Open Enrollment for Health Insurance 2026 North Carolina

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The open enrollment period for 2026 in North Carolina is a crucial time for all north carolina state health plan members. It runs from October 13 to October 31, 2025. During this period, you can:

• Review and make changes to your health insurance plans

• Update your coverage

• Add dependents

• Switch plans

All modifications must be completed within this window. Missing the deadline could result in being locked into your current plan for another upcoming year, so it’s essential to act promptly. The final step is to ensure all changes are made before the money deadline.

New premium rates and benefits for 2026 will be communicated to members ahead of the open enrollment period, giving you ample time to review and decide on the best options for your needs. It’s important to remember:

• Any changes made during the open enrollment period will take effect on January 1, 2026.

• If you’re planning to add dependents, you must submit the necessary documentation by 11:59 p.m. on October 31.

• Failure to submit documentation by this deadline will delay the coverage for your dependents.

To help you navigate this process, the state provides various open enrollment resources, including the Enrollment Support Center. If you need assistance or have questions about your options, don’t hesitate to reach out.

The support center is there to guide you through the process and ensure you make the best choices for your health care needs. For more details, be sure to check the open enrollment information available.

The 2026 health plans come with several important changes that all state health plan members should be aware of. Despite maintaining stable premiums for the past seven years, the state health plan is facing a significant financial deficit, necessitating changes to the premium structure and benefits.

One of the most notable changes is the agreement with healthcare providers in the state to lower their rates for plan members, which aims to help mitigate some of the financial impacts.

Additionally, the 2026 premiums will include a reduction in costs for employees who enroll their children in the plan. This cost reduction is part of the state’s effort to make health insurance more affordable for families.

The approved premiums for 2026 will provide significant savings for those covering children, making it easier for families to manage their health care expenses.

State health plan members will also see changes in the structure of their planned plans. The introduction of two preferred provider organization (PPO) plans, the Standard PPO Plan and the Plus PPO Plan, will offer more options tailored to different needs and budgets.

These plans are designed to provide better access to preferred providers and lower out-of-pocket costs for members. As you prepare for the next open enrollment period, be sure to review these new plan options and consider how they can benefit you and your family to save money.

Starting in 2026, the state health plan will implement salary-based premiums to assist lower-income employees. This new income-based premium structure will determine health insurance costs based on employee salaries, making health insurance more affordable for those with lower incomes.

The introduction of salary-based premiums is part of the state’s effort to alleviate the financial burden on its lowest-paid employees.

The state health plan will create four salary bands. These bands will determine income-based premiums. These bands will determine the premium payments for state employees based on their annual salaries.

The goal is to ensure that health insurance costs are proportionate to income, providing relief to those who need it most. Additionally, members covering children on their plans will see a reduction in costs starting in 2026.

This change comes in response to a significant financial challenge, including a $507 million deficit, which has necessitated adjustments to the premium structure.

By introducing salary-based premiums, the state aims to create a more equitable system that supports all employees while addressing the financial sustainability of the health plan and ensuring that employees can pay their premiums.

Enrolling in a health insurance plan during the open enrollment period is a straightforward process, but it’s important to follow the steps carefully to ensure your coverage is correctly updated. To enroll in health, visit the official State Enrollment Portal, where you can view your options and make your selections.

The enrollment process for non-university employees can also be completed by calling the eligibility and enrollment call center at 855-859-0966, where you may find that you are automatically enrolled.

If you’re happy with your current plan and don’t wish to make any changes, your current elections will automatically carry over at the new rates for 2026. However, it’s crucial to:

• Review the new rates and benefits to ensure they still meet your needs.

• After making your selections, click “save” or “accept” to confirm your choices.

• Keep a copy or picture of your confirmation for your records.

The Enrollment Support Center is available to help those needing additional assistance. You can reach out via email at shpmemberinquiries@nctreasurer.com or by phone.

Utilizing these resources can help you navigate the enrollment process smoothly and ensure you make the best decisions for your health care needs.

Adding and managing dependents during the open enrollment period is a critical task for many state health plan members. The deadline to upload documentation for new dependents is 11:59 p.m. on October 31, 2025.

Gathering and submitting the required documents on time ensures your dependents are covered starting January 1, 2026.

Proper documentation verifies the life events and factors that qualify for adding eligible dependents outside the standard enrollment period.

This includes events such as marriage, the birth of a child, or adoption. Ensuring you have all the required paperwork will help avoid delays and complications in getting your dependents covered.

Managing dependents doesn’t end with adding them to your plan. Regularly reviewing and updating your dependent information is important to maintain accurate records and ensure continued coverage.

