The Georgia Department of Community Health (DCH) serves as the state’s administrator of health insurance coverage for state employees, teachers, school system employees and retirees who continued coverage (including annuitants and former employees on extended coverage), and covered dependents. This health coverage is known as the State Health Benefit Plan (SHBP).
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Beginning July 1, 2013, if you or your covered spouse are advised, or discover, that you have not completed one or more of the 2013 Wellness Requirements, you will be able to appeal if you disagree with the decision. Appeal forms will be available by July 1 and all appeals, along with the requested documents, must be submitted by August 2, 2013. Deadline for completion/submission of all 2013 Wellness and Incentive Requirements was May 31, 2013, 4:30 p.m. ET. For a summary, visit http://dch.georgia.gov/wellness. For details, visit http://dch.georgia.gov/shbp-plan-documents. For the latest news and other reminders for SHBP members and employers who offer the SHBP, please visit SHBP News. |
Plan Overview
Cigna and UnitedHealthcare (UHC) administer medical and pharmacy claims under the Standard and Wellness HRA, HMO and HDHP plan options for members in 2013, and also administer the wellness provisions of these plan options. Former employees continuing coverage who are enrolled in Medicare may also select from two fully insured Medicare Advantage (MA) Options offered by UHC and a fully insured MA Preferred Provider Organization (PPO) Standard option offered by Humana through an alliance with Cigna. In addition, PeachCare for Kids® and Tricare Supplement are available to SHBP members who meet the eligibility requirements under these plans.
- Rate Information
The 2013 premium rates for members are shown here.
- Plan Administration
Please note that SHBP does not administer coverage for either PeachCare for Kids or TRICARE Supplement. These plans are alternatives to SHBP Plan options, and individuals who choose PeachCare for Kids or TRICARE Supplement may later choose an SHBP Plan option if desired. Questions regarding eligibility and enrollment in either of these plans should go directly to PeachCare for Kids or Tricare Supplement.
Visit the links below for more information about your health insurance coverage:
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| Cigna | UnitedHealthcare | PeachCare for Kids | Tricare Supplemental |
Flexible Benefits
Flexible benefits (i.e., for dental, vision, legal services, etc.) are not administered by SHBP. For many state employees, flexible benefits are administered through the Department of Administrative Services (DOAS) through their GaBreeze web portal. For more information, visit www.GaBreeze.ga.gov or contact the GaBreeze Call Center at 1-877-342-7339. For more information about your Flexible Benefits, check with your employer’s HR department.
Open Enrollment
Open Enrollment (OE) and the Retiree Option Change Period are held annually, typically in October/November for the coming Plan Year.
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 SPD.
Appeals
To file a Claims, Eligibility or Wellness Promise/Requirement Appeal, please follow the instructions in your SPD, and use the appropriate form.
Frequently Asked Questions
Our list of FAQs covers a wide range of topics. Visit this page to learn more.
Plan Documents
For the Plan Documents that contain the terms and conditions of coverage, including Summary Plan Descriptions, Summaries of Benefit Coverage, (SHBP Regulations, SHBP Policies, Board Resolutions, and Legal Notices visit the link shown here. Information for Plan Year 2012 (January 1, 2012 through December 31, 2012) including Decision Guides, Rates and more is posted here under Plan Documents Archive.
PrivacyThe Department of Community Health and the State Health Benefit Plan are committed to ensuring the privacy of SHBP members’ protected health information (PHI). We follow the information privacy rules of the Health Insurance Portability and Accountability Act of 1996, (“HIPAA”). Please refer to the HIPAA Privacy Notice for more information about how your PHI is used and shared. |
Contact SHBP
If you have additional questions about benefits, claims or eligibility, visit Contact SHBP to be directed to the appropriate resource.