DCH seeks additional companies for State Health Benefits Plan

The Department of Community Health is looking for additional health insurance companies to participate in the State Health Benefits Plan (SHBP), which provides health coverage to more than 650,000 teachers, state employees, and their dependents.

DCH said Tuesday it has released an invitation for proposals (IFP) for qualified companies interested in getting a piece of the $3 billion a year insurance program.

“SHBP is looking to enhance member choice in the 2015 plan year,” DCH Commissioner Clyde Reese said. “To accomplish this, SHBP is exploring the possibility of increasing the number of vendors that administer the SHBP plan design and expand the type of plan design options that are available.”

The health plan, which was revised this year in an attempt to save the state an estimated $200 million in insurance costs, has become a sore spot for Gov. Nathan Deal, with groups of teachers and state employees criticizing him for increases in the out-of-pocket payments they’re required to make.

Deal and DCH have also come under criticism for the fact that just one vendor, Blue Cross Blue Shield of Georgia, was awarded the contract to administer the health plan this year. Plan participants have complained that they don’t have enough coverage choices.

The department’s goal is to secure a second statewide Third Party Administrator (TPA) and an in-network-only plan for the metro Atlanta area.

Blue Cross Blue Shield of Georgia will continue to offer the Gold, Silver and Bronze Health Reimbursement Arrangements (HRAs), Medicare Advantage to retirees, and will add a statewide HMO option for the 2015 plan year, DCH said.

“The Georgia Association of Educators has been concerned about the financial and health impacts of the State Health Benefit Plan (SHBP) changes since they were announced October of last year,” said Tracey Nelson, GAE’s government relations director.

“We are pleased to see that the Department of Community Health has heard the concerns of teachers and other state employees and has decided to allow more company and plan options,” Nelson said.

The department said the lineup of carriers for 2015 would include:

  • Blue Cross Blue Shield of Georgia as the exclusive provider of Gold, Silver, Bronze HRA plans, along with statewide HMO and Medicare Advantage offerings.
  • The second statewide TPA would be the exclusive provider of a high-deductible health plan, along with statewide HMO and Medicare Advantage offerings.
  • The third company would administer the in-network-only plan for metro Atlanta.
  • The current Pharmacy Benefit Manager (PBM) contract would remain with Express Scripts Inc. and the current wellness contract with Healthways Inc.

DCH officials said they plan to announce the additional vendors for the SHBP by July 1. After the July announcement, the department will finalize the 2015 plan designs and member rates, which will be voted on by the Board of Community Health in August.

Deal signed an executive order Tuesday requiring DCH to include a teacher representative in the process of evaluating the proposals.

“Teachers and their dependents comprise the largest group of SHBP members, and they deserve to have a strong voice in this process,” Deal said. “This executive order accomplishes that.”

© 2014 by The Georgia Report


Tags: Blue Cross Blue Shield , Clyde Reese , DCH , State Health Benefits Plan , vendors