Active decision guide 2010: for active employees

FOR ACTIVE EMPLOYEES

Phone Numbers/Contact Information
State Health Benefit Plan (SHBP): www.dch.georgia.gov/shbp_plans

Vendor
UnitedHealthcare HRA OAP, HDHP, HMO
CIGNA HRA, OAP, HMO, HDHP
Pharmacy SHBP Eligibility

Member Services Web Site

800-396-6515
877-246-4189 TDD 800-255-0056

www.welcometouhc.com/shbp www.welcometouhc.com/shbp

800-633-8519 TDD 800-576-1314

www.mycigna.com/shbp

Call vendor listed above

404-656-6322 800-610-1863

www.dch.georgia.gov/shbp_plans

Disclaimer: The material in this booklet is for informational purposes and is not a contract. It is intended only to highlight principal benefits of the medical plans. 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 all Plan materials provided in order to fully understand the provisions of the option chosen. Availability of SHBP options may change based on changes in federal or state law.
Page 3 of this guide contains Plan changes effective January 1, 2010. Prior to the start of the 2010 Plan Year, or shortly thereafter, the Plan will post a new Summary Plan Description (SPD) for each Plan option to the DCH Web site, www.dch.georgia.gov/shbp_plans. This SPD is your official notification of Plan changes effective January 1, 2010. You may print or request a paper copy by calling the Customer Service number on the back of your ID card. Please keep your SPD for future reference. If you are disabled and need this information in an alternative format, call the TDD Relay Service at (800) 255-0056 (text telephone) or (800) 255-0135 (voice) or write the SHBP at P.O. Box 1990, Atlanta, GA 30301.

Rhonda M. Medows, MD, Commissioner Sonny Perdue, Governor
October 1, 2009

2 Peachtree Street, NW Atlanta, GA 30303-3159 www.dch.georgia.gov

Dear State Health Benefit Plan (SHBP) Member:
Welcome to the 2010 Open Enrollment. This year the Open Enrollment will be held October 9November 10, 2009. Employees will again make their health election on the Web at www.oe2010.ga.gov.
SHBP is committed to providing a comprehensive benefit program while trying to keep prices affordable for all members. During these current financial times, we are faced with decisions that require us to balance our finances while maintaining the standard and quality of care you have come to expect from SHBP. As a result, there will be a number of changes for active members as well as retirees.
Active Member Changes: U/ii>i>LivV>}ivi>vvii`>ViiLi
Please carefully read these changes before making your decision
Be assured that the Georgia Department of Community Health, which administers SHBP, is committed to providing you with meaningful choices while keeping costs down. Be assured that we will continue to seek to provide you with multiple options and the tools to help you make the best decisions for you and your family members.
Sincerely,
Rhonda M. Medows, M.D. Commissioner
Equal Opportunity Employer

WELCOME

Contents
Phone Numbers, Contacts and Provider Information Changes for All SHBP Members Open Enrollment Understanding Your Plan Options SHBP Eligibility If You Are Retiring Health & Wellness Benefits Comparison Important Notices

Inside Front Cover Page 3 Page 7 Page 12 Page 15 Page 17 Page 19 Page 20 Page 28

Common Acronyms
CDHP Consumer Driven Health Plan CMS Centers for Medicare & Medicaid Services COB Coordination of Benefits DCH Georgia Department of Community Health FSA Flexible Spending Account HDHP High Deductible Health Plan HMO Health Maintenance Organization HRA Health Reimbursement Arrangement HSA Health Savings Account

IRS Internal Revenue Service MAPD PFFS Medicare Advantage with Prescription Drugs Private Fee-for-Service OAP Open Access Plan: Open Access PlusCIGNA and Choice Plus-UHC OE Open Enrollment PCF Personalized Change Form PCP Primary Care Physician SHBP State Health Benefit Plan SPD Summary Plan Description UHC UnitedHealthcare

active decision guide 2010

2

CHANGES FOR ALL SHBP MEMBERS

Welcome to Open Enrollment for the State Health Benefit Plan for Coverage Effective January 1, 2010December 31, 2010

The Open Enrollment dates are October 9 through November 10, 2009. This guide will provide you with a brief explanation of each Plan option, important changes in your SHBP options, steps on how to make your Open Enrollment election, information about the health and wellness features available through the health plan options and a comparison of benefits chart. This guide, the Active Employee Decision Guide, can also be found at www.dch.georgia.gov/shbp_plans or www.oe2010.ga.gov.
Employees will make their health election at www.oe2010.ga.gov and the Web site will be open beginning 4 a.m. on October 9 and will close at 4:30 p.m. on November 10, 2009.

Changes for All SHBP Members

U>i*i>ii}iLivvii` U/iiLi>Vi>iiviViv>> U*>
>}i> U->-V>}iVi>ivff{ U/L>VV-V>}iVi>ivf{f U"iVVi*>"*\
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place of the PPO). See page 6 for more information.

Transition of Care Kaiser Members

U/>vV>i>LiiVii`vi>iii`i`vVi>V`>vi December 31, 2009. To request transition of care, call your health plan's Customer Service number early in December but no later than December 31, 2009

Uv>i`i>ViV>>`>V>}ii> you select, benefits for any covered medical services will be covered under the new Plan effective January 1, 2010

Uv>i>i`V>>>VV>viViLivi iViLi]

]iiV>`Livi`>i*i>iiLi]>i

following address: >i*i>ii

Claims Administration





*" n{





>>]n{

No claims will be processed after this date.

Coordination of Benefits (COB) Policy Change for the OAP and HRA Options

To make our COB policy consistent across all options, we are changing the COB policy for the OAP and HRA options. This means when you have other group coverage or Medicare and SHBP coverage, the benefit under SHBP will be no greater than it would have been if there was no coverage other than that of SHBP. For example, many times when you went to the doctor, you did not have to pay anything not even a co-pay. 1`iii
" i]`iiV>i}i`Vv> office visit because the SHBP benefits require a co-pay.
3

active decision guide 2010

CHANGES FOR ALL SHBP MEMBERS
SHBP Plan Changes for 2010

HMO PLAN BENEFITS

Deductible U ii U - ii-i U
ii
`i U> Out-of-Pocket Maximum U ii U - ii-i U
ii
`i U>

January 1, 2009 f{ f f fn
fx fx fx f

Co-insurance

10%

Office Visit Co-pay

f

ER Co-pay

f

Rx Drug Co-pay

fx
2 co-pays for 90 day supply

January 1, 2010 f f f f
f f f f{
20% fx fx fx{x
3 co-pays for 90 day supply

OPEN ACCESS PLAN BENEFITS Replacing PPO*

January 1, 2009

January 1, 2010

Deductible U ii U - ii-i U
ii
`i U> Out-of-Pocket Maximum U ii U - ii-i U
ii
`i U>

