Pricing is based on the broader NC small group market — not PPP's individual claims history. Blue Cross NC remains the most competitive fully insured option. UnitedHealthcare priced higher; Aetna no longer offers fully insured plans for groups under 50 in NC.
| Plan Feature | BlueHPN Silver 3500 Limited Network |
Blue Options Silver 4000 Broad Network |
CHW Plan 9 Broad Net |
CHW Plan 10 Broad Net |
CHW Plan 11 Broad Net |
|---|---|---|---|---|---|
| Monthly Premium | $8,458.23 | $10,256.32 | $10,623.05 | $9,795.31 | $9,605.81 |
| Rate Increase | +22.6% | +23.3% | — | — | — |
| Network | Limited HPN | Broad PPO | Broad PPO | Broad PPO | Broad PPO |
| Deductible (Ind) | $3,500 | $4,000 | $3,500 | $4,000 | $5,000 |
| OOP Max (Ind) | $9,500 | $10,150 | $7,000 | $8,000 | $9,200 |
| Coinsurance | 30% | 30% | 30% | 30% | 30% |
| Primary Care | $55 copay | $50 copay | $35 copay | $35 copay | $35 copay |
| Specialist | $110 copay | $100 (visits 1–4), then 30% | $70 copay | $70 copay | $70 copay |
| Urgent Care | $110 copay | $100 copay | $70 copay | $70 copay | $70 copay |
| Emergency Room | $1,500 copay | 30% after ded. | $500 copay | $500 copay | $500 copay |
| Rx Deductible | $0 | $100 | $100 | $100 | $100 |
| Tier 1 / Tier 2 Rx | $15 / $40 | $15 / $40 | $10 / $15 | $10 / $15 | $10 / $15 |
| Tier 3 / Tier 4 Rx | $80 / $120 | $80 / $120 | $35 / $50 | $35 / $50 | $35 / $50 |
| Telehealth | No Charge | No Charge | No Charge | No Charge | No Charge |
| Preventive Care | No Charge | No Charge | No Charge | No Charge | No Charge |
* CHW plans use composite (non-age-banded) pricing via NC Chamber MEWA. Requires NC Chamber membership. CHW and BCBS plans cannot be offered simultaneously.
BCBS Renewal: Employer pays 50% of each employee's own HPN age-banded rate. Employees electing Blue Options pay the premium difference themselves. Employer cost is identical regardless of which ACA plan employees choose.
CHW (Proposed): Employer pays a flat $271.88/mo per employee — cost-neutral to HPN renewal. CHW Plan 11 is the base plan. Employees electing Plan 9 or 10 pay the difference themselves.
| Scenario | Total Group Premium | Employer/Mo | Employer/Yr | vs 2025 Employer | EE Base Rate |
|---|---|---|---|---|---|
| 2025 Current — HPN (reference) | $6,898.27 | $3,424.89 | $41,098.68 | — | tiered by age |
| 2026 Renewal — BlueHPN 3500 | $8,458.23 | $4,078.23 | $48,938.76 | +$653.34/mo | $45.40–$86.62/wk |
| 2026 Renewal — Blue Options 4000 | $10,256.32 | same as HPN ↑ | same as HPN ↑ | same as HPN ↑ | buy-up from HPN |
| 2026 CHW Plan 11 (cost-neutral) | $9,605.81 | $4,078.23 | $48,938.76 | +$653.34/mo | $55.87/wk (flat) |
CHW employer contribution = $271.88/mo per employee regardless of coverage tier. Blue Options employees pay the HPN-to-Options premium difference. ACA plan employer cost identical for both BCBS plans.
BCBS Renewal: Employee pays 50% of their own HPN age-banded rate (three tiers by age). Blue Options employees pay their HPN tier rate plus the full HPN-to-Options premium difference.
