Plan Options & Programs

Health Plan Overview

SHBP is a self-funded plan that pays claims out of the premiums contributed from members and from monthly contributions from the Employers that offer the SHBP (e.g., State agencies and Public Schools), except for our fully-insured plan options (Blue Cross and Blue Shield of Georgia (BCBSGa) and UnitedHealthcare Medicare Advantage, and Kaiser Permanente Regional HMO). SHBP offers its active and pre-65 members a choice of six different plan options across three different vendors.

bcbs logo
kaiser logo
united healthcare logo

HRA Plan Options:
  • Blue Cross Blue Shield (BCBSGa) GOLD
  • Blue Cross Blue Shield (BCBSGa) SILVER
  • Blue Cross Blue Shield (BCBSGa) BRONZE
HMO Plan Options:
  • Blue Cross Blue Shield of Georgia (BCBSGa) Statewide HMO*
  • UnitedHealthcare Statewide Statewide HMO*
  • Kaiser Permanente (KP) Regional HMO
High Deductible Health Plan Options:
  • UnitedHealthcare HDHP

 

Medicare Advantage Plan

SHBP also offers Medicare-eligible members four Medicare Advantage plan options (standard and Premium) from two different vendors.

Medicare Advantage Plan Options:

  • UnitedHealthcare Medicare Advantage Standard
  • UnitedHealthcare Medicare Advantage Premium
  • Blue Cross Blue Shield and Blue Shield of Georgia (BCBSGa) Medicare Advantage Standard
  • Blue Cross Blue Shield and Blue Shield of Georgia (BCBSGa) Medicare Advantage Premium

Claims Administration

The SHBP Division has delegated full responsibility for claims administration under the various plan components, that is, well-being incentives and programs, medical benefits and pharmacy benefits, to the following Administrators:

  • Medical Claims Administrators: Blue Cross and Blue Shield of Georgia, UnitedHealthcare, and Kaiser Permanente
  • Pharmacy Benefits Manager: Express Scripts**
  • Wellness Program Administrator: Sharecare

The Administrators have the discretion to interpret the terms of their plan component when processing and paying claims and making final decisions with respect to claims that fall under their plan component. Plan benefits provided under each of the three Plan Options are described in their respective SPD or EOC.

*Note: same plan design. 
**Note CVS Caremark is the Pharmacy Benefits Manager for Plan Year 2018.