InNetwork
fx f f fx
fx fx fx f

Out-ofNetwork
f f f f
f f{x f{x f

InNetwork
f f f fn

Out-ofNetwork
f f{ f{ f

f f f f{

f{ f f fn

Co-insurance

{

{

Office Visit Co-pay

f

fx

ER Co-pay

f

fx

Rx Drug Co-pay

f

fx{

*CIGNA's Open Access Plus and UnitedHealthcare's Choice Plus Open Access plans replace the PPO. See page 6 for further information.
4

active decision guide 2010

CHANGES FOR ALL SHBP MEMBERS

HRA PLAN BENEFIT

Deductible

January 1, 2009

U ii U - ii-i U
ii
`i U>

f fx fx fx

Out-of-Pocket Maximum U ii U - ii-i U
ii
`i U>
Co-insurance

f fx fx f{x
{

Rx Drug Co-pay

10%

*See page 26 for more information

January 1, 2010 f f f fx
fx f{ f{ fx x{
15% generic, 25% brand*

HDHP PLAN BENEFIT

Deductible U ii

January 1, 2009

InNetwork

Out-ofNetwork

fx

f

U - ii-i

f

f{

U
ii
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f f

f{ f{

January 1, 2010

InNetwork

Out-ofNetwork

f

f{

f{

f{n

f{

f{n

f{

f{n

Out-of-Pocket Maximum U ii U - ii-i U
ii
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f f f f

fn f f f

fn f f f

f{ f{ f{ f{

active decision guide 2010

5

CHANGES FOR ALL SHBP MEMBERS
Open Access Plan Option
Effective January 1, 2010, as part of the on-going effort to control escalating medical costs, SHBP will offer an Open Access Plan Option (OAP) instituting a different network `iV>V1i`i>V>i1
/i`i>V>}1
OAP network are very similar to the one currently being used by the SHBP although you >iii`vviiVi>]i
v- *iLi> been an Open Access product since January 1, 2009. The options referred to generically as PPO going forward will be referred to as Open Access Plans. When confirming a Vi`ii>V}v>i`i`i
"iVVi *>`1

Vi*i The OAPs function like the PPO plans that were offered last year, with benefits for i>`"v iVi>}i9V>Vi>iV> health care professional without a referral, and you will continue to receive the highest iivLiiv`i>ii i`i>``] like the PPO, under the OAP there's no requirement for designating a primary care physician; however, the selection of a primary care physician is highly encouraged.

>`1
"*V`iVi`>VVi>Viiii of hospitals, facilities, other health care professionals and pharmacies in Georgia and nationwide receiving benefits for office visits, hospital care (inpatient and outpatient) as well as other benefits previously received under the PPO. 1}i>v}i>i`ii}>i``VviVi and there's minimal difference in the network makeup. We are confident that this change in network will cause very little disruption or inconvenience to SHBP members. 9ii>}vV>`vviiViiVii`iVi>iivvii` you under the PPO options as a result of the options now being referred to as an OAP. However, there are plan design changes that are required in 2010 on all options offered to SHBP members such as deductibles, out-of-pocket limits, co-pays and coinsurance as a result of the State's fiscal situation. Please read your benefit materials carefully to understand the changes on all options.
6

active decision guide 2010

Open Enrollment
Who Must Participate in Open Enrollment?
EVERYONE who wants to:
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What Should I Do before I Go Online for Open Enrollment?
U >>ii>V>iii` U,i>`Decision Guide completely for important information about Plan changes Uv>iii`>i*i>iiii`>i>iiiV`}
Open Enrollment U
iViivLivvii` U
iVi>iii>`V}i}>}L>
help you decide between options U
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or provider participates in U
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iVLiiiiqii`ii ixx}i Uv>i>Vi}>`>iV`i}i}i`V>i>i>i>`
enrolled in Medicare, remember that SHBP must pay primary benefits and Medicare will provide secondary benefits Uv>ii`}ii>]V>iviii,iii>i>iVi Decision Guides. The Retiree Decision Guide is available at www.dch.georgia.gov/ shbp_plans

OPEN ENROLLMENT

active decision guide 2010

7

OPEN ENROLLMENT

Go online at www.oe2010.ga.gov October 9November 10, 2009 to complete Open Enrollment. It's fast, easy, and secure! If you do not have access, please go to your personnel/payroll office for assistance.
Follow these Steps to Make Your OE Election Online
1. Go to www.oe2010.ga.gov
>,i}iivi}]LVV},i}i
b) Enter your policy number (Social Security Number) and date of birth
c) Create, enter and re-enter the password to confirm (please remember this password for future reference)
d) Select a security question and answer it
i
iiLVV},i}i
v9>i}}i`viii]Li`iVi`i} screen to enter your policy number and the password you chose above
vii>`}i/i]
`>`V]Vii`vii] VVi}iiL
9>i>`>``i`>vii`i`]>i>V>}i*>Vi>ViV the check box to confirm that you have validated your address
{ 9iiv>v/,ii>>}ii- * data. This information compares your 2008 medical and prescription claims cost against the 2010 plan options and premium structure. The analysis will show which SHBP option for 2010 is expected to have the lowest cost based on the 2008 claims experience
5. Select one of the tiers based on the dependents you wish to cover in 2010
viiiiVi]Vii`iL>VVV>}ii vViiviiiVi>i>``ii`i]i `ii`iVii>i>`V>i9i vi>V`ii`iLi Vii`v>``>i`ii`i]VV`` ii`i] ii`ii`iv>]>`VVi`` ii`iL9i dependent should appear

active decision guide 2010

8

OPEN ENROLLMENT

iiV>}ii
8. Select your health benefit coverage option
9. A considerations page will be displayed. Please read this page carefully as it is designed to assist you with items you may wish to consider before confirming your iiVvV>}iiiV>viii}>}i]VVi ,iL}L>Vi
i>}i-iiV>}iv>i>vi` iiV]VVi
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10. A Pre-Confirmation page will be displayed. Review your health benefit election, i``ii`i>`>iiV>}iiviiV ViV]>i>ViV}ii`vV
V
vv>i your election
11. This is your confirmation page, which reflects your 2010 benefit election. Click *ii``Vi>i>ivVv>>}i] VV`i>Vv>Li9>>>iVv> your computer or to a disk by saving the printer friendly confirmation as a pdf file. This confirmation page is your record of your election. Each time you login to the system and confirm your choices, you will receive a unique confirmation number V`>i/iLiiviiVi`>`Vvi`>v{\ iLi]LiLiiviiVvi*>9i>NOTE: If a confirmation number does not show, you have not completed the process. You must click "Confirm" to complete your election. If you are unable to print or save this page, copy the confirmation number and keep it in a safe place

V}i
13. Do not wait until the last minute to go online to make your election for 2010 as Web traffic may be heavy and exceptions will not be allowed if you were unable to ViiiiV, ,\i7iLiVi>{\ -/ on November 10, 2009
v>i>Li>VVii}>}>i" iiV]V>V personnel/payroll office for assistance prior to the close of OE.

having a baby? adopting a child? getting married or divorced?
Remember you only have 31 days from the qualifying event to add or delete dependents by contacting SHBP.

