Care you can count on - Your 2021 Anthem Blue Cross and Blue Shield health plan choices
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Administered by
SHBP
State Health Benefit Plan
A Division of the Georgia Department of Community Health
Introduction and Overview
Useful Terms
Network & Resources
To-do List
Plan Comparisons
Well-being Incentives
Care you
Digital and Online Access
Health Solutions
can count on
Benefits at a Glance
Important Contacts
Your 2021 Anthem Blue Cross and Blue Shield
health plan choices
1
Administered by
SHBP
State Health Benefit Plan
A Division of the Georgia Department of Community Health
INTRODUCTION AND OVERVIEW
Introduction and Overview
Useful Terms
Confidence earned
In an unpredictable world, you have a reliable partner in health.
Network & Resources
To-do List
If there’s one thing you can expect, it’s the unexpected. At Anthem Blue Cross and Blue
Shield (Anthem), we have made it our mission to ensure that our members have the
Plan Comparisons support they need to meet all of their health care challenges, even the ones they don’t
see coming.
Well-being Incentives
We’ve been revolutionizing the state of health care for a while, implementing innovations
Digital and Online Access
to improve how we connect with and deliver care to our members. Leveraging data and
technology, we’ve simplified the experience, making it more relevant to your life.
Read on
Health Solutions to learn more about
And when life goes sideways, you can rest assured we have your back.
your 2021 plan
options with Anthem.
Benefits at a Glance
Our plans serve more than 40 million members nationwide, with tools, programs,
services, and provider networks that inspire confidence. This guide is designed to help
Important Contacts you understand that comprehensive support. If you don’t find what you’re looking for
here or have any questions, don’t hesitate to reach out to an Anthem Member Services
representative at 855-641-4862, from 8 a.m. to 8 p.m. ET, Monday to Friday.
2
USEFUL TERMS
Administered by
How to speak the language
SHBP
State Health Benefit Plan
A Division of the Georgia Department of Community Health
Often, health care sounds complicated, so to help you navigate, here’s a short glossary of common terms.
Introduction and Overview
Balance billing In-network providers
The difference between the out-of-network provider’s fee and Those who have agreed to provide services to Anthem
the eligible expense (maximum allowed amount by your plan). members at negotiated rates. Typically, your out-of-pocket
costs are lower when you use an in-network provider.
Useful Terms Helpful acronyms
Co-insurance and abbreviations
Network & Resources The percentage you pay for the cost of covered health Maximum allowed amount
expenses after meeting your deductible. For example, you may The highest amount your plan will allow
pay 20% of the cost of a covered service and your health plan for a covered health service. Anthem
To-do List would pay the other 80% of the maximum allowed amount. Anthem Blue Cross and Blue Shield
(This percentage varies depending on your plan choice.)
Out-of-network providers
Plan Comparisons Providers who do not participate in our network and do
HMO
Co-pay not provide services at negotiated rates. You’ll typically Health Maintenance Organization
A flat negotiated fee you pay at the point of service for certain pay more when using out-of-network providers.
medical and pharmacy services—a doctor’s office visit, for
Well-being Incentives example, may require a $35 co-pay. This is not affected HRA
by whether you’ve met your deductible. (Co-pays are only
applicable for the HMO plan.)
Out-of-network maximum Health Reimbursement Arrangement
Digital and Online Access The most you’ll have to pay in a plan year for covered medical
expenses, including deductibles, co-pays (HMO plan only),
co-insurance, and pharmacy costs. If you reach the out-
MIA
Deductible of-pocket maximum, your eligible expenses are covered MyIncentive Account
Health Solutions
The amount you’re responsible for paying each plan year 100% by the plan for the remainder of the plan year.
before your plan begins to cover its portion of the covered cost.
PCP
Benefits at a Glance Primary care physician (PCP) Primary care physician
Eligible expenses A doctor who is in the field of family medicine, general
Important Contacts
All health care expenses that are covered
under your health plan.
practice, internal medicine, obstetrics and gynecology, or
pediatrics and acts as your main source for regular medical
SHBP
services. Your PCP can give you eligible preventive and State Health Benefit Plan
routine care and manage your medication(s). Your PCP can
also coordinate care with a specialist.
