2023 Medical Plan Transition
*This webpage was last updated August 15, 2022.
BlueCross BlueShield of North Carolina announced that it will discontinue Wake Forest’s current medical plan network, Blue Value Network.
Due to this decision, Wake Forest University has evaluated and identified new third-party administrators for the 2023 plan year. Colleagues are encouraged to visit this webpage for the most up-to-date information about this transition.
Questions
Submit your questions about this process to HR using this form or clicking the button below. We are working to incorporate your feedback as decisions are made going forward.
Aetna and CBHA selected as third-party administrators
Wake Forest has selected Aetna as the third-party administrator (TPA) for the University’s medical and prescription plans. Additionally, the University has selected Carolina Behavioral Health Alliance as the TPA for the behavioral health plan. The transition to Aetna will begin January 2023; the University’s benefits plans are on a calendar-year cycle. Read the Aetna and CBHA announcements »
Bottom Line, Up Front
- Aetna has been selected as the University’s medical and prescription third-party administrator.
- Carolina Behavioral Health Alliance (CBHA) will continue to serve as the third-party administrator of the University’s behavioral health plan.
- While Aetna has been chosen as the third-party administrator, plans will not be finalized until fall, allowing the University to use the most up-to-date claims data to identify the most comprehensive plan options within the University’s budget.
- We anticipate sharing the final plans, member costs, and additional resources to navigate this transition prior to open enrollment, scheduled for October 3-21.
Timeline
In reverse order from the Jan. 1, 2023 benefits changes
- Jan. 1, 2023: New benefits take effect
- Oct. 3-21, 2022: Annual Benefits Enrollment for eligible faculty and staff
HR will share the final plans, member costs, and additional resources to navigate this transition prior to open enrollment, scheduled for October 3-21. - Fall 2022: Communicate plans and member costs
Plan options, including member costs such as premiums, co-pays, deductibles, and out-of-pocket maximums, will be finalized in the fall. Final plan options will be informed by the most recent claims information available, and will allow the University to offer the most comprehensive plan options within the University’s budget. - Summer 2022: Plan modeling and implementation
Throughout the summer, the University will continue plan modeling in coordination with Gallagher Benefits Services. The FBC will meet with HR to provide feedback on plan modeling. - August 2022: WFU announced CBHA as behavioral health TPA
On August 15, Human Resources announced that CBHA would continue to serve as the University’s behavioral health administrator for the 2023 calendar year. - June 2022: WFU announced Aetna as medical and prescription TPA
On June 15, Human Resources announced that Aetna had been selected as the TPA for the University’s medical and prescription plans. - April 2022: WFU continued to evaluate TPAs and possible plan options
In April, HR performed reference checks with employers in higher education and health care who utilize the top TPA finalists. HR and the FBC revisited key campus concerns, including continuation of CBHA and access to Novant Health providers, possible pharmacy disruption, and out-of-region coverage. - March 2022: WFU reviewed and evaluated TPA interview results
In March, the FBC met to discuss the results of the finalist interviews and began initial conversations regarding plan options, such as two-tier plans, three-tier plans, and a high-deductible plan as an addition to the tiered plan options. HR continued to gather additional information and data from these finalists to inform the decision-making process. - Feb. 2022: WFU held TPA finalist interviews
In February, the FBC met to review the RFP results, which ranked the four proposals based on the evaluation criteria – including recent medical and behavioral health providers and prescription drug usage – and three finalists to participate in interviews with the Wake Forest administration. - Jan. 2022: WFU evaluated returned RFPs
In January, the four RFPs submitted were evaluated and ranked based on three core evaluation criteria: minimized member disruption, network options, and financial impact. The FBC met to review the fringe budget, to orient new committee members to the process, and to review the RFP criteria and overall evaluation process. - Dec. 2021: WFU sent out RFPs
In December, five TPAs were invited to participate in the request for proposal (RFP) process; one declined to participate.
Frequently Asked Questions
Colleagues across campus have shared feedback with Human Resources and the Fringe Benefits Committee (FBC) throughout this process. Below is a collection of the most common questions received.
The RFPs submitted by potential third-party administrators were evaluated and ranked based on the following criteria:
- minimized member disruption (prioritizing continued access to current providers and prescription formularies),
- network options (member access and broad versus narrow networks), and
- financial impact (cost to members, plan costs, administrative fees, and network discounts).
The evaluation also considered Workday integration capabilities, implementation process and support, access to robust member services, and more. The FBC participated in the review of this evaluation process. Five third-party administrators were invited to participate in the RFP process, one of which declined to participate. Based on the RFP evaluation, three third-party administrators participated in finalist interviews in late February with Wake Forest administration. After the University completed an extensive evaluation of competing proposals, Aetna emerged as the third-party administrator that most closely met the primary criteria.
Beginning Jan. 1, 2023, Aetna will be the third-party administrator for the University’s medical and prescription plans. Any changes to plan options and member costs will not be finalized until fall.
The disruption analysis included medical plan members’ recent providers, with the goal of minimizing disruption. Plan participants’ frequently used providers, including Atrium Health Wake Forest Baptist (AHWFB), Novant Health, and others will still be in-network. A tiered plan option would include these in-network providers, with no changes to current member copays, deductibles, and out-of-pocket maximums for one tier and potentially lower costs for providers in another tier. This change would begin in the 2023 plan year.
As WFU’s medical plan offers today, there will be in-network coverage available for those individuals who do not live locally.
The Student Health Insurance Program, a health care plan available to students who are not currently insured, is not associated with the employee insurance program and will not be impacted by the decision to move to Aetna.
The FBC is comprised of faculty representatives elected to serve on the Faculty Senate, staff representatives elected to serve on the Staff Advisory Council, and administrative staff from Human Resources as well as Audit and Compliance.
A list of FBC members is outlined below:
Faculty Senate
- Tracey Banks, JD
Associate Professor | School of Law - Michael Cartwright, MD
Associate Professor | School of Medicine - Melissa Jenkins, PhD
Associate Professor | English Department - Julie Wayne, PhD
Professor | School of Business
Staff Advisory Council
- Adam Carlson
Senior UNIX Systems Administrator | Information Systems - David Clingenpeel
Associate Director, Graduate Student Academic Services | School of Business - Ulylisa Frazelle
Parking Services Manager | Parking & Transportation - Mandy Martin
Assistant Director | Campus Recreation - Noel Shepherd
Director, Development and Legacy Giving | Athletics - Tim Covey
Senior Analyst, Quality Assurance | Information Systems
Administration
- Shannon Araya
Director of Absence & Benefits, Human Resources - Dedee DeLongpré Johnston
Vice President, Human Resources and Sustainability - Beth Fay
Assistant Vice President, Total Rewards & HR Solutions - Hof Milam
Executive Vice President, Finance & Administration - James Ponce
Associate Vice President, Chief Audit & Compliance Officer - Jeff Ries (Gallager)
Area Vice President, Gallagher