active decision guide 2010

9

OPEN ENROLLMENT

SHBP Surcharges
9`i>`>``i>`- *V>}iV>}i> election for 2010.
Spousal
f{i>V>}iLi>``i`iv elect to cover your spouse and your spouse is eligible for coverage through his/her ii]LViiiV>Vi>}ivii}Liv coverage with SHBP through his/her employment, the spousal surcharge will be waived. 9>>V>LiV>}i`iV>}ivv>}i>`>i> questions concerning the surcharge. The surcharge will apply to your premium for the *>9i>
Please note that SHBP may audit any member covering a spouse who does not pay the spousal surcharge.
Tobacco
fiL>VVV>}iLi>``i`iv any of your covered dependents have used tobacco products in the previous 12 months or if you fail to go online and answer these questions. The surcharge will apply to your ivi*>9i>
The tobacco surcharge may be removed by completing the tobacco cessation requirements. Details are available at www.dch.georgia.gov/shbp_plans. NOTE: No refunds in surcharges can be given.
Intentional misrepresentation in response to surcharge questions will have significant consequences. You will automatically lose State Health Benefit Plan coverage for 12 months beginning on the date that your false response is discovered.
What Happens if I Don't Go Online During Open Enrollment?
Uv>iii`>i*i>ii>`v>}i>i>ii> iiV]>>V>Liii`i
,"ivviVi January 1, 2010, and you will be assessed the tobacco surcharge and the spousal surcharge (if you cover your spouse)
Uv>iii`>
1
]Vi>}iii same option and you will be assessed the tobacco surcharge and the spousal surcharge (if you cover your spouse)

active decision guide 2010

10

State Personnel Administration (SPA) Flexible Benefits Program Participants [formerly Georgia Merit System (i.e. dental, life, etc.)]
U9ii`}i}>}>ii>LiiviiV9 should print your confirmation page and make sure it contains a confirmation number. This number confirms your health benefit election for 2010
Uv>ii}Liv-*viLiLiivi`i>]vi]iV]ii`} >i>>i7iLi]i>}i}>}vi9`VvviLi benefits elections and print your confirmation statement that includes the confirmation number for your elections
Your 2010 elections must be made on two separate Web sites and you must confirm on both. You should print your confirmations (health and flex) and make sure they both contain confirmation numbers.
Board of Education or Agencies Not Participating in the SPA Flexible Benefits Program (formerly the Georgia Merit System)
9ii`>ii>iiVi}>}] confirmation and make sure it contains a confirmation number. This number confirms your health benefit election for 2010. Contact your personnel/payroll office to obtain information regarding your flexible benefits.
CIGNA and UnitedHealthcare Each Offer:
Ui>,iLii>}ii, U} i`VLii>*> * U"iVVi*>"*i>Vii**"\"iVVi*
]
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1
Ui>>i>Vi"}>>"

OPEN ENROLLMENT

active decision guide 2010

11

UNDERSTANDING YOUR PLAN OPTIONS
Understanding Your Plan Options
Health Reimbursement Arrangement (HRA)
The HRA is a Consumer Driven Health Plan option (CDHP) whose plan design offers >`vvii>>Vv>>}}i>V>iii`>>vi OAP with an in-network and out-of-network benefit, except SHBP funds dollar credits to your HRA each year to provide first dollar coverage for eligible health care and pharmacy iii1i``>,>VViii*>i>v>i still participating in this option, but will be forfeited if you change options during Open Enrollment or due to a qualifying event.
Plan Features
U/i>vvii`iiLiivL>i`>}i>`}i`i>>}`ii when seeing in-network providers only
U,`>Vi`>i>v>`V>Lii`i, option
U/i>,i`i`Vii`i`VLi>`>v pocket
U/ii>i>>i`i`VLi>`vVi>vvi expenses
Uvi>v}`i`VLi]>V>Vi>i>V your out-of-pocket maximum
U
i>`}V>i>i`v- *>>`>V>iivi Disease State Management Programs (DSM) for Diabetes, Asthma and/or Coronary Artery Disease
High Deductible Health Plan (HDHP)
The HDHP design is very similar to that of the OAP with an in-network and out-ofnetwork benefit.
iv>i]>v>}`i`VLi>>i> health care expenses except preventive care. If you have family coverage, you must meet the ENTIRE family deductible before benefits are payable for any family member. You pay co-insurance after you have satisfied the deductible rather than set dollar co-payments for medical expenses and prescription drugs. Also, you may qualify to start a Health Savings Account (HSA) to set aside tax-free dollars to pay for eligible health care expenses now or in the future. HSAs typically earn interest and may even offer investment options. See the benefits comparison chart that starts on page 20 to compare benefits under the HDHP to other Plan options.
Plan Features:
U/vviiVii`iiLiivL>i`>>>}i>` gender guidelines
U9>v>i>>ii>`vi`i`VLi>`v pocket maximum
U9>V>Vi>viii}iiiv>`i`VLiv>i`V>iii and prescriptions
U/>Vi`>Liv`}vi`V>iivLiVi eligible; you may be charged a late enrollment penalty
12

active decision guide 2010

UNDERSTANDING YOUR PLAN OPTIONS

Open Access Plans (OAP)
OAP options allow you to receive benefits from in-network and out-of-network `i]>``i>VVi>>i`i>`>>L>>Vi1i`->i To receive the highest level of benefit coverage and to avoid filing claims and balance L}]`i>i`ivi>vi`i] the reimbursement will be lower and you will be subject to balance billing from your provider.
Plan Features
U9`>iiiV>>V>iV>*
*L>>ivi>ii> specialist; however, you are encouraged to select a PCP to help coordinate your care
U9>v>i>>ii>`vi`i`VLi>`i>>i of-pocket maximum
U"viLiiv>iLiVL>>ViL}i>>Lii negotiated rate approved by the vendor)
U
>i`>>``i`VLivVi>i otherwise noted
Health Maintenance Organization (HMO)
An HMO allows you to obtain benefits from participating providers only and does not require you to select a Primary Care Physician (PCP). HMOs provide 100 percent benefit coverage for preventive health care needs after paying applicable co-payments. Certain services are subject to a deductible and co-insurance. See pages 2027 for more information.
Plan Features
U
>`1i`i>V>i`i>>>i>`iVi>i>` at the same benefit levels when using network providers outside of Georgia
U9`>iL>>ivi>ii>iV>ii]>iiV>}i` select a PCP to help coordinate your care
U
i>}i>>>Lii}i`iiViV>iv emergencies)
U
>i`V>``i`VLivVi>

adopting a child? getting married or divorced?
Remember you only have 31 days from the qualifying event to add dependents by contacting SHBP.

active decision guide 2010

13

UNDERSTANDING YOUR PLAN OPTIONS

Health Savings Account (HSA) For Information Only
An HSA is like a personal savings account with investment options for health care, iVi>>vii9>i>->L>>`ii`i- administrator/custodian.
9>i>-vii- * *>``>iiVi>}i }\9iii>i`V>ii`V>`{ii>*i Health Care Spending Account (GPHCSA) or any other non-qualified medical plan.
U9V>VLif]x}i]f]xv>>}>>iii` i */ii>iiLvi`i>>1i`i>VVV>i v>`ii*>9i>>`i>ii
U-`>V>Lii`vi}Lii>V>iiiiiiv>i}i enrolled in the HDHP or any SHBP coverage
U-`>V>Lii`>vi>V>iiiii`V>]`i>]]i iVii`V>>i,-V`i>`i`VLi>>iNOT covered L>i>>ii,-*LV>x>}
U9V>VLi>>``>f]v>ixx`iii,-*LV> 502 at www.irs.gov)

Overview
Who is eligible? Can I have other coverage and take advantage of this benefit? Who owns the money in these accounts?

