2020 State Health Benefits Plan Annual Open Enrollment (OE) - Presentation to Active Employees
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2020 State Health Benefits Plan
Annual Open Enrollment (OE)
Presentation to Active Employees
1
Date: October 2019
Making Your 2020 Benefit Election
• Website Open & Close Dates
– Website opens at 12:00 a.m. October 21, 2019
– Website closes at 11:59 p.m. November 8, 2019
• Online Election
- Members make their health election at
www.myshbpga.adp.com
2
2020 Open Enrollment (OE)
• Open enrollment is from October 21, 2019 thru November 8, 2019
• You may go online as many times as you like but the last election
confirmed at the time OE closes will be your election for the 2020
Plan Year
• You should print and keep a copy of the confirmation page
which will contain a confirmation number - once OE is closed,
you will be able to go online at www.mySHBPga.adp.com and view
your 2020 election
3
SHBP Enrollment Portal – mySHBPga.adp.com
Save Time! Update Your Password Before Open Enrollment
• Your password expires every 45 days. Login to
the SHBP Enrollment Portal now to update
your password.
• If you do not know your current User Name or
Password:
– Click the Forgot User ID? or Forgot
Password? from the login page
– Links are located to the right of the User
Name and Password blocks
• Need additional help? Call 800.610.1863 for
assistance. Call center hours 8:30a-7:30p,
Monday-Friday and 8:00a-5:00p Saturday
4
Open Enrollment (OE) and Your Responsibilities
• Read and make sure you understand the Decision Guide, Plan Documents, Plan Options
and Rates posted at www.shbp.ga.gov and other information provided by your employer,
and take the required actions
• Confirm that you answered the Tobacco Surcharge question appropriately
• Check your payroll deduction in December 2019 to verify that the correct deduction
amount has been made. If you are not being charged the correct amount, immediately
contact HR/Payroll.
• If your home/mailing address has changed, visit Team Georgia Self Service and notify
HR.
• Notify SHBP whenever you have a change in covered dependents (within 31 days of a
Qualifying Event)
• New Hires or Qualifying Events during the enrollment period should complete two
enrollments – one for the remainder of 2019, and one for 2020 coverage.
5
Planning to Retire?
Retirement can have a HUGE impact on your benefits!
Contact Human Resources for personalized information on needed actions prior to
filing for retirement.
6
What Happens If I Don’t Do Anything?
• Members who do not make an election, either through the web portal
or by calling the SHBP Member Services Center, will be defaulted to
the plan option previously selected for 2019.
• If you do not make an election and are currently paying the Tobacco
Surcharge, your coverage will default to the 2019 plan option, and
the Tobacco Surcharge you are currently paying will continue to
apply.
• If you do not make an election and are currently enrolled in TRICARE
Supplement in 2019, you will be enrolled in TRICARE Supplement
for 2020.
7
Qualifying Events and Dependent
Verification Process
• For Employees with Qualifying Events:
– Dependents will not be added to coverage until verification of eligibility is
complete.
– Documentation to demonstrate eligibility must be submitted to SHBP within 45
days of the Qualifying Event.
• Qualifying Events Include:
– Marriage/Divorce
– Gain/Lose Other Coverage
– Dependent Gains/Loses Medicaid/PeachCare
– Gain/Lose Guardianship
• Qualifying Events due to Birth/Adoption/Death will be processed
immediately, but verification must occur within 45 days of the event.
8
Plan Options 2020
SHBP will continue to offer Anthem and United Healthcare plan options for
2020, with NO CHANGES to premiums, copays, co-insurance, or deductibles.
Health Maintenance Organization (HMO) High Deductible Health Plan (HDHP)
Statewide, In-Network Only CVS Caremark
• United Healthcare administers
• Anthem prescription drug
pharmacy benefits
• United Healthcare for all plans.
Health Reimbursement Arrangement (HRA)
Sharecare provides
• Anthem well-being
resources and
incentive programs
for all plans..
* Additional Options: TRICARE Supplement, PeachCare for Kids®
9All Plans Include…
Access to Telemedicine/Virtual Visits
• SHBP will continue to provide access to physicians through telemedicine/virtual visits in 2020
• Face-to-face consultations with physicians will be available 24/7, 365 days a year
• Services will be available from home, office or on the go from a computer, tablet or smartphone that has a web
camera
• There is a Co-Pay for the Anthem and UnitedHealthcare HMO Plan Options, Co-Insurance for the HRA-Gold, Silver
and Bronze Plan Options, Co-Insurance subject to Deductible for the UnitedHealthcare HDHP.
Preventive Care Benefits
• All plans include 100% coverage for services provided in-network, that are properly coded as “Preventive Care,” as
defined by the Affordable Care Act.
