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 Anthem Blue Cross and Blue Shield (Anthem) and UnitedHealthcare Medicare Advantage, and Kaiser Permanente (KP) Regional HMO). SHBP offers its active and pre-65 members a choice of six different plan options across three different vendors.
HRA Plan Options:
- Anthem GOLD
- Anthem SILVER
- Anthem BRONZE
HMO Plan Options:
- Anthem Statewide HMO*
- UnitedHealthcare Statewide HMO*
- 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
- Anthem Medicare Advantage Standard
- Anthem Medicare Advantage Premium
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: Anthem, UnitedHealthcare, and KP
- Pharmacy Benefits Manager: CVS Caremark
- 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.