CHW Cost-Neutral: Employer contributes $271.88/mo per employee. All employees pay $55.87/wk for Plan 11 employee-only coverage. Plans 9 and 10 are buy-up options.
| Age Tier | # EEs | HPN 2025 | HPN 2026 | HPN YoY ↑ | CHW Cost-Neutral | vs HPN 2026 |
|---|---|---|---|---|---|---|
| Age 30 & Under | 7 | $38.13/wk | $45.40/wk | +$7.27/wk | $55.87/wk | +$10.47/wk |
| Age 31 – 50 | 3 | $53.25/wk | $63.41/wk | +$10.16/wk | $55.87/wk | −$7.54/wk |
| Age 51 & Up | 5 | $72.74/wk | $86.62/wk | +$13.88/wk | $55.87/wk | −$30.75/wk |
Employee-only, EE pays 50% of their own HPN age-banded rate on BCBS. CHW cost-neutral = flat $55.87/wk regardless of age. HPN 2026 is the benchmark for comparison.
At $50/wk, employees pay $216.67/mo for Plan 11 employee-only coverage. The employer contributes $297.32/mo per employee ($4,459.85/mo total across 15 employees). This is more generous to employees than the cost-neutral strategy ($55.87/wk) and results in a higher total employer cost than renewing on HPN.
| Age Tier | # EEs | HPN 2026 | CHW Cost-Neutral | CHW $50/wk | $50/wk Delta vs HPN 2026 |
|---|---|---|---|---|---|
| Age 30 & Under | 7 | $45.40/wk | $55.87/wk | $50.00/wk | +$4.60/wk |
| Age 31 – 50 | 3 | $63.41/wk | $55.87/wk | $50.00/wk | −$13.41/wk |
| Age 51 & Up | 5 | $86.62/wk | $55.87/wk | $50.00/wk | −$36.62/wk |
At $50/wk the employer contributes $297.32/mo per employee (57.8% of Plan 11 EE-only rate). Employees on Plan 9 or 10 pay the buy-up above the Plan 11 rate.
| Coverage Tier | CHW Plan 9 (buy-up) | CHW Plan 10 (buy-up) | CHW Plan 11 (base) |
|---|---|---|---|
| Employer Contribution/mo | $297.32/mo | $297.32/mo | $297.32/mo |
| Employee Only (base) | $62.39/wk | $52.31/wk | $50.00/wk |
| Employee + Spouse | $185.54/wk | $165.38/wk | $160.77/wk |
| Employee + Children | $167.07/wk | $148.42/wk | $144.15/wk |
| Family | $321.01/wk | $289.76/wk | $282.61/wk |
| Age Tier | BlueHPN 3500 | Blue Options 4000 | Difference |
|---|---|---|---|
| Age 30 & Under | $45.40/wk | $64.70/wk | +$19.30/wk |
| approx. $196.73/mo | approx. $280.37/mo | approx. +$83.64/mo | |
| Age 31 – 50 | $63.41/wk | $90.38/wk | +$26.97/wk |
| approx. $274.78/mo | approx. $391.65/mo | approx. +$116.87/mo | |
| Age 51 & Up | $86.62/wk | $123.45/wk | +$36.83/wk |
| approx. $375.35/mo | approx. $534.95/mo | approx. +$159.60/mo |
| Dependent Age | BlueHPN 3500 | Blue Options 4000 |
|---|
Employee contributions use three age tiers (30 & under / 31–50 / 51+). Dependent contributions are individually age-banded by the dependent's age. Monthly equivalents are approximate (weekly × 52 ÷ 12).
Both options use the same Dental Blue Traditional plan design through Blue Cross NC. The CHW alternate quote was generated from Prospect #456681 on the same census (11 enrolled) and returns slightly lower composite rates — a modest additional savings if PPP switches to CHW for medical.