HRA A tax-exempt account that reimburses retirees and dependents for qualified medical expenses. Can be funded by employer only. Available to SHBP members enrolled in an HRA. See benefits chart for amounts funded by SHBP. 9i
SHBP. Money reverts back to SHBP upon loss of SHBP HRA coverage.

HSA A tax-exempt custodial account that exclusively pays for qualified medical expenses of the employee and his or her dependents. Can be funded by retiree, employer, or other party. Available to SHBP members who elect HDHP and may enroll in an HSA of your choice. No other general medical insurance coverage ii`9V>Liii` Medicare Parts A or Part B. The member.

Can these dollars be rolled over each year? Is there a monthly service charge? If I terminate my SHBP coverage or change options...

9i No. 1i`>V>Li`Li` depleted to pay for claims incurred before termination.

9i Check with your HSA administrator. Fund disbursement is not tied to individual's ii1i`>V>Li distributed tax-free for qualified medical expenses. Subject to income and excise tax for non-qualified expenses.

active decision guide 2010

14

SHBP Eligibility
The SHBP covers dependents who meet SHBP guidelines and requires eligibility documentation before SHBP can send dependents' notification of coverage to the health plans.
Eligible Dependents Are:
UYour legally married spouse,>`ivi`Li}>>
U9ii>i``ii`iV`i>i\
1. Natural or legally adopted children under age 19, unless they are eligible for coverage as employees. Children that are legally adopted through the judicial courts become eligible only after they are placed in your physical custody
2. Stepchildren under age 19 who live with you at least 180 days per year and for whom you can provide documentation satisfactory to the Plan that they are your dependents
3. Other children under age 19 if they live with you permanently and legally depend on you for financial support as long as you have a court order, judgment or other satisfactory proof from a court of competent jurisdiction
{Your natural children, legally adopted children or stepchildren who are V>i>`>Li`i>V}>}i>``ii`v primary support and meet clinical guidelines
5. Your natural children, legally adopted children, stepchildren or other children ages 19 through 25 from categories 1, 2, or 3 above who are registered fulltime students at accredited secondary schools, colleges, universities or nurse training institutions and, if employed, who are not eligible for a medical benefit plan from their employer. The number of credit hours required for full-time student status is defined by the school in which the child is enrolled
SHBP requires documentation annually from the college or university your student attends verifying he/she is a full-time student.
Making Changes When You Have a Qualifying Event
viiiVi>>v}ii]>Li>Li>iV>}iviv>` your dependents, provided you make the request to SHBP within 31 days of the qualifying event. Also, your requested change must correspond to the qualifying event. >Vii`iVv>v}ii]ii->*> iV9 V>V>Vi }L1v>>Vi>nni>>>i>> {{x
Qualifying Events Include, but Are Not Limited to:
U >`v>V`]>Viiv>`
U
>}ii`iViL]i`ii`i>ii}Lv coverage in your selected option because of location
U i>v>iV`]vi`ii`iii`
U9i`ii`ivi}Lvi}i>Vi>}i
U>>}i`Vi
Ui`V>ii}L

SHBP ELIGIBILITY
health tip:
Eating a low-fat, lowsugar diet with plenty of fruits and vegetables can boost your physical and mental health.
15

active decision guide 2010

SHBP ELIGIBILITY

Please submit your request, within 31 days of the event to your personnel/ benefit coordinator. Requests should not be held while waiting for additional information, such as Social Security Number, marriage or birth certificate. SHBP will accept dependent verification at anytime during the Plan Year and coverage will be retroactive to the qualifying event date or first of the Plan Year, whichever is later as long as the request is received within 31 days of the qualifying event. SHBP will NOT change the tier because of a failure to verify dependent eligibility. The tier will be in effect for the plan year unless there is a qualifying event which allows for a change.
Documentation Confirming Eligibility for Your Spouse or Dependents
SHBP requires documentation concerning eligibility of dependents covered under the plan.
USpouse: A copy of your certified marriage certificate or a copy of your most recent Federal Tax Return (filed jointly with spouse) including legible signatures for you and your spouse with financial information blacked out
UNatural or student child: A copy of the certified birth certificate listing the parents by name or a letter of confirmation of birth for newborns. Birth cards without the parents' names are not acceptable
U`i>}i}>}ix, SHBP requires the child's birth certificate and documentation from the school's registrar's office verifying full-time student status and a completed and signed student status form
U-iV`\
1. A copy of the certified birth certificate showing your spouse is the natural parent;
2. A copy of the certified marriage certificate showing the natural parent is your spouse; and
>i`>ii>i`ii`iii>i>n`>ii>
NOTE: No health claims will be paid until the documentation is received and approved by SHBP. The member's Social Security Number MUST be written on each document so we can match your dependents to your record. Do not send originals as they will not be returned.
What if I Am Working and Am Eligible for Medicare?
i`i>>ii- *>>Liivv>Viiii>`i dependents. Active members or their covered dependents may choose to delay Medicare enrollment. Termination of active employment is a qualifying event for enrolling in Medicare without penalty. Except HDHP, see page 31.

active decision guide 2010

16

IF YOU ARE RETIRING

If You Are Retiring . . . What You Need to Know
State Health Benefit Plan (SHBP) Medicare Policy
If you want to have health insurance under SHBP when you retire, you must enroll for coverage for you and any eligible dependents during the Open Enrollment period prior to your retirement.
Once retired, you will have an annual Retiree Option Change Period (ROCP) that allows you to change your Plan option only. You may add dependents only if you experience a qualifying event and request the change within 31 days and provide the documentation required by SHBP.
/iv}v>>`> Vi>L9*iV } Coverage and Medicare" are provided to assist you with Retirement Planning. See Page 28.
If You Are Retiring and You or Any of Your Covered Dependents Are Not Eligible for Medicare
- *>>Liivviiii>`>Vii``ii`i9>i the same SHBP options as active employees.
9>`iV>}iiLiVii}Livi`V>iSee below for more information.
If You Are Retiring and You or Any of Your Covered Dependents Are Eligible for Medicare
The premiums you pay and your options change when you or one of your dependents LiVii}Livi`V>iLiV>iv>}ixi>`>L

IMPORTANT NOTE:
THERE IS CRITICAL INFORMATION ABOUT SHBP OPTIONS AND PREMIUMS FOR RETIREES IN THE RETIREE DECISION GUIDE. IT IS YOUR RESPONSIBILITY FOR READING THIS INFORMATION.

