are Preferred, along with other individual providers who joined the Preferred program. Members who use them get the lowest deductibles and out-of-pocket maximums and flat copays for hospital stays, outpatient surgery, and high-cost imaging.

Access

Most providers in North Carolina are in the Access tier, including Duke Health, ECU Health, and Cone Health, as well as all providers outside the state. Access-tier costs are about the same as in-network costs in 2026.

Non-Preferred, and the Exceptions

Atrium Health and WakeMed are Non-Preferred for 2027. They remain in the network, but deductibles and out-of-pocket maximums there are much higher. WakeMed's emergency departments are treated as Access providers, and emergency room copays are the same at every tier. Members who are in cancer treatment, awaiting or recovering from a transplant, pregnant, or have a child in the NICU can keep Access-tier benefits with their current providers by filing a Transition of Care form. Members with certain complex conditions can request an Access-tier exception for a Non-Preferred provider.

Standard or Plus: How to Decide

The Plus PPO costs more every month but less when you use care. The right choice depends on how much care you expect to use and which tier your providers are in.

What the Plus Plan Costs Extra

For employee-only coverage, the Plus plan lowers the out-of-pocket maximum by $1,000 at Preferred providers and $1,500 at Access providers. That is the most it can save you on large bills, before counting its lower copays.

When the Standard PPO Makes Sense

Choose the Standard plan if you are generally healthy and expect mostly preventive care and a few office visits, especially if your doctors are Preferred. Consider a single teacher earning $48,000 who sees a Preferred primary care doctor twice and a specialist once. On the Standard plan, that year costs about $511: $441 in premiums plus $70 in copays. On the Plus plan, it costs about $877. The Standard plan wins by about $366.

When the Plus PPO Makes Sense

Choose the Plus plan if you expect a surgery, a hospital stay, a pregnancy, or ongoing treatment, or if your providers are in the Access tier. Take the same teacher with a planned surgery that reaches the out-of-pocket maximum at an Access hospital such as Duke. The Standard plan's total is about $6,941: $441 in premiums plus the $6,500 maximum. The Plus plan's total is about $5,832: $832 in premiums plus the $5,000 maximum. The Plus plan wins by about $1,109. At higher salaries the gap narrows, because the Plus premium rises faster. An employee earning more than $90,000 who reaches the Preferred-tier maximum comes out about even on either plan.

What It Means for Your Paycheck

Health premiums are deducted from every paycheck, so the plan you choose shows up directly in your take-home pay.

Premiums Are Usually Pre-Tax

Most employers deduct State Health Plan premiums before taxes through a Section 125 arrangement. That means premiums are not subject to federal income tax, North Carolina's 3.99% income tax, or Social Security and Medicare tax. For a teacher in the 12% federal bracket, about 24 cents of every premium dollar comes back in lower taxes, so a $36.76 monthly premium actually reduces take-home pay by about $28. Check the "pre-tax" label on your pay stub, as our guide to reading an NC pay stub explains.

The Cost of Covering a Family

Dependent coverage is where premiums become a large share of pay. A teacher earning under $50,000 who covers a spouse or family on the Standard plan pays $603.76 a month, or about $7,245 a year, and $9,400 a year on the Plus plan. If your spouse has coverage through their own employer, compare it carefully. It is often cheaper for each spouse to take their own employer's plan, and to put children on whichever plan costs less.

Seeing the Full Picture

For what a teacher's paycheck looks like after the pension contribution, health premiums, and taxes, see our NC teacher salary after taxes guide. To model your own pay with your premium as a pre-tax deduction, use the NC paycheck calculator and enter the premium under health insurance. For other moves to make before the year ends, see our guide to year-end tax moves.

Your Open Enrollment Checklist

You have until November 6, 2026. Doing nothing puts you in the Standard PPO with your current dependents.

Before You Choose

• Look up the 2027 tier for your primary care doctor, specialists, and the hospital you would use, in the plan's Find a Doctor tool.
• List any planned care for 2027, such as a surgery, a pregnancy, or ongoing treatment.
• Find your salary band and compare the yearly premium for each plan.
• If you or a family member is in active treatment with a Non-Preferred provider, ask about the Transition of Care form.

Your Primary Care Doctor

The lowest primary care copay, $15 on the Standard plan and $10 on the Plus plan, applies only to a Preferred primary care provider listed on your ID card. If your current doctor is already Preferred, you do not need to do anything. If not, you can switch to a Preferred doctor after January 1, 2027, and new ID cards usually arrive within about 10 days.

Other Benefits to Review

Dental, vision, and flexible spending accounts are separate from the State Health Plan and are offered through your employer's own benefits program, often during the same window. If your pension contribution and health premiums leave room, consider the supplemental retirement plans as well; our NC 457(b) plan guide and TSERS pension guide cover them. The plan also offers a high-deductible health plan; if you choose it, our NC HSA guide explains how to pair it with a health savings account.

Frequently Asked Questions

When is State Health Plan open enrollment for 2027?

Open enrollment runs from October 12 to November 6, 2026, through eBenefits, and the choices you make take effect January 1, 2027. If you do nothing, you are enrolled in the Standard PPO with the same dependents you have now. Your employer may set an earlier internal deadline.

How much is the State Health Plan premium for a teacher in 2027?

It depends on salary and coverage. A teacher earning $50,000 or less pays $36.76 a month for employee-only coverage on the Standard PPO, or $69.32 on the Plus PPO. Between $50,001 and $65,000, the rates are $52.52 and $98.72. Covering a spouse or family on the Standard PPO costs $603.76 to $651.00 a month depending on salary.

Is Duke or Atrium in-network for 2027?

Both are in the network, at different tiers. Duke Health is an Access provider, with costs about the same as in 2026. Atrium Health and WakeMed are Non-Preferred, which means much higher deductibles and out-of-pocket maximums, though emergency care costs the same. UNC Health, Novant Health, and Iredell Health are Preferred and cost the least.

Should I switch from the Standard plan to the Plus plan?

Switch if you expect significant medical costs in 2027 or rely on Access-tier providers, since the Plus plan's lower out-of-pocket maximum and copays can save more than its higher premium. Stay on the Standard plan if you expect little more than preventive care and a few visits. The higher your salary, the more the Plus plan costs, so the case for it weakens above $90,000.

Sources: State Health Plan 2027 open enrollment information, 2027 rate sheet for active subscribers, and 2027 Plan Comparison; NC Department of State Treasurer.