| Coverage Tier | BCBS Renewal (D00003N) | CHW Alternate (D00003N) | Difference |
|---|---|---|---|
| Employee Only (9 enrolled) | $32.92/mo | $32.84/mo | −$0.08/mo |
| Employee + Spouse (1 enrolled) | $65.83/mo | $65.68/mo | −$0.15/mo |
| Employee + Children (0 enrolled) | $78.94/mo | $76.81/mo | −$2.13/mo |
| Family (1 enrolled) | $119.13/mo | $113.52/mo | −$5.61/mo |
| Benefit | Detail (both options — same plan design) |
|---|---|
| Annual Maximum | $1,000 (Basic + Major Care combined) |
| Annual Deductible | $100 Individual / Lifetime — applies to Basic and Major Care only |
| Preventive Care | 0% (exams, cleanings, x-rays — 2× per year; no deductible) |
| Basic Care | 20% after deductible (fillings, extractions, endodontics, periodontal maintenance) |
| Major Care | 50% after deductible (crowns, bridges, dentures, periodontics, occlusal guards) |
| Orthodontia | 50%, up to $1,000 lifetime maximum (through age 18) |
| Implants | Not Covered |
| No Missing Tooth Clause | Included — no exclusion for pre-existing missing teeth |
| Composite Fillings | Covered on any tooth |
| Teledentistry | Covered same as in-office for eligible evaluations |
BCBS Quote #7144685 | CHW Alternate Quote #7144685 (Prospect #456681) | Dental Blue Traditional D00003N | Effective 05/2026
Current and renewal vision is Blue 20/20 Exam Plus 42V (V000062) — no rate change at renewal, $124.29/mo total. The CHW alternate is a different variant, Blue 20/20 Exam Plus 18V (V00005F), at $100.80/mo on the same census. Both are administered by EyeMed through Blue Cross NC.
| Coverage Tier | BCBS Renewal — 42V (V000062) | CHW Alternate — 18V (V00005F) | Difference |
|---|---|---|---|
| Employee Only (8 enrolled) | $9.68/mo | $7.85/mo | −$1.83/mo |
| Employee + Spouse (1 enrolled) | $18.39/mo | $14.92/mo | −$3.47/mo |
| Employee + Children (0 enrolled) | $19.36/mo | $15.70/mo | −$3.66/mo |
| Family (1 enrolled) | $28.46/mo | $23.08/mo | −$5.38/mo |
| Benefit | In-Network | Out-of-Network |
|---|---|---|
| Routine Eye Exam | $10 copay (1× per 12 months) | Up to $39 |
| Frames | $130 allowance + 20% discount on balance | Up to 50% of allowance |
| Standard Lenses — single/bifocal/trifocal/lenticular | $25 copay each | Up to $25–$63 |
| Standard Progressive | $25 copay + $65 | Up to $39 |
| Contact Lenses (conventional or disposable) | $130 allowance + 15% discount | Up to 80% of allowance |
| Medically Necessary Contacts | $0 copay | Up to $200 |
| Lenses / Contacts frequency | 1 set every 12 months | |
| Frames frequency | 1 pair every 24 months | |
| Participation | Voluntary — 20% minimum employee participation required | |
BCBS Quote #7144697 | CHW Alternate Quote #7144697 (Prospect #456681) | Blue 20/20 Exam Plus V00005F / 18V | Effective 05/2026 | Administered by EyeMed
Carolina Health Works (CHW) is a NC Chamber of Commerce MEWA (Multiple Employer Welfare Arrangement). Plans are underwritten through Blue Cross Blue Shield of NC and use the Blue Options broad network — the same network as Blue Options Silver 4000. CHW uses composite (non-age-banded) pricing, meaning all employees pay the same rate regardless of age.
| Coverage Tier | CHW Plan 9 | CHW Plan 10 | CHW Plan 11 |
|---|---|---|---|
| Monthly Group Premium | $10,623.05 | $9,795.31 | $9,605.81 |
| Employee Only | $567.67/mo | $523.99/mo | $513.99/mo |
| Employee + Spouse | $1,101.34/mo | $1,013.98/mo | $993.98/mo |
| Employee + Children | $1,021.29/mo | $940.48/mo | $921.98/mo |
| Family | $1,688.38/mo | $1,552.97/mo | $1,521.97/mo |
CHW and BCBS plans cannot be offered simultaneously. This is a binary decision: renew with BCBS or switch to CHW. CHW Plan 11 is the recommended base plan — Plans 9 and 10 are voluntary buy-ups for employees who want richer benefits.