3
Administered by
SHBP
State Health Benefit Plan
A Division of the Georgia Department of Community Health
NETWORK & RESOURCES
Introduction and Overview
Useful Terms
Here for you
Network & Resources
Whenever you need us
Wherever you need us
To-do List Whenever you need us
Life happens when you least expect it and you want your health plan to be there when you
need it. That’s why Anthem’s plan options provide support around the clock, including:
Plan Comparisons
24/7 access to an online doctor 24/7 access to Registered 24/7 access to health information
Well-being Incentives
anywhere with LiveHealth Online Nurses via our NurseLine on the go via our Engage mobile app
Digital and Online Access
24/7 access to our Behavioral 24/7 access to a dedicated
Health Resource Center website at anthem.com/shbp
Health Solutions
Benefits at a Glance
Important Contacts
1 of 2
Continued on next page
4
NETWORK & RESOURCES
Administered by
SHBP
State Health Benefit Plan Wherever you need us
A Division of the Georgia Department of Community Health
With Anthem, both the HMO and HRA plans offer access to the same extensive national
network and negotiated discounts. Our network happens to be one of the largest in Georgia,
which means you can feel confident about finding an in-network doctor.
34,000+
Physicians and non-physician
Introduction and Overview specialists in Georgia.1
180
Useful Terms Hospitals in Georgia.1
Network & Resources
Whenever you need us
Wherever you need us
Benefits around the world
To-do List
With the Blue Cross Blue Shield Global Core Program, you’re covered when traveling outside the U.S.
It offers access to in-network doctors and hospitals in nearly 190 countries and territories worldwide.2
Plan Comparisons
If you need care outside of the United States, you can:
Well-being Incentives
Digital and Online Access Go to bcbsglobalcore.com Use the Blue Cross Blue Shield Call the Blue Cross Blue Shield Global Core Go straight to the nearest
to search for an in-network Global Core app to find an Service Center 24/7 at 1-800-810-2583 (BLUE) or hospital in an emergency.
doctor or hospital. in-network doctor or hospital. call collect at 1-804-673-1177. They can help you
set up an in-network doctor visit or hospital stay.
Health Solutions
Be sure to call the Global Core Service Center before receiving medical care outside the
Benefits at a Glance United States, unless it’s an emergency. Global Core will work closely with the local provider
and Anthem to ensure a Guarantee of Payment (GOP) for any necessary treatment.3
Important Contacts 1 Network subject to change. 2 of 2
2 GeoBlue website, More than 20 years as a leader in international healthcare (accessed November 2019): about.geo-blue.com. GeoBlue is the trade name for the international
health insurance program of Worldwide Insurance Services (WIS), an independent licensee of Blue Cross Blue Shield Association. Blue Cross Blue Shield Association
is an association of independent Blue Cross and Blue Shield companies. Blue Cross Blue Shield Global is a brand owned by Blue Cross Blue Shield Association.
5 3 A Guarantee of Payment (GOP) assures payment directly to a health care professional outside the U.S. for covered services.
Administered by
SHBP
State Health Benefit Plan
A Division of the Georgia Department of Community Health
TO-DO LIST
Introduction and Overview
Useful Terms Your Open Enrollment to-do list
Network & Resources
To-do List
Plan Comparisons
This year, the Open Enrollment selection period is 1 Check
October 19, 2020 through November 6, 2020. monthly premium rates for plan options at
Well-being Incentives
shbp.georgia.gov to see your monthly payment.
If you don’t make any changes to your current plan
Digital and Online Access option and tier, your plan will automatically roll over
for 2021 — you don’t need to do a thing. If you do plan 2 Review
to change anything, follow this handy checklist. the information in this guide to compare Anthem’s
Health Solutions
plan options. If you need assistance, use the Plan
Comparison tool at anthem.com/shbp.
Benefits at a Glance Have questions about the Anthem plan options?
Call Anthem’s Member Services team at 855-641-4862 3 Log-in
Important Contacts from 8 a.m. to 8 p.m. ET, Monday to Friday. to mySHBPga.adp.com to select your plan option
and tier, if you wish to make a change.