Disease Management Programs
• Certain drug costs are waived if you actively participate in the Disease Management Program for diabetes, asthma
and/or coronary artery disease. (High Deductible Plan members must first satisfy deductible)
Out-of-Pocket Maximums Combined
• All plans combine medical and pharmacy expenses, when calculating progress toward the out-of-pocket maximum.
10Health Reimbursement Arrangement (HRA) Plan
How the Health Reimbursement Arrangement (HRA) Works
•Offered by Anthem only.
•The HRA is funded by SHBP and provides an up-front credit to be used for eligible medical and
pharmacy expenses.
•When going to the doctor, you pay the applicable deductible and co-insurance.
•There are separate in-network and out-of-network deductibles and out-of-pocket maximums.
•No specialist referral required, but it is encouraged to have a Primary Care Physician coordinating care.
•If you have remaining wellness credits in your current HRA account, those credits will roll over to the
plan option and/or vendor you select for the 2020 Plan Year.
Plan Features
Deductible: Co-Insurance:
Credit:
Credits are exhausted. Deductible is met.
Use HRA Credits to pay for
initial medical or pharmacy Pay 100% out-of-pocket Pay co-insurance
expenses. for medical or pharmacy percentage until out-of-
expenses until deductible pocket maximum is met.
No out of pocket expense is met. 85% 80% 75% in-network.
11Health Reimbursement Arrangement (HRA) Plan
12High Deductible Health Plan (HDHP)
How the High Deductible Health Plan (HDHP) Works
•Offered by UnitedHealthcare only. Lowest monthly premium of all plans offered.
•Separate in-network and out-of-network deductibles and out-of-pocket maximums..
•100% out of pocket, until high deductible is satisfied, applicable to all covered medical and pharmacy
expenses. After the deductible is met, you pay co-insurance for medical/pharmacy services.
•Family coverage deductible does not have to be met before benefits are payable for any family member.
The individual deductible for each family member is $3,500 in-network/$7,000 out-of-network.
•You may qualify for a Health Savings Account (HSA) through an external banking institution to set aside tax-
free dollars to pay for eligible health care expenses. NOTE: Per IRS Rules, the Health Savings Account
cannot be used in conjunction with a Flexible Spending Account.
•Remaining 2019 well-being incentive credits will roll over to the plan option and/or vendor selected for the
2020 plan year.
•Before well-being incentive credits can be used, a threshold of $1,400 for individual coverage or $2,800 for
other tiers must be met.
Co-Insurance:
Deductible: Deductible is met.
Pay 100% out-of-pocket for Pay co-insurance
medical or pharmacy percentage until out-of-
expenses until deductible is pocket maximum is met.
met. 70% in-network/50% out-of-
network
13Health Maintenance Organization (HMO) Plan
How the Statewide Health Maintenance Organization (HMO) Works
• Offered by Anthem and United Healthcare - the difference is the provider network, both plans
operate identically.
• In-network coverage only (except for emergency care). Verify your current provider is in-
network when selecting an HMO Plan Option.
• Co-pays: $35 Primary Care/Urgent Care, $45 Specialist, $150 Emergency Room
• Co-pays do not count toward deductible, but do count toward out-of-pocket maximum.
• Certain services are subject to deductible and
85% co-insurance. Ex. Surgery, non-routine services.
• No specialist referral required, but it is encouraged
to have a Primary Care Physician coordinating care.
All physicians must be in-network.
• If you have remaining well-being incentive credits
in your account, those credits will roll over to the
plan option and/or vendor you select for 2020.
142020 Premium Rates *$80.00 Additional surcharge applies to monthly premium for tobacco users 15
2020 Pharmacy Benefits
Pharmacy Services for Anthem and UnitedHealthcare Plans
• CVS Caremark has been selected to administer the pharmacy benefits for members who
choose Anthem or UnitedHealthcare.
• CVS Caremark has a broad pharmacy network for retail prescription drug products, mail
order, home delivery and specialty pharmacy services. Retail network includes additional
pharmacies – Walgreens, Publix, Walmart, etc.
• CVS Caremark offers a variety of ways to manage your prescriptions:
• Get up to a 90-day supply of your maintenance medication through CVS Caremark
home delivery pharmacy services or at a participating 90-day retail pharmacy
• Mobile app for easy refills, track expenses, cost comparison, refill reminders, and
more.
• Co-Pay/Co-Insurance Waiver for members enrolled in Disease Management
programs for asthma, diabetes or coronary artery disease. You may be eligible to
receive management prescription products at no cost.
16ShareCare Wellness 2020
ShareCare Wellness Benefits
• SHBP will continue partnership with Sharecare to provide Anthem and UnitedHealthcare
members with well-being resources and incentive programs.
