A snapshot of Georgia State Health Benefit Plan fact sheet for new employees

Georgia Department of Community health
A SNAPSHOT OF GEORGIA
State Health Benefit Plan Fact Sheet for New Employees

Overview

The State Health Benefit Plan (SHBP) is the division of the Georgia Department of Community Health (DCH) responsible for the administration of the health insurance offered to state employees, teachers, school personnel and certain contract groups.

SHBP offers new employees the opportunity to choose between two consumer driven health options: the

Health Reimbursement Arrangement and the High Deductible Health Plan (HDHP) are offered by both CIGNA

and UnitedHealthcare (UHC). Benefits are similar under each option, but each vendor has a separate Georgia

and national network.

Health Reimbursement Arrangement (HRA)

How an HRA Works
(Single Coverage Shown)

Benefits include:

Low premiums

Preventive Care
100% Paid

One-hundred percent unlimited wellness benefit for each covered member based on national age and gender guidelines when seeing an in-network provider. This benefit does not reduce your HRA account
SHBP contributes dollars to your HRA for medical and pharmacy expenses - - - - $1,000 Deductible - - -
Once the HRA dollar credits are exhausted, the member is responsible for a deductible
Once the deductible has been satisfied, eligible charges are payable at 90 percent in-network contracted amount and 60 percent of the usual and customary out-of-network rate

Health Coverage SHBP pays 90/60% up to $2,000
Out-of-Pocket maximum
$500 Member Responsibility
$500 Health Reimbursement Account - funded by SHBP

Any unused HRA dollars roll over to the next Plan Year

Access to a national network of physicians, facilities and other health care professionals

Ability to see specialists without a referral

Selection of a primary care physician is not required 2 Peachtree Street, Atlanta, Ga 30303 www.dch.georgia.gov

January 2009

A Snapshot of SHBP Coverage for New Employees

HRA dollars reduce your deductible and the out-of-pocket maximum you pay

(Note: This option does not have co-pays even for prescription drugs. Members will pay the 10 percent or 40 percent co-insurance if out-of-network even for prescription drugs).

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, including:
Access to a licensed Registered Nurse any time of the day or night whenever a member has a question or concern
Online services that provide direct access to track the member's HRA balance, view claims and access to a wealth of health care information, as well as the ability to interact with a health professional
A Treatment Cost Estimator to help research costs for treatments Customer Service by telephone 24-hour pharmacy information

Single

EE + Spouse

HRA Credits HRA Deductibles*
Maximum Out-Of-Pocket*
Preventive Care/Wellness
Emergency Room or Urgent Care Center, Allergy Short, Prescription Drugs (30 day supply), Home Health Care, Outpatient lab, Transplant,
Durable Medical Equipment

$500

$1,000

$1,000

$1,750

$2,000

$3,250

In-Network

100 percent unlimited based on national age and gender guidelines

90 percent

EE + Child(ren)
$1,000

Family EE + Spouse + Child(ren)
$1,500

$1,750

$2,500

$3,250

$4,500

Out-of-Network

No benefit

60 percent

*Your deductibles and out-of-pocket maximums will be reduced by your HRA dollar credits. This is a partial listing of benefits.

The High Deductible Health Plan:

The HDHP works like a Preferred Provider Organization (PPO) plan with an in-network and out-of-network benefit for covered services. It has higher annual deductibles and out-of-pocket maximums than most other SHBP health care plans in return for lower premiums than most other SHBP options.

What are the Benefits of the High Deductible Health Plan?