6
PLAN COMPARISONS
Administered by
Choose a plan and feel good about it
SHBP
State Health Benefit Plan
A Division of the Georgia Department of Community Health
What’s the difference between Anthem’s HMO and HRA plan options?
Introduction and Overview
HMO
Anthem’s HMO, or Health Maintenance Organization, is a plan that offers access to in-network providers
HMO
only, who have agreed to accept special, negotiated rates for covered services provided. Anthem’s HMO
Useful Terms
plan offers set co-pays for certain covered services and doesn’t require a referral to see a specialist.
This plan might be right for you if you or your family use a doctor that is in
Network & Resources
HRA
Anthem’s network and prefer paying co-pays for most services.
To-do List
Plan Comparisons
Both plan options feature flexibility and savings
All Anthem plan options include access to a wide range of personalized solutions
Choose a plan designed to help you and your family have confidence and control in your health.
Compare your plan options
Coverage designed to fit your life Find your best care
9 Direct access to specialists, no referrals needed For information on
Well-being Incentives 9 24/7 access to in-network providers via LiveHealth Online monthly rates for these
9 Access to our national network of doctors, and even some doctors outside of the U.S. plan types,
visit shbp.georgia.gov.
Digital and Online Access Create your savings
9 You and your covered spouse can each earn 480 well-being incentive points (a total of 960 points) by completing certain health actions
9 You can redeem these points as credits to apply toward eligible medical and pharmacy expenses1 (p. 9)
Health Solutions
9 Rollover unused credits from your 2020 SHBP health plan, if you have any remaining
Maintain your health
Benefits at a Glance
9 Eligible preventive care is covered at 100% when you see an in-network provider2
9 Anthem Personal Health Coaches are available at no extra cost to help you and covered members of your family manage chronic conditions
9 On-the-go access to your health plan via the Engage mobile app
Important Contacts 1 of 3
1 Completing your well-being incentive actions with Sharecare will earn you well-being incentive points. You can choose to redeem these points for well-being incentive
credits to use on covered medical and pharmacy expenses or the Visa Reward Card option. Visit BeWellSHBP.com for more information.
7 2 Services must be properly coded as preventive care under the Patient Protection and Affordable Care Act.
PLAN COMPARISONS
Administered by
Compare your options
SHBP
State Health Benefit Plan
A Division of the Georgia Department of Community Health
View Benefits at a Glance
Our HMO and HRA plans are designed to accommodate a range
of financial and health goals. Here’s a high-level comparison to
HMO HRA
help you select the one that best fits you and your family. 1 plan option 3 plan options
Paying for your care
Introduction and Overview
Co-pays
A flat negotiated fee you pay at the point of service for certain covered medical and pharmacy services �
Useful Terms Co-insurance
The percentage you pay for the cost of covered health expenses after meeting your deductible � �
Deductible
Network & Resources
The amount you’re responsible for paying each plan year before your plan begins to cover its � �
portion of the covered cost
To-do List Preventive care covered at 100%1
When provided by an in-network doctor, encouraging you to be proactive in your health � �
Medical and pharmacy2 costs count toward your out-of-pocket maximum
Plan Comparisons Expenses you pay for covered medical care—including prescriptions, co-pays (HMO only), � �
co-insurance, and deductibles—apply to your out-of-pocket maximum
Choose a plan Access to providers
Compare your plan options Access to Anthem’s expansive network of providers
Includes coverage in GA, nationally and internationally � �
Coverage designed to fit your life
See any provider you choose (in-network or out-of-network)
Negotiated rates only apply to in-network providers �
Well-being Incentives
No referrals necessary
Both plans are open-access, so no PCP referral is needed to see a specialist � �
Digital and Online Access Access to LiveHealth Online
See a provider online 24/7 � �
Incentive credits to help reduce your costs
Health Solutions
Plan comes with starter credits contributed by SHBP
From 100 to 800 depending on the plan option and tier you select �
Benefits at a Glance Can earn well-being incentive points
You can choose to redeem these points for well-being incentive credits to use on covered � �
medical and pharmacy expenses3
Important Contacts Can roll over unused credits from 2020 � �
2 of 3
8 1 Services must be properly coded as preventive care under the Patient Protection and Affordable Care Act. 3 Completing your well-being incentive actions with Sharecare will earn you well-being incentive points. You
2 Pharmacy is administered by SHBP’s partner CVS Caremark. can choose to redeem these points for well-being incentive credits to use on covered medical and pharmacy
expenses or the Visa Reward Card option. Visit BeWellSHBP.com for more information.