active decision guide 2010

17

IF YOU ARE RETIRING

9- *iVi>iivviV>`ii`i i>Vi>}ixLiVii}Livi`V>i`i`>L7iiv Medicare Part B, you will pay a monthly premium for this coverage to Social Security. 9`>>Vvi`V>i*>>` V>`>`Vv>v*> D coverage to SHBP at P.O. Box 1990, Atlanta, GA 30301-1990 and include the social iVLivi- *iii/v>`Liv>`i`- * days prior to the first of the month in which you or a covered dependent become eligible vi`V>i1iVi]- *>`iiviVi`V>i coverage. SHBP is not able to refund premiums when notification is not received timely.
v>ii`V>i`i `->}i,i> i>i -, ]ii`V>Vi Social Security Administration to determine when Medicare becomes primary.
Medicare information is available at:
UV}
Ui`V>i}
U>}
Unnni}>
>i
Un{i`V>i
v>ii>L- *>`ii>ii]V> i- *
>
ii>{{xnn

active decision guide 2010

18

Health & Wellness
Did You Know?
U
>`>V> i>iii>`}V>iv`i>i}>
U >Liii}>n}i>i>>>i
U>>Lii`>}i`>>i]V`ii}>Liiii >}ivqi>`
U
i>`}V>i>i`v,>`"*iLi>V>ii Disease State Management (DSM) Programs for Cardiovascular Disease, Diabetes or Asthma
What Can You Do About Your Health?
Take a Personal Health Assessment at least once a year to assist you in learning about potential health risks related to your lifestyle and family history. Each vendor has a health assessment questionnaire available on their Web site that you can complete. After completing ii>>ii}i>Vi`i>`ivii>>` provides recommendations on ways to help you reduce health risks and suggestions on how to make better lifestyle choices. Members who complete the health assessment may be contacted by the vendor's registered nurses or health coaches regarding steps they can take to control or eliminate these risks. Participant data is completely confidential and individual results are not shared with your employer or SHBP.
Utilize the Preventive Health and Wellness Services: One of the best ways to stay healthy is to take advantage of preventive health care. Check with the vendor regarding the >ViVvViiiiVi>iVii`>``]i>V vendor offers health coaching and wellness programs such as weight loss, nutrition, and stress management. Contact the vendors to learn more about the programs they offer or visit their Web site to view available services.
Engage in the Health Management Services: Each vendor offers assistance with health care services including disease management, case management and behavioral health. Please contact the vendor of choice for additional details on programs offered such as the DSM Program that waives prescription drug co-payments/costs on certain medications for members who have Cardiovascular Disease, Diabetes and/or Asthma and remain compliant with the DSM Program requirements.
Call the Nurse Advice Line: >Vi`>>{]ii`>>iiV`} holidays) nurse advice line that is available to assist you in making informed decisions about your health. Check with your health plan option for the telephone number.
Good health is priceless. When you live a healthy lifestyle, you can feel better, live easier and save money on health care expenses!

HEALTH & WELLNESS

active decision guide 2010

19

BENEFITS COMPARISON

Benefits Comparison: OAP HRA HDHP HMO

Schedule of Benefits for You and Your Dependents for January 1, 2010

December 31, 2010

OPEN ACCESS OPTION

HRA OPTION

i

Out-of-Network

i Out-of-Network

Covered Services Maximum Lifetime Benefit
(combined for all SHBP Options)
Pre-Existing Conditions (first i>*>]LiV*

The Plan Pays: f
f]

Lifetime Benefit Limit for Treatment of: (combined for Open Access Option and HDHP) U/i>`L>
dysfunction (TMJ)

f]

Deductibles/Co-Payments:

EE = Employee

- r ii-i


r ii
`i

r ii-i



Child(ren)

U>`i`VLii>`

Out-of-Pocket Maximum:

EE = Employee

- r ii-i


r ii
`i

r ii-i



Child(ren)

f f] f] f]n f] f] f] f{]

fx

f] f]{ f]{ f] f{] f] f] fn]

HRA Credits:

EE = Employee

- r ii-i


r ii
`i

r ii-i



Child(ren)

Physicians' Services

None

Primary Care Physician or Specialist Office or Clinic Visits: Treatment of illness or injury

fxivvVi co-payment; subject to deductible for associated lab and x-ray

Vi>}i subject to deductible

The Plan Pays: f
Not applicable

f]
f]I f]I f]I f]xI *HRA credits will reduce this amount. Not applicable f]xI f{]I f{]I fx]I HRA credits will reduce this amount.
fx f] f] f]x

85% coverage; subject to deductible

Vi>}i subject to deductible

active decision guide 2010

Primary Care Physician or Specialist Office or Clinic Visits for the Following: U7iiV>iiii
health care U>}iV}V>i>
(these services are not subject to the deductible)
20

fxV>i per office visit; No co-payment for associated tests and > Maximum of fii i*>9i>

Not covered. Charges do not apply to deductible or annual out-ofpocket limits

100% coverage; not subject to deductible

Not covered. Charges do not apply to deductible or annual out-ofpocket limits

BENEFITS COMPARISON

Dollar amounts, visit limitations, deductibles and out-of-pocket limits are based on a January 1December ]*>9i> "/ \
i>}i`ivi`>>i`i}Liiii V>`>> among Plan options. Contact your specific Plan option for more information.

HIGH DEDUCTIBLE OPTION (HDHP)

i

Out-of-Network

The Plan Pays: f

HMO OPTIONS
i"
The Plan Pays: f

Not applicable

Not applicable

f]

No separate lifetime benefit limit

f] f]{ f]{ f]{ f]n f] f] f]

f]{ f{]n f{]n f{]n Not applicable f{] f]{ f]{ f]{

f f f f] Not applicable f] f] f] f{]

None

None

90% coverage; subject to deductible

Vi>}i subject to deductible

fxivvVi co-payment

100% coverage; not subject to deductible

Not covered; Charges do not apply to deductible or annual out-of-pocket limits

100% after a per visit V>ivfxv primary care and specialty care; No co-payment for >>` mammograms

Chart continued pg. 22

21

active decision guide 2010

active decision guide 2010

BENEFITS COMPARISON
Physicians' Services Maternity Care (prenatal, delivery and postpartum)
Physician Services Furnished in a Hospital U6}i}ii>]
including charges by surgeon, anesthesiologist, pathologist and radiologist Physician Services for Emergency Care Non-emergency use of the emergency room not covered Outpatient Surgery-- U7iLi`>vvVi U7iLi`>>i surgery at a facility Allergy Shots and Serum
Hospital Services Inpatient Services U>iV>i]`ii>`
inpatient short-term acute rehabilitation services U7iiLV>i Outpatient Surgery-- Hospital/facility Emergency Care--Hospital U/i>iv>ii}iV medical condition or injury U ii}iVivi emergency room not covered 22

OPEN ACCESS OPTION

i

Out-of-Network

The Plan Pays:

