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State Benefits Programs & Additional Benefit Options

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Many public-sector employees rely on state benefits programs  for their healthcare needs. These plans vary from state to state when it comes to coverage, exclusions, and support.  At Pierce Group Benefits (PGB), we support public-sector employers across North Carolina, South Carolina, and Virginia. This article serves as a resource outlining the programs available in those states, along with voluntary benefits that help support employees’ overall health and well-being.

North Carolina

The North Carolina State Health Plan (NCSHP) serves over 740,000 individuals, including teachers, state employees, retirees, and their dependents.  For active and non-Medicare members, this plan offers:

  • A Standard Preferred Provider Organization (PPO) Plan
  • A Plus PPO Plan
  • A High-Deductible Health Plan (for eligible employees as deemed by their employer)

For those retirees who are Medicare eligible, this plan offers:

  • A Medicare Advantage PPO & Prescription Drug Base Plan
  • A Medicare Advantage PPO & Prescription Drug Enhanced Plan
  • A 70/30 Plan

The NC State Health Plan offers a variety of tools and resources to help save on health care costs and make informed choices. It offers specific resources for:

  • Active Employees
  • Non-Medicare Eligible Retirees
  • Medicare Retirees

It also offers specific resource centers for:

  • Pharmacy
  • Diabetes
  • Cancer Prevention
  • Opioid
  • Behavior Health
  • Disability

For information on the North Carolina State Health Plan, please visit their website: https://www.shpnc.gov/.

South Carolina

In South Carolina, employee insurance programs are  combined with the retirement system under the South Carolina Public Employee Benefit Authority (PEBA). PEBA serves over 550,000 individuals, spanning state agencies, higher education institutions, school districts, and optional employers. There are four plan options:

  • The Standard Plan
  • The Savings Plan
  • The Medicare Supplemental Plan (for those retired employees enrolled in Medicare)
  • The TRICARE Supplement Plan (for eligible military members)

PEBA also offers a variety of tools and resources to help control medical costs and reduce the risk of high-cost health issues over time. Resources offered include:

  • PEBA Perks
  • Well Visits
  • Telehealth
  • Health Coaching
  • Hello Heart
  • Personify Health
  • Virta
  • Wondr Health
  • Hospital Quality

For information on PEBA, please visit their website: https://www.peba.sc.gov/.

Virginia

The Commonwealth of Virginia (COVA) offers two primary public sector health benefit programs administered through the Virginia Department of Human Resource Management (DHRM): the COVA Health Benefits Program and The Local Choice Health Benefits Program (TLC).

COVA is designed for state agency employees, eligible retirees, and their dependents, and covers more than 200,000 individuals. There are three statewide plans and two regional plans offered:

  • COVA Care
  • COVA HealthAware
  • COVA High-Deductible Health Plan
  • Kaiser Permanente HMO (regional)
  • Sentara Health Vantage HMO (regional)

COVA offers a comprehensive benefits package beyond medical, prescription, and dental coverage, including:

  • Employee Assistance Program (EAP)
  • CommonHealth Wellness Program
  • Shared Savings Program
  • Telehealth Services

For more information on COVA, please visit their website: https://www.dhrm.virginia.gov/

TLC is built exclusively for local government jurisdictions, local school divisions, and constitutional offices, and participating political subdivision employees, retirees, and their dependents. This program serves 60,000 individuals, spanning 335 VA jurisdictions. There are five statewide plans and two regional plans offered:

  • Key Advantage Expanded
  • Key Advantage 250
  • Key Advantage 500
  • Key Advantage 1000
  • TLC High-Deductible Health Plan
  • Kaiser Permanente HMO (regional)
  • Sentara Health Vantage HMO (regional)

All TLC health plans also offer Employee Assistance Programs, which provide helpful support covering a variety of topics including:

  • Mental Health
  • Alcohol / Drug Abuse Assessments
  • Child / Elder Care
  • Grief Counseling
  • Legal Services
  • Financial Services

For information on The Local Choice, please visit their website: https://www.thelocalchoice.virginia.gov/.

