The Georgia Department of Community Health (DCH) and its State Health Benefit Plan Division serve as the state’s Plan 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.
The SHBP is actually three plans: the State Employees Plan, the Teachers Plan, and the Public School Employees Plan.
The SHBP is a self-insured, self-funded plan that pays benefits out of the money contributed from members (through monthly premiums) and from monthly contributions from the employers that offer the SHBP (e.g., state agencies and public school systems). The SHBP also offers fully-insured Medicare Advantage options for former employees who are continuing coverage and are eligible for Medicare. Employer contributions and member premiums are used to purchase the Medicare Advantage insurance.
Approximately 639,611 individuals were covered by the State Health Benefit Plan as of May 2016. SHBP currently offers eligible active employees and non-Medicare eligible former employees the choice of Gold, Silver or Bronze Health Reimbursement Arrangement (HRA), High Deductible Health Plan (HDHP) and Health Maintenance Organization (HMO) plan options. All plan options offer medical, wellness and pharmacy benefits. The HRA plan options offer a starting balance of spending dollars in an HRA account, while the HMO allows members to earn well-being incentive credits. In addition, SHBP offers eligible former employees enrolled in Medicare two types of fully-insured Medicare Advantage options (Standard and Premium).
|Georgia’s SHBP Wellness Plan is one of the largest in the nation.|
Your Employer and SHBP
If you are an active employee, your employer is responsible for determining whether you are eligible for SHBP coverage. Your employer is also responsible for providing eligible employees with Plan Documents and other SHBP Publications published on this website, instructing you how to enroll or decline coverage, and providing necessary information to DCH’s SHBP Division for you to be enrolled correctly. Your employer is also responsible for making sure the correct premium amounts are deducted from your pay, and for correctly paying employer contribution amounts. Your employer has designated a Benefits Coordinator who has special responsibilities related to SHBP.
SHBP Division and You
The State Health Benefit Plan Division of DCH is comprised of six operating units. These units include:
- Plan Management develops benefit Plan design and designates the Plan documents, which contain the terms and conditions of the SHBP, and is responsible for the negotiation of vendor contracts and compliance.
- Medical Management oversees the vendors’ performance of services related to clinical programs including, but not limited to, utilization management, case management, disease management, behavioral health, wellness and pharmacy management and the overall quality of these services.
- Communications provides information to employers and members on the Plan’s benefits, eligibility, policies and requirements.
- Employer Services assists participating employers that offer the SHBP with billing and training.
- Member Services assists members with all matters related to eligibility including member changes and premium payments.
- Vendor Program Management provides oversight and monitoring of vendor performance, member correspondence and eligibility appeals.