Access to a national network of physicians, facilities and other health care professionals



Ability to see specialists without a referral



Selection of a primary care physician is not required



Ability to use both in- and out-of-network providers

A Snapshot of SHBP Coverage for New Employees



Out-of-pocket maximum limit for expenses the member pays



Ability to contribute to a Health Savings Account (HSA)

Benefit
Deductibles/Co-Payments: EE=Employee EC=Employee + Child(ren) ES=Employee+Spouse EF=Employee+Child(ren)+Spouse
The full deductible must be satisfied before benefits are payable for any individual member

In-Network
$1,150 $2,300 $2,300 $2,300

Out-of-Network
$2,300 $4,600 $4,600 $4,600

Annual Out-of Pocket Maximum: EE=Employee EC=Employee + Child(ren) ES=Employee+Spouse EF=Employee+Child(ren)+Spouse

$1,700 $2,900 $2,900 $2,900

$3,800 $7,000 $7,000 $7,000

Primary Care Physician or Specialist for wellness care/ preventive health care
Primary Care Physician or Specialist Treatment of illness or injury Maternity Care, Outpatient Surgery Hospital Services - Inpatient Outpatient and Well-newborn care

100 percent coverage as determined by
national age and gender guidelines. Not subject to
deductible

Not covered; charges do not apply to
deductible or annual out-of-pocket limit

90 percent of coverage; 60 percent of coverage;

subject to deductible

subject to

deductible

Pharmacy Tier 1, 2 or 3 Co-Payment

80 percent of coverage; subject to deductible (Minimum $10/ Maximum $100)

Not covered

What is a Health Savings Account?

Members participating in the High Deductible Health Plan may also participate in an HSA. An HSA allows members to set aside tax-exempt funds for future medical expenses. Many HSA accounts offer investment options and are portable. Unused funds roll over from year to year, are owned by the member and can be taken into retirement. Eligibility rules are as follows:



Cannot be enrolled in Medicare



Cannot be covered by another group health plan, and



Cannot be claimed as a dependent on someone else's federal tax return

A SnapShot of SHBP Coverage for New Employees

How Does an HSA Work?



The employee contributes to the HSA through pre-tax payroll deductions or through an

individual HSA account



The employee uses the HSA to pay for eligible health care expenses



The employee owns unused HSA money in the account



Strategic Health Progessive Solutions is the company that administers HSAs for employees who

are participating in the Flexible Benefits Program offered by the State Personnel Administration

(SPA)



If the member's flexible benefits are not administered by SPA, the member should contact

his/her Human Resources Manager to determine if his/her employer offers an HSA as part of

their flexible benefits program

These are a partial listing of benefits. See the 2009 Health Plan Decision Guide or Summary Plan Descriptions available at www.dch.ga.gov/shbp_plans for more information. -----------------------------------------------------------------------------------------------------------------
SHBP Qualifying Events If members have a qualifying event, they may be able to make changes for themselves and their dependents, provided they request the change prior to or within 31 days after the qualifying event. Also, the requested change must correspond to the qualifying event. For a complete description of qualifying events, members should contact the Eligibility Unit at 800-610-1863 or refer to their Summary Plan Description (SPD).

SHBP Tobacco and Spousal Surcharges The $30 monthly Spousal Surcharge applies to any member 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 who uses and/or one of his/her dependents use tobacco products. This surcharge is designed to encourage tobacco users to adopt a healthier lifestyle. Smoking cessation classes are offered to members wanting to stop using tobacco products.

Each year, members must go on-line and answer surcharge questions during the annual Open Enrollment. Members who fail to answer these questions will automatically be assessed the applicable surcharges. The surcharges will apply to your premium until the next Plan Year.

SHBP Annual Open Enrollment Period SHBP offers an annual open enrollment period each year in the fall and members will be able to select from the consumer driven health options as well as the Preferred Provider Organizations (PPO) and the Health Maintenance Organizations (HMO) offered by CIGNA and UHC during this period.

Disclaimer: This material is for informational purposes and is not a contract. It is intended only to highlight principal eligibility and benefits. Every effort has been made to be as accurate as possible; however, should there be a difference between this information and the Plan documents, the Plan documents govern. It is the responsibility of each member, active or retired, to read the Summary Plan Description and all Plan materials provided in order to fully understand the
eligibility and option provisions.