Complementing State Benefits Programs with Voluntary/Supplemental Benefits

While state benefits programs provide essential medical coverage, optional voluntary benefits can help employers enhance their overall benefits strategy by providing a separate, additional layer of financial protection. These optional employee-paid benefits provide added choice and flexibility and are designed to work alongside existing medical coverage. Examples of these voluntary benefits include:

  • Flexible Spending Accounts (FSAs): FSAs allow employees to set aside pre-tax dollars to pay for eligible healthcare and related expenses throughout the year. By reducing taxable income, FSAs can help make healthcare costs more manageable. It’s important to note that FSA funds are generally subject to a “use-it-or-lose-it” rule, meaning unused funds may be forfeited at the end of the plan year.
  • Health Savings Accounts (HSAs): HSAs provide a tax-advantaged way to save for qualified medical expenses. Unlike FSAs, HSA funds roll over from year to year and remain with the account holder, even if they change employers or retire. This makes HSAs a valuable tool for both current healthcare costs and long-term financial planning.
  • Short Term Disability Benefits (STD): Short-term disability coverage helps replace a portion of an employee’s income if they are temporarily unable to work due to a covered illness, injury, or medical condition. These benefits can help individuals maintain financial stability while they focus on recovery.
  • Long Term Disability Benefits (LTD): Long-term disability insurance provides income protection for individuals who are unable to work for an extended period due to a covered injury or illness. LTD benefits can serve as a critical financial safety net during prolonged absences from work.
  • Telemedicine Benefits: Telemedicine services offer convenient 24/7 access to licensed healthcare providers through phone or video consultations. These benefits can help employees receive timely care, avoid unnecessary urgent care visits, and manage their health from virtually anywhere.
  • Accident Benefits: Accident insurance provides cash benefits directly to the insured following a covered accidental injury. These funds can be used however they’re needed, whether for medical bills, transportation costs, childcare, or everyday household expenses during recovery.
  • Cancer Benefits: Cancer insurance helps offset the financial impact of a cancer diagnosis by providing benefits that can be used for both medical and non-medical expenses. Covered costs may include treatments, surgeries, travel and lodging during care, home health services, and other cancer-related expenses that traditional health plans may not fully cover.
  • Critical Illness Benefits: Critical illness coverage provides a lump-sum cash benefit when an insured individual is diagnosed with a covered serious condition, such as a heart attack, stroke, or cancer. The benefit can help cover out-of-pocket medical expenses, lost income, or other financial obligations during treatment and recovery.
  • Medical Bridge Benefits: Often referred to as hospital indemnity insurance, medical bridge coverage pays cash benefits directly to the insured for covered hospital stays, admissions, and medical procedures. These funds can help fill gaps left by traditional health insurance and reduce the burden of unexpected healthcare expenses.

Partnering with Pierce Group Benefits

Pierce Group Benefits is proud to assist clients in offering a suite of voluntary benefits that may provide financial support when covered events occur. Our team of on-the-ground Benefits Counselors are honored to assist employees in evaluating whether additional protection aligns with their individual needs and budget. To customize your voluntary benefits to help complement state health plan offerings, contact your Pierce Group Benefits Account Executive or email partnership@piercegroupbenefits.com.

 

This article is provided for informational and educational purposes only and should not be construed as benefits, legal, or tax advice. Benefit provisions, eligibility requirements, limitations, and exclusions vary by plan. Employees should consult official plan documents and resources provided by their employer and the applicable state benefits program for complete and current information regarding their core benefits. Pierce Group Benefits (PGB) is an independent voluntary benefits broker and is not the broker, administrator, sponsor, or representative of the North Carolina State Health Plan (SHP), South Carolina Public Employee Benefit Authority (PEBA), or Virginia’s The Local Choice (TLC) program. Any voluntary benefits referenced are separate products offered independently of these programs and are not affiliated with, endorsed by, sponsored by, or administered by SHP, PEBA, or TLC.