If you need assistance with this process, the Enrollment Support Center is available to help you navigate the necessary steps and provide additional information as needed.

The 2026 open enrollment period brings exciting new benefits and programs for state health plan members. One of the most notable additions is the Lantern Surgical Benefit, which covers over 1,500 non-emergency surgeries.

Members will not incur any charges for covered surgeries performed by Lantern providers, making it easier to access necessary surgical care without worrying about out-of-pocket costs.

Another significant change is the introduction of the Preferred Providers Program, set to replace the previous Clear Pricing Project starting January 1, 2026. This program will allow members to access care from preferred providers at reduced copays, offering substantial savings on health care services.

The goal is to provide better access to high-quality care while lowering costs for members.

These new benefits and programs are designed to enhance the overall health care experience for state employees. By reducing out-of-pocket costs and providing access to a broader range of services, the state aims to improve the health and well-being of its members.

Be sure to review the details of these new benefits during the open enrollment period to take full advantage of the upcoming changes.

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Receiving and managing your health insurance ID cards is an important part of the open enrollment process. After the open enrollment period closes, new health insurance ID cards will be sent out to members.

These cards are essential for accessing health care services, so it’s important to ensure that your address is up-to-date in the ConnectCarolina Self Service portal to avoid any delays in receiving your ID cards.

Your health insurance ID card contains important information that you will need when visiting doctors, filling prescriptions for medications, and accessing other health care services.

Make sure to keep your card in a safe place and carry it with you to all medical appointments. If you have any questions about your ID card or need a replacement, contact the Enrollment Support Center for assistance.

Understanding your health insurance ID card and keeping it up-to-date is crucial for ensuring seamless access to health care services. Be proactive in managing your card to avoid any disruptions in your coverage and care.

Special Enrollment Periods (SEPs) offer a limited opportunity to sign up for health insurance outside the usual enrollment period. These periods are triggered by qualifying life events, such as:

• Marriage

• The birth of a child

• Losing other coverage

If you experience a qualifying life event, you must provide documentation to confirm the event and access special enrollment.

SEPs typically last for 60 days following a qualifying event, allowing you to make changes to your health plan outside the regular open enrollment period. This flexibility ensures that you and your family can maintain continuous coverage even when life changes unexpectedly.

Understanding the requirements and timelines for SEPs is important for all state health plan members. If you experience a qualifying life event, be sure to act quickly and provide the necessary documentation to ensure your coverage is updated promptly.

The Enrollment Support Center can provide assistance and answer any questions you may have about SEPs and qualifying life events.

While the open enrollment period is the primary time to make changes to your health insurance plan, there are options available to get health insurance any time of year in North Carolina.

For instance, you can apply for Medicaid year-round if you meet the eligibility requirements. Additionally, short-term health plans are available for those who need temporary coverage.

Various health insurance options are available throughout the year, providing flexibility for those who may miss the open enrollment period or experience a change in their health care needs.

Understanding these options and how they apply to your situation can help you maintain continuous coverage and access to health care services.

If you need assistance exploring year-round health insurance options, the Enrollment Support Center can provide guidance and help you determine the best plan for your needs. Staying informed about your options ensures that you and your family are always covered, regardless of the time of year.

For help with enrollment or eligibility questions, the Enrollment Support Center is your go-to resource. You can contact the support center by calling 855-859-0966, Monday to Friday from 8 a.m. to 5 p.m.

The knowledgeable staff can assist you with everything from enrolling in a plan to managing dependents and understanding new benefits.

If you prefer to reach out via email, you can contact the support center at shpmemberinquiries@nctreasurer.com.

This can be a convenient option for getting detailed responses to your questions and ensuring you have all the information you need to make informed decisions about your health insurance coverage.

The Enrollment Support Center is dedicated to helping state health plan members and active members navigate the open enrollment process and beyond. Don’t hesitate to reach out for assistance and make the most of the resources available to you.

In summary, the 2026 open enrollment period in North Carolina is an essential time for making critical decisions about your health insurance coverage. With new changes to premiums, benefits, and plan structures, it’s important to review your options and take action within the enrollment period to ensure you and your family are adequately covered for the upcoming year.

Remember to utilize the available resources, such as the Enrollment Support Center, and stay informed about the new benefits and programs. By being proactive and prepared, you can make the best choices for your health care needs and enjoy the peace of mind that comes with comprehensive coverage.

Self-employed or working freelance? Affordable Marketplace health insurance can keep you covered. Call 1-877-517-5357 to explore your 2026 options.

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