• Anthem and UnitedHealthcare members can earn up to 480 well-being incentive credits, plus
an additional 480 for a covered spouse, up to 960 per household.
• Health actions must be completed and submitted between January 1, 2020 and November
30, 2020 in order to earn 2020 well-being incentive credits.
• All members will have access to a variety of Sharecare’s
tools, activities and services such as the Sharecare
RealAge assessment, personalized profile, personalized
content to help improve your health habits, earn green days
with daily tracking, wellness resources, well-being coaching,
biometric screening, tobacco cessation and more!
17ShareCare Wellness 2020
Wellness Incentive Credits
• 2019 credits can still be earned through November 30, 2019.
• Wellness incentive credits will continue to roll over in 2020.
• Rollover credits will be available in April 2020; this allows for processing of any
claims submitted at the end of 2019 to apply credits.
• If you do NOT change Vendor or Plan option, your credits will be available
January 1, 2020.
• United Healthcare bonus credit program will not be continued into 2020.
• United Healthcare members can earn up to a total of $1,440 credits through
the end of 2019. In 2020, the maximum for all plans will be $960 credits.
• Reminder: Anthem and UnitedHealthcare members control how their wellness
credits are used, via the Sharecare Redemption Center.
• Credits may be allocated dollar-for-dollar to healthcare expenses.
• Members can redeem 480 wellness credits for $150 Visa Gift Card or $225
Walmart Pharmacy/Vision Gift Card.
18ShareCare Wellness 2020
19ShareCare Wellness 2020
Online Tracking - Green Days, 5K Steps, Stress
• Green Day Challenge Offered in March, June, and September:
• Tracking of 12 key RealAge health indicators:
• Stress, activity, sleep, relationships, weight, blood pressure, blood glucose,
cholesterol, smoking, drinking, diet, and fitness
• The Goal: to get at least 8 of 12 indicators from a red/yellow status to green each day.
• 21 green days in a 30-day period = 120 wellness incentive credits.
• 5K Steps Challenge Offered in January, April, July, and October:
• Track steps daily.
• 5K steps per day for 21 days in the 30-day period = 120 wellness incentive credits.
• Stress Challenge Offered in February, May, August, and November:
• Track your stress level daily for 21 days in the 30-day period = 120 wellness
incentive credits
**You must track every day, and cannot enter responses retroactively**
20ShareCare Redemption Center
Wellness credits accessed via the ShareCare
Redemption Center at www.bewellshbp.com
Three options for redeeming credits:
1. 480 credits earned in 2020 redeemable for $225 Walmart
Pharmacy/Vision gift card. (New for 2020!)
2. 480 credits earned in 2020 redeemable for $150 Visa gift card.
3. Increments of 120 credits may be redeemed to your Health
Incentive/HRA account for use towards medical/pharmacy
expenses.
21Tricare Supplement
•The Tricare supplement is available for families who are covered under Tricare
military insurance coverage.
• To be eligible, the STC employee and dependents must be:
•Under age 65
•Ineligible for Medicare
•Registered in DEERS (Defense Enrollment Eligibility Reporting System)
• How it works:
• Tricare remains your primary insurance coverage - The supplement is
considered secondary coverage.
• Members have flexibility in selecting civilian physicians, specialists, hospitals and
pharmacies.
• Covers unmarried dependent children under 21, or under 23 if enrolled as a full
time student.
• No tobacco surcharges apply.
• No COBRA rights, but a portability feature is offered.
22PeachCare for Kids
Don’t forget, State of Georgia employees are
eligible for PeachCare Coverage!
• Program is income based.
•Visit www.peachcare.org for income requirements
and income calculator tool.
• Monthly premiums are incremental based on income.
• $11-$36 for one child; $72 household max for two
or more children.
• Most services require $0.50-$12.50 co-pay based upon
medical services received.
• No co-payments for:
Eligibility Questions? • Emergency services
• Preventive Care Services
Contact PeachCare: 877.427.3224
• Immunizations
• Routine preventive and diagnostic dental services
23If you think you might be eligible for
PeachCare…
•Start the enrollment process now!
•DO NOT drop your children’s health
coverage under State Health.
•PeachCare will notify you if you are accepted
into the program.
• Upon being accepted into the program, you may
drop your children’s State Health insurance
coverage.
• You must notify State Health of your acceptance
into PeachCare within 60 days of acceptance. If you are accepted into
PeachCare, but lose the
coverage in the future, you
have 60 days to notify
State Health of the loss
and add your children to
your current health plan.
24Questions/Additional Information
25Important Notice
• The information provided in this presentation is a summary of changes
for the 2020 Plan Year. It is intended only to highlight principal benefits.
• Please refer to the Active Member Decision Guide for more details.
• Premium rates, decision guides and other information will be available at
www.shbp.ga.gov
THANK YOU!
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