State Health Benefit Plan (SHBP)
State Health Benefit Plan (SHBP) Overview
There are two health plan carriers available to employees and their families: Anthem and UnitedHealthcare (UHC). Each carrier has multiple plan options available, and each plan includes coverage for preventive care, visits to primary care and specialty care providers, coverage for hospital stays, and visits to urgent care & the emergency room.
Anthem offers three Health Reimbursement Arrangement (HRA) plan options, along with an HMO plan option that provides in-network coverage only, but that includes copays for many services.
UnitedHealthcare offers an HMO similar to the Anthem plan, along with a High Deductible Health Plan (HDHP). The HDHP has the highest deductible and out-of-pocket costs, but the lowest premiums.
The Anthem plans include Gold, Silver, and Bronze HRA plan options, and an HMO plan option. On the HRA plan options, most services are subject to a deductible and there are no copays. After you meet your in-network deductible, you pay coinsurance up to the out-of-pocket maximum. For prescription drugs, you pay a percentage of the retail cost. The HRA plans include a board-funded Health Reimbursement Account to reduce / offset your deductible and pharmacy expenses (unused balances carry forward into new plan years). Preventive care is always covered at 100% before the deductible, and certain drug costs are waived if you participate in a Disease Management Program (diabetes, asthma and coronary artery disease).
The HMO plan option has the lowest deductible out of all plans, but provides in-network coverage only. Some services (office visits, ER visits, and prescription drugs) are covered at 100% after a copay. For most other services, you are responsible for a deductible and coinsurance until you meet your out-of-pocket maximum. Please be aware that copays do not count towards your deductible. Preventive care is always covered at 100% before the deductible, and certain drug costs are waived if you participate in a Disease Management Program (diabetes, asthma and coronary artery disease).
The UnitedHealthcare plans include an HMO option, and a High Deductible Health Plan (HDHP) plan option. This HMO plan has the same benefits as the Anthem HMO, but utilizes the UHC network.
The HDHP plan has the lowest premiums, highest deductible, and highest maximum out-of-pocket costs. All services, including pharmacy, are subject to the deductible and coinsurance, and there are no copays with this plan. Once you meet your deductible, you pay coinsurance until you satisfy the out-of-pocket maximum. As with the other State Health plan options, wellness incentive credits can be earned by High Deductible Health Plan members.
Transfers from Other Georgia Systems
- If you are transferring from another Georgia system, you must keep your current medical coverage for the remainder of the plan year.
- No changes are allowed to your SHBP coverage until the next Open Enrollment period, unless you have a Qualifying Life Event (QLE).
Medicare
For active employees with spouses that are enrolled in Medicare and not disabled, SHBP is primary. The spouse is not required to elect Part B (medically necessary services such as outpatient care and preventive care) until the active employee retires. However, the spouse will automatically receive Part A (hospital insurance).
2024 Active Member SHBP Rates
2024 SHBP Open Enrollment Information and Important Links
2024 SHBP Video Guide
Contact SHBP or Carrier
Contact State Health Benefit Plan at (800) 610-1863 or visit the State Health Website
Contact Anthem at (855) 641-4862 or visit them at: www.anthem.com/shbp
Contact United Healthcare at (888) 364-6352 or visit them at www.welcometouhc.com/shbp
Telemedicine / Virtual Visits
The medical plans include a telemedicine benefit which allows you to speak to a participating doctor from home or work through your smartphone, tablet or computer 24 hours a day / 7 days a week.
You must use in-network providers for coverage to apply. HMO members pay a copay and HRA members pay coinsurance for telemedicine. High Deductible Health Plan members can access this benefit subject to the health plan deductible.
Consider this convenient benefit for non-complex medical conditions. Download the LiveHealth mobile app today!
Pharmacy Benefits
CVS Caremark is the pharmacy vendor for all medical options.
- For the HRA, you pay a percentage of the cost subject to a minimum and maximum per prescription.
- For the HMO plans, prescription drugs are covered at 100% after a copay at participating pharmacies.
- For the High Deductible Health Plan, prescription drugs are subject to deductible and then coinsurance, similar to other medical services.
The pharmacy costs are included in your out-of-pocket maximums, and a mail order benefit for a 90 day supply is also available. Additional details are located in the State Health Benefit Plan Decision Guide.
Dependent Verification
- If you wish to add dependent(s) (spouse and / or children) to your health plan, ADP will contact you (by mail and email) to request appropriate verification documents. If you do not receive the request, contact SHBP directly to have the request sent to you. They can be reached at (800) 610-1863.
- The communication from ADP will include a personalized fax cover sheet with a bar code that must be used when submitting documentation.
- Appropriate documentation must be attached to the fax cover page and provided by the deadline set by ADP.
- Dependents will not be covered until they are approved. Non-verified dependents cannot be reinstated until the next open enrollment period and would require appropriate documentation.
- Additional information can be found on the SHBP website.
Wellness
ShareCare, your wellness program vendor, provides comprehensive well-being and incentive programs for SHBP members. As you complete your wellness activities, you will earn credits in your Health Incentive Account to help offset your medical expenses. HDHP members must meet a portion of the deductible before well-being credits may be used.
All employees and covered spouses are eligible to receive a Well-Being Reward of up to 480 Well-Being Incentive Credits (960 family total) for completion of activities between January 1 and November 30.
Enrolled members can choose to redeem Well-Being Incentive Credits for either a $150 Visa gift card or 480 Well-Being Incentive Credits can be applied towards eligible medical or pharmacy expenses. Credits remain in your account until you decide how to use them.
More information can be found by clicking here.