80% coverage; not subject to deductible >vi>fx co-payment

Vi>}i subject to deductible

80% coverage; subject to deductible

Vi>}i subject to deductible

80% coverage; subject to in-network deductible

80% coverage; subject to deductible

Vi>}i subject to deductible

80% coverage; subject to deductible

Vi>}i subject to deductible

100% for shots and ifxi visit co-payment not subject to deductible (no co-payment if office visit not billed)

Vi>}i subject to deductible

80% coverage after deductible; and LiV>fx per admission deductible 100% coverage; not subject to deductible 80% coverage; subject to deductible

Vi>}i>vi deductible; and LiV>fx per admission deductible Vi>}i subject to deductible Vi>}i subject to deductible

80Vi>}i>vifxi visit co-payment; co-payment waived if admitted; subject to
in-network deductible

HRA OPTION
i Out-of-Network

The Plan Pays:

85% coverage; subject to deductible

Vi>}i subject to deductible

85% coverage; subject to deductible

Vi>}i subject to deductible

85% coverage; subject to in-network deductible

85% coverage; subject to deductible 85% coverage; subject to deductible 85% coverage; subject to deductible

Vi>}i subject to deductible Vi>}i subject to deductible Vi>}i subject to deductible

85% coverage; subject to deductible

Vi>}i subject to deductible

85% coverage; subject to deductible 85% coverage; subject to deductible

Vi>}i subject to deductible Vi>}i subject to deductible

85% coverage; subject to deductible

HIGH DEDUCTIBLE OPTION (HDHP)

i

Out-of-Network

The Plan Pays:

90% coverage; subject to deductible

Vi>}i subject to deductible

HMO OPTIONS
i"
The Plan Pays: >vi>fx co-payment

90% coverage; subject to deductible

Vi>}i subject to deductible

80% coverage; subject to deductible

BENEFITS COMPARISON

90% coverage; subject to in-network
deductible

90% coverage; subject to deductible

Vi>}i subject to deductible

90% coverage; subject to deductible

0% coverage; subject to deductible

90% coverage; subject to deductible

Vi>}i subject to deductible

fxV>>i to facility expenses) >vifxV>i if billed as office visit 80% coverage; subject to deductible 100% for shots and serum >vi>fxi co-payment; No co-pay if office visit not billed

90% coverage; subject to deductible

Vi>}i subject to deductible

80% coverage; subject to deductible

90% coverage; subject to deductible 90% coverage; subject to deductible

Vi>}i subject to deductible Vi>}i subject to deductible

90% coverage; subject to in-network deductible

100% coverage not subject to deductible 80% coverage; subject to deductible >vi>fx per visit co-payment; if admitted co-payment waived; subject to deductible

Chart continued pg. 24

23

active decision guide 2010

BENEFITS COMPARISON

OPEN ACCESS OPTION

i

Out-of-Network

HRA OPTION
i Out-of-Network

Outpatient Testing, Lab, etc.

The Plan Pays:

Non Routine Laboratory; X-Rays; Diagnostic Tests; Injections--including medications covered under medical benefits--for the treatment of an illness or injury

80% coverage; subject to deductible

Vi>}i subject to deductible

Behavioral Health
Mental Health and Substance Abuse Inpatient Facility and Partial Day Hospitalization NOTE: Contact vendor regarding >>

80% coverage; subject to deductible

coverage; subject to deductible

Mental Health and Substance Abuse Outpatient Visits and Intensive Outpatient NOTE: All iViii>>

80% coverage; subject to deductible

Vi>}i subject to deductible

The Plan Pays:

85% coverage; subject to deductible

Vi>}i subject to deductible

85% coverage; subject to deductible

Vi>}i subject to deductible

85% coverage; subject to deductible

Vi>}i subject to deductible

Dental Dental and Oral Care
NOTE: Coverage for most procedures for the prompt repair of sound natural teeth or tissue for the correction of damage caused by traumatic injury.
Temporomandibular Joint Syndrome (TMJ) NOTE: Coverage for diagnostic testing and non-surgical treatment up f]iivii maximum benefit. This limit does not apply to the HMO. Vision Routine Eye Exam NOTE: i`iii i>ii{

80% coverage; subject to deductible

Vi>}i subject to deductible

85% coverage; subject to deductible

Vi>}i subject to deductible

"/ \ vV>ii`v>1


80% coverage; subject to deductible

Vi>}i subject to deductible

85% coverage; subject to deductible

Vi>}i subject to deductible

80% coverage; not subject to deductible

Eye exam not covered

100% coverage; not subject to deductible

Eye exam not covered

Other Coverage Hearing Services Routine hearing exam

Not covered

active decision guide 2010

Ambulance Services for Emergency Care "/ \>` or air ambulance" to nearest facility to treat the condition.
Urgent Care Services NOTE: All subject to deductible except HMO.

80% coverage; subject to in-network deductible

80% coverage after >f{xi co-payment

Vi>}i

24

85% coverage for routine exam and v}LiV`i`VLif]x hearing aid allowance every 5 years;
not subject to the deductible 85% coverage;
subject to in-network deductible

85% coverage; subject to deductible

Vi>}i subject to deductible

HIGH DEDUCTIBLE OPTION (HDHP)

i

Out-of-Network

The Plan Pays:

90% coverage; subject to deductible

Vi>}i subject to deductible

HMO OPTIONS
i"
The Plan Pays: 80% coverage; subject to deductible

BENEFITS COMPARISON

90% coverage; subject to deductible

Vi>}iLiV to deductible

80% coverage; not subject to deductible

90% coverage; subject to deductible

Vi>}iLiV to deductible

>vifxi V>if co-payment for group therapy

90% coverage; subject to deductible

Vi>}iLiV to deductible

>vifxi co-payment; if inpatient/ outpatient facility, 80% subject to deductible

"/ \ vV>ii`v>1


90% coverage; subject to deductible

Vi>}iLiV to deductible

>vifxV>i for related surgery and diagnostic services; excludes appliances and orthodontic treatment; if inpatient/ outpatient facility, 80% subject to deductible

100% coverage; not subject to deductible

Eye exam not covered

>vifxV>i not subject to deductible. f>>Liivv glasses and contacts

90% coverage for route exam and v}LiV`i`VLif]x hearing aid allowance every 5 years; not
subject to the deductible 90% coverage; subject to
in-network deductible

Not covered 100% coverage; not subject to deductible

90% coverage; subject to deductible

Vi>}iLiV to deductible

>vifx co-payment

Chart continued pg 26

25

active decision guide 2010

BENEFITS COMPARISON
Other Coverage Home Health Care Services
NOTE: Prior approval required. Skilled Nursing Facility Services NOTE: Prior approval required.
Hospice Care NOTE: Prior approval required. Durable Medical Equipment (DME)--Rental or purchase NOTE: Prior approval required for certain DME.

