A snapshot of Georgia: State Health Benefit Plan [Feb. 2008]

A Division Of The Georgia Department Of Community Health
A SNAPSHOT OF GEORGIA
State Health Benefit Plan

Overview

The State Health Benefit Plan (SHBP) is a division of the Georgia Department of Community Health (DCH) and is responsible for the administration of the health insurance offered to state employees, teachers, school personnel and certain contract groups. As of April 1, 2008, the SHBP provides health coverage for 691,845 active and retired state employees and their dependents

SHBP offers nine options including three consumer driven health care options which assist in attracting and maintaining a healthy workforce. The SHBP is a self-insured plan, which means that member premiums and employer contributions fund the plan and pay for SHBP administration and claims.
Overview of State Health Benefit Plan Options
All options, except the High Deductible Health Plan (HDHP), provide a wellness benefit without requiring the member to meet a deductible. This encourages members to get age-appropriate check-ups and exams.
The Options offered are:
HRA: The SHBP offers two consumer driven health plans with Health Reimbursement (HRA) Accounts: Definity HRA through United Healthcare and Lumenos HRA through BlueCross Blue Shield of Georgia

PLAN OPTIONS
nIndemnity n Preferred Provider
Organization n High-Deductible Health Plan n Kaiser Health Maintenance
Organization n Kaiser Medicare Plus Senior
Advantage n Blue Choice HMO n UnitedHealthcare Choice
HMO n Lumenos HRA n Definity HRA

Benefits are the same under both options (except the family deductible must be satisfied before benefits are paid for any family member under the Lumenos HRA) and members will make their selection between the two options based on the network and some administrative differences. Both options offer a national network and in and out of network benefits

These options encourage members to be wise health care consumers. Features include a 100 percent wellness benefit and an annual contribution of $500 for single and $1,000 for family funded by the SHBP to provide first dollar coverage to members. Any unused HRA dollars roll over to the next year and can be taken into retirement.

High Deductible Health Plan (HDHP): The HDHP is a consumer driven health option. In return for a lower premium, each family member must satisfy a higher deductible prior to benefit being paid. This option offers a national network and in- and out-of-network benefits. Typically, benefits are paid at 90 percent for in-network and 60 percent for non-network charges. Members may also participate in a Health Savings Account (HSA) offered through the State of Georgia Flexible Benefits Program or by the member's employer. Employee contributions to an HSA are tax deductible and may be used to pay medical expenses. Unused HSA funds carry over to the next Plan Year and may earn interest. HSAs are also portable.

Preferred Provider Organization (PPO): This option offers a national network and members may receive services from participating or non-participating providers. Typically, benefits are paid at 90 percent for in-network and 60 percent for non-network charges.

2 Peachtree Street, Atlanta, Ga 30303 w www.dch.georgia.gov

February 2008

A Snapshot Of The State Health Benefit Plan
Kaiser Health Maintenance Organization (HMO): Kaiser offers lab, x-ray and full services at their facilities in specific locations. Specialist services are paid only if the visit was referred by the patient's Primary Care Physician (PCP). Kaiser coverage is only available in the metro Atlanta area.
Kaiser Medicare Plus Senior Advantage: This option is designed for retirees who are covered by Medicare. Members who participate in this plan do not have to enroll in a Medicare Part D prescription plan. This option is only available in the metro Atlanta area.
Blue Choice Health Maintenance Organization (HMO): This traditional HMO provides coverage by Blue Choice participating providers in the state of Georgia only. Members must select a PCP and obtain a referral to see a specialist.
United Healthcare (UHC) CHOICE HMO: This HMO provides coverage by UHC participating provides in the state of Georgia only. Members do not have to select a PCP or to obtain a referral to see a UHC participating specialist.
Note: HMO's typically provide a 100 percent benefit after a co-payment for in-network providers and no coverage for services received by non-participating providers unless there is a life (or limb) threatening emergency.
Consumer Choice Options
Consumer Choice Option (CCO): All Plan Options offer CCO. For an additional cost, the CCO allows the member and each dependent to nominate a non-network provider and receive benefits at the in-network rate. All nominated providers must meet credentialing requirements and agree to the reimbursement levels. Tobacco and Spousal Surcharges : The $30 monthly Spousal Surcharge applies to members whose spouse is eligible for coverage through his/her employer but elects not to take the coverage. The $40 Tobacco Surcharge applies to any member and/or one of his/her dependents who use(s) tobacco products. This surcharge is designed to encourage tobacco users to a healthier lifestyle. Smoking cessation classes are offered to members and dependents who want to stop using tobacco products. Each year, members must go online and answer surcharge questions during the annual Open Enrollment. Members who fail to answer these questions will automatically be assessed the applicable surcharges. Retirees are not subject to surcharges at this time.
VISIT WWW.DCH.GEORGIA.GOV/SHBP