georgia state health benefit plan

georgia state health benefit plan - As the Plan Administrator, the Georgia Department of Community Health has delegated full responsibility for argues administration to the following Declarations Executives for the 2016 plan options:


- Blue Cross and Blue Shield of Georgia( BCBSGa ), UnitedHealthcare and Kaiser Permanente of Georgia( KP) for medical benefits

- Express Scripts, Inc.( ESI) for pharmacy advantages for BCBSGa and UnitedHealthcare members; and

- Healthways, Inc. for well-being benefits and programs disposal for BCBSGa and UnitedHealthcare members.

There are six non-Medicare Advantage State Health Benefit Plan( SHBP) alternatives offered to SHBP members( including new hires) and their eligible dependents through BCBSGa, UnitedHealthcare and KP. Former works continuing coverage who are enrolled in Medicare may also choose to enroll in one of the two SHBP Medicare Advantage( MA) Strategy too governed by UnitedHealthcare.

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( r) Please note that SHBP does not dispensed the TRICARE plan or PeachCare for Kids.

Blue Cross and Blue Shield of Georgia( BCBSGa) will provide medical argues disposal and medical management services for the State Health Benefit Plan during 2016. Through BCBSGa, the State Health Benefit Plan offers active members and pre -65 retirees a alternative of three Health Reimbursement Arrangement( HRA) Plan options: Gold HRA, Silver HRA and Bronze HRA. Additionally, BCBSGa offers a statewide Health Maintenance Organization( HMO) plan option

- Health Reimbursement Arrangement Participating Provider Option( HRA ): The HRA is a consumer-driven health plan featuring a participating provider system. Members receive treatment at dismissed proportions from system providers, and system providers will not statement for extents that outdo the dismissed proportions. Members have the flexibility of receiving treatment from out-of-network providers, but SHBP does not pay for any indicts that outdo 110% of the amount Medicare would pay for the therapy. The HRA boasts an annual contribution funded under the SHBP to provide first-dollar coverage for members' medical expenditures and pharmacy. For more information, going to see www.bcbsga.com/ shbp.

- Health Maintenance Organization( HMO) option: An HMO allows you to receive considered medical services from in-network providers merely( except for emergency care ). Members are not required to select a Primary Care Physician( PCP) with a statewide HMO. The HMO plan option compensates 100% of considered services supplied by in-network providers that are properly coded as "preventive care" within the meaning of the Affordable Care Act( ACA ). The HMO offers a statewide and national system of providers across the United States.

UnitedHealthcare will be delivered medical argues disposal and medical management services for the State Health Benefit Plan during 2016. Through UnitedHealthcare, the State Health Benefit Plan offers active members and pre -65 retirees a alternative of a statewide HMO plan option and a High Deductible Health Plan( HDHP) plan option.

- Health Maintenance Organization( HMO) option: An HMO allows you to receive considered medical services from in-network providers merely( except for emergency care ). Members are not required to select a Primary Care Physician( PCP) with a statewide HMO. The HMO plan option compensates 100% of considered services supplied by in-network providers that are properly coded as "preventive care" within the meaning of the Affordable Care Act( ACA ). The HMO offers a statewide and national system of providers across the United States.

- High Deductible Health Plan( HDHP) option: The HDHP offers in-network and out-of-network benefits and provides access to a system of providers on a statewide and national basis across the United States. The HDHP has a low-spirited monthly payment; nonetheless, you must satisfy a high deductible that is applicable to all medical and pharmacy expenditures( except preventive care ). Also, you may qualify to launch a Health Savings Account( HSA) to set aside tax-free dollars to pay for eligible health care expenses.

- Medicare Advantage Preferred Provider Organization( MA PPO ): Eligible retirees enrolled in at least Part B Medicare may choose from two Medicare Advantage PPO alternatives: Standard or Premium. 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.

Kaiser Permanente of Georgia( KP) offers a regional HMO plan option to SHBP-eligible employees who either live or work in one of the 27 counties within the Metro Atlanta Service Area.

An HMO allows you to receive considered medical services from in-network providers merely( except for emergency care ). You are responsible for to choose a Primary Care Physician( PCP) from a directory of participating providers. The HMO plan option compensates 100% of considered services supplied by in-network providers that are properly coded as "preventive care" within the meaning of the Affordable Care Act( ACA ).