SHBP Info and Stats
The Department of Community Health administers the State Health Benefit Plan (SHBP). The SHBP provides health coverage to nearly 640,000 state employees, teachers, retirees and dependents. Teachers and school personnel represent 72 percent and retirees comprise about 18 percent of the covered lives.
Six operating units within the SHBP process and manage the information necessary for member coverage and claim payments. The units and responsibilities are as follows:
Member Services applies the eligibility regulations and assists members with their issues and problems and efficiently process member changes and payroll deductions.
Plan Management determines benefit Plan design and negotiation of vendor contracts and compliance.
Employer Services assists employer and agencies research and solve any employee problems and to assist employers with SHBP Bills and training issues
Communications provides information to both payroll locations and members on the plan’s workings and changes.
Clinical Services oversees the vendors clinical and quality operations, as well as, assists members and providers with questions related to clinical coverage issues that include, but are not limited to, medical/surgical procedures, wellness, disease management, behavioral health, ransplants, durable medical equipment and pharmacy management.
Vendor Program Management provides oversight and monitoring of vendor performance, member correspondence and eligibility appeals.
SHBP offers the following Options:
- PPO
- High Deductible Health Plan
- UnitedHealthcare HMO
- Kaiser Permanente HMO
- BlueChoice HMO
- Consumer Driven Health Plan HRA
- Indemnity (frozen)
Each plan option also includes a consumer choice option where the member can elect to nominate a doctor and if the doctor is approved and agrees to accept the reimbursement level, benefits will be paid at the in-network rate.
Prescription drug benefits for all options (except Kaiser and the HRA) include a three tiered co-payment structure to encourage use of generics and preferred brands to control costs while giving members choice.
PPO members may select from a broad network of providers to receive in-network benefits. They also may use providers who are not in the network but will receive benefits at a lower level. Out of network services may result in balance billing to members.
The High Deductible Health Plan provides coverage for members for a lower monthly premium than the other options offer. In return for the lower premiums, members must meet a larger deductible before the Plan pays benefits. This Option may also be coupled with a Health Care Savings account that may provide members with investment opportunities. These savings accounts must be arranged with financial institutions.
HMO members must use network providers to have their expenses paid. Services performed in a physician’s office are paid at 100 percent after the member pays a nominal co-payment. Other services are paid at 90 percent after satisfying the annual deductible.
Retiree Coverage – retirees may elect to change options only during the annual retiree option change period. Retirees who drop the coverage may not pick up the coverage at a later date. Retirees can only add dependents if they experience a qualifying event. The SHBP is coordinating benefits with the Medicare Part D program.
Indemnity members may see any participating doctor in Georgia and will receive a 90 percent payment level on covered services. However, there are not any contracted Indemnity providers outside of Georgia and those providers may balance bill the Indemnity member.
State Health Benefit Plan Enrollment (April 1, 2008)
| Option | Enrollees |
| PPO | 263,518 |
| PPO CCO | 7,742 |
| Indemnity | 5,885 |
| N/A | - |
| N/A | - |
| Kaiser | 41,832 |
| Kaiser CCO | 347 |
| Kaiser Medicare Advantage | 1,195 |
| BlueChoice | 165,138 |
| BlueChoice CCO | 1,025 |
| United | 176,685 |
| United CCO | 960 |
| Definity CDHP | 14,285 |
| Definity CCO CDHP | 549 |
| Lumenos CDHP | 10,118 |
| Lumenos CCO CDHP | 691 |
| N/A | - |
| HDHP | 1,807 |
| HDHP CCO | 68 |
| Total | 691,845 |