State workers: Your benefits will soon go through Aetna. Blue Cross NC won’t appeal.

Blue Cross Blue Shield NC is calling it quits on its legal fight to retain the contract to administer the state’s health insurance plan.

The insurance giant won’t be appealing its loss earlier this month on a case arguing the State Health Plan made a mistake in granting the health contract to Aetna starting in 2025, according to Blue Cross NC spokesperson Laura Eberhard,

“While disappointed in the outcome, Blue Cross NC will not appeal the court’s ruling regarding the State Health Plan’s RFP process,” Eberhard said in an email to The News & Observer on Monday.

“While we will continue to provide the highest level of service throughout the current agreement, we know that our relationship with North Carolina’s teachers, public safety officers, and state employees is guided by something far more meaningful than a contract. Together, we share a vision of a better, healthier tomorrow and remain united by a common sense of purpose and commitment to the state we call home,” she wrote.

Blue Cross NC, which had been the state’s third-party administrator for the SHP for more than 40 years, in February 2023 filed a complaint with the North Carolina Office of Administrative Hearings. This followed the announcement by State Treasurer Dale Folwell earlier that year that Aetna would replace Blue Cross NC.

Throughout 2024, the case was heard in the OAH, with witness testimony and lengthy legal arguments on why the state had or had not made the right decision.

Administrative Law Judge Melissa Owens Lassiter ultimately ruled in favor of the state and Aetna.

In early July, she wrote in her final decision that “the preponderance of the evidence showed that the Plan conducted the procurement carefully and thoughtfully, fairly and in good faith, and that its decisions were properly within its discretion. It also showed that the vendors’ proposals were evaluated and scored carefully, accurately, and fairly.”

Blue Cross NC could have opted to appeal Lassiter’s decision in the state’s superior courts. Any decision there could also have been appealed.

This decision means that hundreds of thousands of state employees will now be covered under the Aetna umbrella.

A third-party administrator handles all of the administrative tasks associated with health insurance, which include issuing cards, processing claims, setting up technological systems and more. For this, the state pays a fixed per-member cost.

In North Carolina, the administrator also lays out contracts with a network of providers and negotiates the prices paid to them for health care services. This means some members could see a change in in-network providers.

According to the SHP website, 99% of State Health Plan claims processed over a year would have been paid to in-network providers under Aetna.