Health Plan Overview
There are six State Health Benefit Plan (SHBP) options offered to SHBP members and their eligible dependents through Cigna and UnitedHealthcare (UHC). Former employees continuing coverage who are enrolled in Medicare may also choose to enroll in Medicare Advantage (MA) Plans administered by Humana (through an alliance with Cigna) or UHC. Tricare Supplement coverage is available as an alternative to SHBP coverage for eligible retired military personnel under age 65. Children of SHBP members may be eligible for enrollment in PeachCare for Kids.®
Cigna and UnitedHealthcare
The Wellness Plan Options promote wellness by requiring members and spouses (if covered) to make the 2013 Wellness Promise, and fulfill the Promise by participating in certain health actions to improve and maintain their health. Premiums (rates) for the 2013 Wellness Plan Options are currently lower than the premiums paid under the 2013 Standard Plan Options. 2013 Wellness Plan Option members also receive richer plan benefits than those members covered under the 2013 Standard Plan Option. For more information, click here.
The Standard Plan Options also promote wellness, however, the Standard Plan Options do not require the member and spouse (if covered) to make or fulfill the 2013 Wellness Promise. Members in the 2013 Standard Plan Options currently have higher deductibles, out-of-pocket limits and pay higher premiums than members enrolled in the 2013 Wellness Plan Options. For more information, click here.
Plan Requirements and Incentives
- 2013 SHBP Wellness Requirements
In exchange for receiving lower premiums and receiving richer benefits, 2013 SHBP Wellness Plan Option members and spouses (if covered) agree to take certain health actions before the 2013 Wellness Promise/Requirements deadline of May 31, 2013, at 4:30 p.m. ET. Please see the Wellness section of your SPD in Plan Documents for a complete description of the requirements, with examples of how they work. For an overview of wellness requirements, click here.
- 2014 SHBP Incentive Fund Contribution Requirements
SHBP members and covered spouses enrolled in either a 2013 Standard or Wellness Plan Option who complete certain health actions by the required deadline will earn a 2014 Incentive Fund Contribution. Each enrolled member and spouse (if covered) may earn a $240 Incentive Fund Contribution in 2014; for a total of $480 for the member and spouse (if covered). The required deadline for completing these health actions (including required submissions) is May 31, 2013, 4:30 p.m. ET. Please see the Wellness section of your Summary Plan Description for a complete description of the requirements, with examples of how they work. For an overview, learn more here.
Wellness and Standard Plan Options below offer varying benefits, premiums, co-pays and deductibles.
- Health Reimbursement Arrangement Participating Provider Option (HRA): The HRA is a consumer-driven health plan featuring a participating provider network. Members receive treatment at discounted rates from network providers, and network providers will not bill for amounts that exceed the discounted rates. Members have the flexibility of receiving treatment from out of network providers, but SHBP does not pay for any charges that exceed 110% of the amount Medicare would pay for the treatment. The HRA features an annual contribution funded by the SHBP to provide first-dollar coverage for members’ medical expenses and pharmacy.
- High Deductible Health Plan (HDHP): The HDHP is a consumer-driven health option featuring a participating provider network with the similar features as the HRA. However, in return for a lower premium, members must satisfy a larger deductible prior to any benefits other than benefits for specific types of preventive care being paid. Individuals enrolled in this option may participate in a Health Savings Account (HSA) to use for medical out-of-pocket expenses. To set up an HSA, the member would need to contact an independent financial institution.
- Health Maintenance Organization (HMO): Under the HMO options, members must use network providers to have their health expenses paid. Covered services performed in a physician's office are paid at 100 percent after the member pays a co-payment. HMO members do not have to select a Primary Care Physician (PCP) or obtain a referral to see a participating specialist. However, members are encouraged to select a PCP to help coordinate care.
Former employees continuing coverage who are eligible for Medicare may also choose to enroll in Medicare Advantage Plans with Humana (through an alliance with Cigna) or UHC.
- Medicare Advantage Preferred Provider Organization (MA PPO): This plan is offered to retirees and/or their dependents enrolled in at least Medicare Part B; it provides the benefits covered under original Medicare as well as additional benefits such as a hearing aid.
A Qualifying Event (QE) or life event change is defined as a personal change in status which may allow you to change your benefit elections. Examples of a QE are a change in marital status, number of dependents, employment status or eligibility for health coverage. The QE rules that apply to you will depend on whether you are an active employee, former employee continuing coverage, or a surviving spouse or surviving child. These rules are set forth in your Summary Plan Description.
Other Important Information
For further information, including Frequently Asked Questions, Publications and Forms, see below or visit Employees, Retirees/Former Employees Continuing Coverage & Employers.
- Frequently Asked Questions
- Publications & Forms
- Open Enrollment for Calendar (Plan) Year 2014 – To be posted in late 2013.
For more information, visit:
* Please note that SHBP does not administer the Tricare plan