PLAN COMPARISONS
Administered by
Coverage designed to fit your life
SHBP
State Health Benefit Plan
A Division of the Georgia Department of Community Health
Click through the tabs to view the different plan tiers.
Introduction and Overview
Single coverage
HMO HRA
Useful Terms You + your spouse The HMO plan only covers in-network care
Gold Silver Bronze
(except for emergency care)
or child(ren)
Network & Resources Deductible $1,300 $1,500 $2,000 $2,500
in-network in-network in-network in-network
The amount you’re responsible
for paying each plan year
Out-of-network not $3,000 $4,000 $5,000
To-do List
You + your family before your plan begins to cover
its portion of the covered cost covered out-of-network out-of-network out-of-network
20% 15% 20% 25%
Co-insurance in-network
after deductible
in-network
after deductible
in-network
after deductible
in-network
after deductible
Plan Comparisons The percentage you pay for the
cost of covered health expenses
after meeting your deductible Out-of-network not 40% 40% 40%
covered out-of-network out-of-network out-of-network
Choose a plan after deductible after deductible after deductible
Compare your plan options 100% 100% 100% 100%
Preventive care in-network in-network in-network in-network
Coverage designed to fit your life The amount covered by your
Out-of-network not Out-of-network Out-of-network Out-of-network
plan for preventive care*
covered not covered not covered not covered
Well-being Incentives $35 co-pay $45 co-pay 15% 20% 25%
Physician office for in-network primary for in-network in-network in-network in-network
care providers (PCPs) specialists after deductible after deductible after deductible
services
Digital and Online Access
The amount you’re responsible for
paying when you see your doctor Out-of-network not 40% 40% 40%
covered out-of-network out-of-network out-of-network
for a covered medical service after deductible after deductible after deductible
Health Solutions Out-of-pocket $4,000 $4,000 $5,000 $6,000
in-network in-network in-network in-network
maximum
The most you’ll have to pay in a
plan year for covered medical Out-of-network not $8,000 $10,000 $12,000
Benefits at a Glance expenses, including deductibles, covered out-of-network out-of-network out-of-network
co-pays (HMO plan only), co-
insurance and pharmacy costs
Important Contacts
3 of 3
* Services must be properly coded as preventive care under the Patient Protection and Affordable Care Act and provided by an in-network doctor.
9
Administered by
SHBP
State Health Benefit Plan
A Division of the Georgia Department of Community Health
WELL-BEING INCENTIVES
Introduction and Overview
Useful Terms
Rewards for healthy living
Reduce your costs by earning well-being incentive credits*
Network & Resources
To-do List
To put you in control, Anthem lets you earn well-being incentive credits for both HMO and HRA plan options. These can
be applied to covered medical and pharmacy expenses. HRA plans come pre-loaded with credits contributed by SHBP,
Plan Comparisons while the HMO plan option does not.
With all plan options, you and your covered spouse can each earn 480 well-being incentive credits
Well-being Incentives (for a total of 960) through the Be Well SHBP well-being program administered by Sharecare.*
Earning rewards is easy
Credits by plan
Earning rewards is easy
Once you complete healthy actions in the Be
Digital and Online Access
Well SHBP Program, you will earn points that
you can choose to redeem as credits. Take Get Complete
Health Solutions If redeemed as credits, the credits will the RealAge Test® a biometric telephonic coaching
screening online challenges, and/or
be deposited into a spending account
the RealAge Program
Benefits at a Glance tied to your HMO or HRA plan.