OPEN ACCESS OPTION

i

Out-of-Network

HRA OPTION
i Out-of-Network

The Plan Pays:

80% coverage;

Vi>}i

subject to deductible subject to deductible

80% coverage after deductible; up to 120 days per Plan 9i>LiV> fxi>` deductible

Not covered

The Plan Pays:

85% coverage; subject to deductible 85% coverage; up to 120 days per Plan 9i>LiV deductible

Vi>}i subject to deductible Not covered

100% coverage; subject to deductible

Vi>}i subject to deductible

85% coverage; subject to deductible

Vi>}i subject to deductible

80% coverage; subject to deductible

Vi>}i subject to deductible

85% coverage; subject to deductible

Vi>}i subject to deductible

Outpatient Acute Short-Term Rehabilitation Services
U *V>/i> U -iiV/i> U "VV>>/i> U "ii
rehabilitative services

80% coverage; sub- Vi>}i

ject to deductible; subject to

fiV>- deductible; up to

i{ {i*>

i*>9i> 9i>iVii`

to exceed a total of {VLi`] including any out-

>>v{] including any in-network visits)

of-network visits)

85% coverage;

Vi>}i

subject to

subject to

deductible; up to deductible;

{i*> {

9i>iVii` >>v{ visits combined, including any outof-network visits)

i*>9i> (not to exceed >>v{ visits combined, including any in-network visits)

Chiropractic Care NOTE: Coverage for up to a maximum of 20 visits per Plan 9i>
Transplant Services NOTE: Prior approval required.
Pharmacy You Pay Tier 1 Co-payment
NOTE: No Tiers in HRA Option

80% coverage; >vi>fxi visit co-payment; not subject to deductible

Vi>}i subject to deductible

80% coverage at

Not covered

contracted transplant

facility; subject to de-

`VLi>`fxi

admission deductible

fx

fxI

Tier 2 Co-payment

f{

f{I

85% coverage; subject to deductible

Vi>}i subject to deductible

85% coverage; subject to deductible

Vi>}i subject to deductible

15% generic; 25% brand; subject to deductible Not applicable

{}iiV{ brand; subject to deductible* Not applicable

active decision guide 2010

Tier 3 Co-payment

f

fI

Not applicable

Not applicable

Tier 4 Co-payment

Not applicable

Not applicable

Not applicable

Not applicable

*Member must pay full charges at point of sale and submit a paper claim. Members will be reimbursed at the pharmacy network

26

rate less the required co-payment for covered drugs. Member is responsible for charges that exceed the pharmacy network rate.

HIGH DEDUCTIBLE OPTION (HDHP)

i

Out-of-Network

The Plan Pays:

90% coverage; subject to deductible

Vi>}iLiV to deductible

90% coverage up to `>i*>9i> subject to deductible

Not covered

HMO OPTIONS
i" The Plan Pays:
100% coverage; up to 120 i*>9i>
80% coverage; up to 120 `>i*>9i>LiV to deductible

90% coverage; subject to deductible

Vi>}iLiV to deductible

90% coverage; subject to deductible

Vi>}iLiV to deductible

100% coverage; subject to deductible 100% coverage when medically necessary

90% coverage up to {ii> i*>9i>LiV to deductible (not to exceed a total of {VLi`] including any out-ofnetwork visits)

Vi>}i {ii> i*>9i>LiV to deductible (not to exceed a total of {VLi`] including any in-network visits)

Vi>}i>vifx per visit co-payment; up to {ii>i *>9i>

90% coverage; subject to deductible

Vi>}iLiV to deductible

Vi>}i>vifx co-payment per visit

90% coverage at contracted transplant facility; subject to deductible

Not covered

20% coverage; subject to deductible; ff> 20% coverage; subject to deductible; ff> 20% coverage; subject to deductible; ff> Not applicable

Not covered Not covered Not covered Not covered

80% coverage; subject to deductible
fx f{ fx Not covered

BENEFITS COMPARISON 27

active decision guide 2010

IMPORTANT NOTICE

About the Following Notices
The notices on the following pages are required by the Center for Medicaid & Medicare Services (CMS) to explain what happens if you buy an individual Medicare Prescription Drug (Part D) Plan. The chart below explains what happens if you buy an individual Medicare Part D Plan.

YOUR SHBP OPTION
SHBP Medicare Advantage Standard or SHBP Medicare Advantage Premium Plan Open Access Plan/HRA HDHP
HDHP (High Deductible)

WHAT HAPPENS IF YOU BUY AN INDIVIDUAL MEDICARE PART D PLAN
9i>ii- *Vi>}ivV>i>*> *>Viii`>- *i`V>i`>>}i*>9 >>i`V>i>iiii>
9i`V>i*> *>Li>viV drugs unless you are in the deductible or doughnut hole and then - *`iLiiwvi>Vi"v*Vi] - *V`>iLiiwi`V>i*> *>9 >>i`V>i>iiii>
9>i>>i`V>i>iiii>v miss the initial enrollment period because the HDHP option is not V`ii`Vi`>LiVi>}i

These notices state that prescription drug coverage under all SHBP coverage options except for the HDHP (High Deductible) option is considered Medicare Part D Vi`>LiVi>}i/i>}ii>>iiV`}Vi>}i`i - *->`>`]- **i]"*]"]>`,>i>>}` better than" the prescription drug coverage offered through Medicare Part D plans that are sold to individuals.

active decision guide 2010

WARNING! Buying any individual Medicare insurance product outside of the Medicare Advantage plans 28 offered through SHBP could AUTOMATICALLY and PERMANENTLY END your SHBP Coverage.

IMPORTANT NOTICE

/*i>Vii-iiU>>] {{xUnn

October 1, 2009

About Your Prescription Drug Coverage with CIGNA and UnitedHealthcare OAP, HMO and Medicare
For Plan Year: January 1December 31, 2010
Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with the State Health Benefit Plan (SHBP) and about your options under Medicare's prescription drug coverage. This information can help you decide whether or not you want to join >i`V>i`}>v>iV`i}}]`V>iViVi>}i]V`} which drugs are covered at what cost, with the coverage and cost of the plans offering Medicare prescription `}Vi>}i>i>v>>LiiV>}ii>i`iV>L prescription drug coverage is at the end of this notice.
There are two important things you need to learn about your current coverage and Medicare's prescription drug coverage.
i`V>iiV`}Vi>}iLiV>i>>>Liiiii`V>i9V>}i this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.
/i- *>`iii`>iiV`}Vi>}ivvii`Li
>` 1i`i>V>i"*]">`,vvii``i- *]>i>}iv>>>V>] expected to pay out as much as standard Medicare prescription drug coverage pays and is considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.
When Can You Join a Medicare Drug Plan?
9V>>i`V>i`}>ivLiVii}Livi`V>i>`i>Vi>v iLi 15th through December 31st. However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan.
What Happens to Your Current Coverage if You Do Join a Medicare Drug Plan?
v`iV`i>i`V>i`}>]- *Vi>}iLi>vviVi`9V>ii- * coverage if you elect Part D and SHBP will coordinate with Part D coverage the month following receipt of iiVi9i>Lii`Vi`Li>V*>vi`V>i>i9`i`> copy of your Medicare cards to SHBP at P. O. Box 1990, Atlanta, GA 30301.
v``iV`i>i`V>i`}>>``Vi>}ii->ii> iiv*>]Li aware that you and your dependents can not get this coverage back if you are a retiree.

active decision guide 2010

WARNING! Buying any individual Medicare insurance product outside of the Medicare Advantage plans

offered through SHBP could AUTOMATICALLY and PERMANENTLY END your SHBP Coverage.

