an Option of the Division of State health Benefit Plan A Program Of The Georgia Department Of Community Health 
A SNAPSHOT OF GEORGIA 
Consumer Driven Health Plan and Health Reimbursement Account 
 
Background 
Consumer Driven Health Plan (CDHP) is a relatively new concept and innovative approach in health care benefits. A CDHP is a health plan that works like a Preferred Provider Organization (PPO) plan with an in-network and out-of-network benefit for covered services. The plan contains a Health Reimbursement Account (HRA) that is credited by the State Health Benefit Plan. Under this plan, a member has greater responsibility to manage their own health care dollars wisely, but in return, they gain freedom of choice about how their health care dollars are used. 
What are the Benefits of the Consumer Driven Health Plan? 
nAccess to a national network of physicians, facilities and other health care professionals nThe ability to see specialists without a referral nSelection of a primary care physician is not required nAbility to use In- and Out-Of-Network providers nCoverage for emergency care nOut-of-pocket maximum limit for expenses covered by the Plan nWellness Benefit nLower premiums What is a Wellness Benefit? 
Under the Wellness Benefit, a member receives 100 percent coverage up to $500 per individual per year for annual physicals, well-child visits, mammograms, etc. when using an in-network provider only. This benefit is in addition to the dollars in the member's HRA. There is no coverage for out-of-network providers. 
What is a Health Reimbursement Account? 
A Health Reimbursement Account (HRA) is an arrangement by which the SHBP credits a certain dollar amount each year to help pay the member's share of the cost for covered medical expenses. 
 
What are the benefits of a Health Reimbursement Account? 
 
n Provides first dollar coverage for eligible expenses n All HRA credits are tax free n Unused HRA credits will roll over at the end of the benefit year, as long as a member is enrolled in the 
CDHP 
Health Tools and Resources 
 
Members have access to a wide variety of health tools and resources to help them make their own decisions about their health care and their health care expenses. n Online services that provide direct access to track the member's HRA balance, view claims and access 
to a wealth of healthcare information, as well as the ability to interact with a Health Coach n A Treatment Cost Estimator to help research costs for treatments 
 
2 Peachtree Street, Atlanta, Ga 30303 w www.dch.georgia.gov 
 
April 2007 
 
 A Snapshot Of Consumer Driven Health Plan and Health Reimbursement Account 
 
n 24-hour Nurse Line that allows communication with a licensed RN any time of the day or night whenever a member has a question or concern 
n Customer Service by telephone n 24-hour pharmacy information 
 
State Health Benefit Plan 
Consumer Driven Health Plan Design 
(Only nine agencies currently participate in the CDHP Pilot program) 
 
Employer Responsibility Spending Account Type Annual Deductible (combined in/out-of- network) Annual Maximum Out- of-Pocket (combined in/out-of-network) 
Preventive Care/Wellness Allergy Shots Emergency Room 
Mental Health/Substance Abuse Inpatient or Outpatient 
Vision (Exam); no eyewear Skilled Nursing Facility 
Physical/Occupational/Speech Therapy 
Outpatient Lab 
Chiropractic Care 
Transplant Services Urgent Care Dental- coverage for most procedures for prompt repair of sound natural teeth or tissue for the correction of damage caused by traumatic injury Temporomandibular Joint Syndrome (TMJ) Coverage for diagnostic testing and/or non-surgical treatment of TMJ, up to $1100 per person per lifetime maximum benefit Prescription Drugs (30-day supply) Hospice DME Home Health Care 
 
Single 
 
Family 
 
$500 
 
$1,000 
 
Health Reimbursement Account 
 
$1,000 
 
$2,000 
 
$2,000 
 
$4,000 
 
In-Network 
 
Out-of-Network 
 
$500 per person per plan year 
 
90% 
 
60% 
 
90% 
 
60% 
 
90% 30 day limit per year 
 
60% 30 day limit per year 
 
Not Covered 
 
Not Covered 
 
90% 40 visits per year 
 
60% 40 visits per year 
 
90% 
 
60% 
 
90% 20 visits per year 
 
60% 20 visits per year 
 
90% 
 
60% 
 
90% 
 
60% 
 
90% 
 
60% 
 
90% for related surgical 
procedures 90% 
90% 
90% 
90% 
 
60% for related surgical 
procedures 60% 
60% 
60% 
60%