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Health Plans & Programs

2014 Plan Design Changes

To learn more about the 2014 SHBP Plan Design changes announced at the January 27, 2014, Board of Community Health meeting, read the updated Decision Guides, SBCs, and FAQs. New insurance cards reflecting these plan design changes were mailed on March 10, 2014.  Additional information will be posted as it becomes available.

Health Plan Overview

As the Plan Administrator, the Georgia Department of Community Health has delegated full responsibility for claims administration to the following Claims Administrators for the 2014 plan options:

  • Blue Cross Blue Shield of Georgia (BCBSGa) for medical benefits
  • Express Scripts, Inc. (ESI) for pharmacy benefits; and
  • Healthways, Inc. for well-being benefits and programs administration.

There are three non-Medicare Advantage State Health Benefit Plan (SHBP) options offered to SHBP members (including new hires) and their eligible dependents through Blue Cross Blue Shield of Georgia (BCBSGa). Former employees continuing coverage who are enrolled in Medicare may also choose to enroll in one of the two SHBP Medicare Advantage (MA) Plans also administered by BCBSGa.

Additionally, TRICARE Supplement Plan coverage is available as an alternative to SHBP coverage for eligible retired military personnel (and their dependents) under age 65; and children of SHBP members may be eligible for enrollment in PeachCare for Kids.®   Please note that SHBP does not administer the TRICARE plan or PeachCare for Kids.

Effective January 1, 2014, Cigna and UnitedHealthcare will no longer administer the SHBP plan options.

Claims Administration

Blue Cross Blue Shield of Georgia (BCBSGa) will provide medical claims administration and medical management services for the State Health Benefit Plan during 2014. Through BCBSGa, the State Health Benefit Plan offers active members and retirees a choice of three Health Reimbursement Arrangement (HRA) Plan options:  Gold HRA, Silver HRA and Bronze HRA.  Eligible retirees enrolled in at least Part B Medicare may choose from two Medicare Advantage PPO options:  Standard or Premium.  

·         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. For more information, go to

·         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 not covered by traditional Medicare covered by traditional Medicare. MA Plan options (Standard and Premium) mirror the 2013 SHBP MA Plan options. For more information, go to   


Healthways, the State Health Benefit Plan’s new wellness partner, will provide members and covered spouses with comprehensive well-being resources and incentive programs.  Healthways will also administer the 2014 action-based Health Reimbursement Arrangement (HRA) incentives that will allow members and covered spouses to earn additional dollars for their HRA account.  Non-Medicare Advantage members can easily participate in all wellness activities and incentives, starting with their registration at

Express Scripts, Inc., SHBP’s new pharmacy benefit partner, will provide members with safety, care and convenience for their prescription needs.  Non-Medicare Advantage members can manage their prescriptions, enjoy savings on 90-day orders and get prescriptions delivered through the new portal at  The pharmacy benefit for retirees covered under a SHBP Medicare Advantage plan is administered through BCBSGa.

Qualifying Events

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, please refer to the various sub-menu pages listed in the left navigation of this web page.

For more information, visit:


* Please note that SHBP does not administer the Tricare plan or PeachCare for Kids.


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