29

IMPORTANT NOTICE

When Will You Pay a Higher Premium (Penalty) to Join a Medicare Drug Plan?
9`>>v`iVi>}i- *>``>i`V>i`}> V`>>viViVi>}ii`]>>>}ii>i> a Medicare drug plan later.
v}V`>}iVi`LiiV`}Vi>}i>>i>>}`> Medicare's prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the i`V>iL>iLiivV>i9>>i>}ii>i>>}>>i i`V>iiV`}Vi>}i>``]>>i>iv} iLi
For More Information about this Notice or Your SHBP Current Prescription Drug Coverage...

>Vi- * }L1>{{xnn "/ \9}iVi i>Vi>9>}iLiviiii`V>>i`V>i`}>]>`vVi>}i }i->ii> iiv*>V>}i9>>ii>VvVi>>i
For More Information about Your Options under Medicare Prescription Drug Coverage...
More detailed information about Medicare plans that offer prescription drug coverage is in the Medicare & You>`L9}i>Vvi>`Li>iii>vi`V>i9>>Li contacted directly by Medicare drug plans.
For more information about Medicare prescription drug coverage:
U6i`V>i}
U
>->ii>>Vi>Vi*}>iii`iL>VVivVviMedicare & You>`LviiiiLivi>i`i
U
>n
, n{//9i`V>n{n{n
v>ii`Vi>`iVi]i>i>}vi`V>iiV`} coverage is available. For information about this extra help, visit Social Security on the Web at V>iV}]V>i>n//9nxn
Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty).
Date: October 1, 2010 Name of Sender: State Health Benefit Plan Office: Call Center Address: P. O. Box 1990, Atlanta, GA 30301 Phone Number:{{xnn

active decision guide 2010

WARNING! Buying any individual Medicare insurance product outside of the Medicare Advantage plans

30

offered through SHBP could AUTOMATICALLY and PERMANENTLY END your SHBP Coverage.

IMPORTANT NOTICE

/*i>Vii-iiU>>] {{xUnn

October 1, 2009

Important Notice from the SHBP about Your Prescription Drug Coverage and Medicare
About Your Prescription Drug Coverage with the CIGNA and UnitedHealthcare High Deductible Health Plan (HDHP) and Medicare
For Plan Year: January 1December 31, 2010
Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with the State Health Benefit Plan (SHBP) and about your options under Medicare's prescription drug coverage. This information can help you decide whether or not you want to join a i`V>i`}>v>>LiiV>}ii>i`iV>LiV`} coverage is at the end of this notice.
There are three important things you need to know about your current coverage and Medicare's prescription drug coverage:
i`V>iiV`}Vi>}iLiV>i>>>Liiiii`V>i9V>}i coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.
2. The SHBP has determined that the prescription drug coverage offered by the HDHP Option, is on average for all plan participants, NOT expected to pay out as much as standard Medicare prescription drug coverage pays. Therefore, your coverage is considered Non-Creditable Coverage. This is important, because most likely, you will get more help with your drug costs if you join a Medicare drug plan, than if you only have prescription drug coverage from the HDHP offered by SHBP. This is also important because it may mean that you may pay a higher premium (a penalty) if you do not join a Medicare drug plan when you first become eligible.
9V>iiViVi>}i>
1i`i>V>i *vvii`Li- * However, because your coverage is non-creditable, you have decisions to make about Medicare prescription drug coverage that may affect how much you pay for that coverage, depending on if and when you join a drug plan. When you make your decision, you should compare your current coverage, including what drugs are covered, with the coverage and cost of the plans offering Medicare prescription drug coverage in your area. Read this notice carefully as it explains your options.
When Will You Pay a Higher Premium (Penalty) to Join a Medicare Drug Plan?
Since the HDHP coverage under SHBP is not creditable, depending on how long you go without creditable prescription drug coverage, you may pay a penalty to join a Medicare drug plan. Starting with the end of the last month that you were first eligible to join a Medicare drug plan but didn't join, v}V`> or longer without credible prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without credible coverage, your premium may consistently be at least 19% higher than

active decision guide 2010

WARNING! Buying any individual Medicare insurance product outside of the Medicare Advantage plans offered through SHBP could AUTOMATICALLY and PERMANENTLY END your SHBP Coverage. 31

IMPORTANT NOTICE
ii`V>iL>iLiivV>i9>>i>}iii>>}>>i i`V>iiV`}Vi>}i>``]>>i>iv} iLi
When Can You Join a Medicare Drug Plan?
9V>>i`V>i`}>ivLiVii}Livi`V>i>`i>Vi>v iLi 15th through December 31st. However, if you decide to drop your current coverage under SHBP, since it is an employer sponsored group plan, you will be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan, however you also may pay a higher premium (a penalty) because you did not have Credible Coverage under SHBP.
What Happens to Your Current Coverage if You Decide to Join a Medicare Drug Plan?
v`iV`i>i`V>i`}>] *Vi>}i`i- *Li>vviVi`vi in Medicare Part D when you become eligible for Medicare Part D, you can keep your HDHP coverage and i *V`>iLiivi*> Vi>}iv``iV`i>i`V>i`}> and drop your HDHP coverage under SHBP, be aware that you and your dependents will not be able to get your SHBP coverage back if you are a retiree.
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For More Information about this Notice or Your Current Prescription Drug Coverage...

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For More Information about Your Options under Medicare Prescription Drug Coverage...
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Date: October 1, 2010 Name of Sender: State Health Benefit Plan Office: Call Center Address: P. O. Box 1990, Atlanta, GA 30301 Phone Number:{{xnn
WARNING! Buying any individual Medicare insurance product outside of the Medicare Advantage plans 32 offered through SHBP could AUTOMATICALLY and PERMANENTLY END your SHBP Coverage.

active decision guide 2010

Notify the Plan of any fraudulent activity regarding Plan members, providers, payment of benefits, etc. Call 1-877-878-3360 or 404-463-7590.
Penalties for Misrepresentation
If an SHBP participant misrepresents eligibility information when applying for coverage, during change of coverage or when filing for benefits, the SHBP may take adverse action against the participants, including but not limited to terminating coverage (for the participant and his or her dependent(s) or imposing liability to the SHBP for fraud or indemnification (requiring payment for benefits to which the participant or his or her beneficiaries were not entitled). Penalties may include a lawsuit, which may result in payment of charges to the Plan or criminal prosecution in a court of law.
In order to avoid enforcement of the penalties, the participant must notify the SHBP immediately if a dependent is no longer eligible for coverage or if the participant has questions or reservations about the eligibility of a dependent. This policy may be enforced to the fullest extent of the law.