Board of Community Health Approves 2014 Plan Design Changes

January 27, 2014

ATLANTA (January 27, 2014) – Today, the Board of Community Health voted 5-0 to approve changes to the State Health Benefit Plan (SHBP) plan designs for 2014. The design changes enhance the health plan options for SHBP members by replacing co-insurance with co-pays for medical and pharmacy benefits. Blue Cross Blue Shield of Georgia (BCBSGA) will administer SHBP’s enhanced plan designs.

“While the original plan design approved in August of 2013 focused on quality and affordable care, we could not ignore the financial distress created by the institution of cost sharing with our members,” said Commissioner Clyde L. Reese III, Esq. “As such, the Department presented changes to the Board, who voted to approve the enhanced plan that will create immediate financial relief from the increased out-of-pocket costs associated with the original SHBP plan designs.”

Original Plan Design

Enhanced Plan Design

Approximate 75/25 premium cost share

Approximate 75/25 premium cost share

100% Preventive Care

100% Preventive Care

State-Funded Base HRA Dollars

State-Funded Base HRA Dollars

State-Funded HRA Incentive Dollars

State-Funded HRA Incentive Dollars


Replace pharmacy coinsurance with 3 Tier co-pays like 2013 HMO option with lower Tier 3 co-pay:

  - Tier 1: $20

  - Tier 2: $50

  - Tier 3: $80


Apply Office Visit and ER co-pays across all plans at the following rates:

  - Primary Care (Family Practice, General Practice, Internal Medicine, Pediatrics, OB/GYN): $35

  - Specialist : $45

  - Rehab Services: $25

  - ER: $150

  - Urgent Care: $35

Co-pays will become effective on March 14, 2014 and will be retroactive to January 1, 2014. Premiums, deductibles, out-of-pockets and HRA contributions will not be affected. SHBP members do not need to take any action to receive these new benefits. SHBP members will remain in the plan they chose during Open Enrollment for the balance of 2014.

The cost of these changes is being absorbed by the SHBP reserves, and will not be passed on to members. The total estimated claims cost to SHBP is approximately $116 million for 12 months.

About the Georgia Department of Community Health

Through effective planning, purchasing and oversight, the Georgia Department of Community Health (DCH) provides access to affordable, quality health care to millions of Georgians, including some of the state’s uninsured and most vulnerable populations.

DCH is responsible for Medicaid and PeachCare for Kids,® the State Health Benefit Plan, Healthcare Facility Regulation and Health Information Technology in Georgia.

Clyde L. Reese III, Esq., serves as Commissioner for the Georgia Department of Community Health.

To learn more about DCH and its dedication to A Healthy Georgia, visit

Contact Information: 
Lisa Marie Shekell