Important Contacts
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Continued on next page
* Completing your well-being incentive actions with Sharecare will earn you well-being incentive points. You can choose to redeem these points for well-being incentive
10 credits to use on covered medical and pharmacy expenses or the Visa Reward Card option. Visit BeWellSHBP.com for more information.WELL-BEING INCENTIVES
Administered by
SHBP
State Health Benefit Plan
A Division of the Georgia Department of Community Health
Credits by plan
YOU YOU + SPOUSE YOU + CHILD(REN) FAMILY
Credits contributed by SHBP 0 0 0 0
Introduction and Overview
HMO Credits you can earn 480 960 480 960
Useful Terms
Total possible credits 480 960 480 960
Credits contributed by SHBP 400 600 600 800
Network & Resources
HRA-GOLD Credits you can earn 480 960 480 960
To-do List Total possible credits 880 1,560 1,080 1,760
Credits contributed by SHBP 200 300 300 400
Plan Comparisons
HRA-SILVER Credits you can earn 480 960 480 960
Well-being Incentives Total possible credits 680 1,260 780 1,360
Earning rewards is easy Credits contributed by SHBP 100 150 150 200
Credits by plan
HRA-BRONZE Credits you can earn 480 960 480 960
Digital and Online Access Total possible credits 580 1,110 630 1,160
Unused credits will roll over to the 2021 plan year, regardless of which Anthem plan option you choose.
Health Solutions
Benefits at a Glance
Important Contacts
2 of 2
11Administered by
SHBP
State Health Benefit Plan
A Division of the Georgia Department of Community Health
DIGITAL AND ONLINE ACCESS
Introduction and Overview
Useful Terms
Online resources
Available at no additional cost, Anthem’s online tools offer you a safe, secure,
and interactive experience built around your health and benefits.
Network & Resources
To-do List
Plan Comparisons Compare plans
Our plan comparison tool shows you which Anthem plan
might work best for you and your family.
Well-being Incentives
Digital and Online Access
Find Care To access
Online resources
Available with both HMO and HRA plan options, the Find Care tool
helps you locate an in-network doctor or facility near you. these tools
Engage Mobile App
Manage your health
and more
LiveHealth Online Visit anthem.com/shbp
Check the status of a claim, review medical benefits, chat
Health Solutions with a Member Services representative, view your member
ID card, or take advantage of discounts on health products—
available when you register online at anthem.com/shbp.
Benefits at a Glance
Important Contacts 1 of 3
12Administered by
SHBP
State Health Benefit Plan
A Division of the Georgia Department of Community Health
DIGITAL AND ONLINE ACCESS
Engage:
next-generation
Introduction and Overview
Useful Terms
Network & Resources digital health
To-do List When it comes to innovation, we’re aggressive.
Engage is Anthem’s revolutionary and robustly
interconnected digital platform that offers a
Plan Comparisons
personalized set of tools in an intuitive app.
Well-being Incentives
9 Clearly see what’s covered by your plan
9 Get an estimate for how much services may cost
Digital and Online Access 9 See where you’ve spent your health care dollars
Online resources 9 Find high-quality, in-network doctors
or specialists near you
Engage Mobile App
LiveHealth Online 9 Access your digital ID card
Health Solutions
Download the Engage
app today from the App
Benefits at a Glance Store or Google Play.
Important Contacts 2 of 3
Continued on next page
13Administered by
SHBP
State Health Benefit Plan
A Division of the Georgia Department of Community Health
DIGITAL AND ONLINE ACCESS
Introduction and Overview
Useful Terms LiveHealth Online
Network & Resources
To-do List
Health care needs don’t always coincide with working hours. LiveHealth Online allows you to speak
with a doctor or health professional from the comfort of your home or the convenience of your office.
Plan Comparisons
Well-being Incentives
See Visit Receive
Digital and Online Access a board-certified
medical doctor in a
with a licensed therapist,
psychologist, or
video-based lactation
and postpartum
Call
Online resources
Engage Mobile App
few minutes without
an appointment, 24/7.
psychiatrist from the
privacy of your own home.1
support after the
birth of a child. 911
for emergencies
LiveHealth Online
Doctors can answer questions, make diagnoses and even prescribe basic medications when
Health Solutions needed.2 You can use LiveHealth Online for non-emergency health concerns or when your own
doctor isn’t available. All you need is a smartphone, tablet, or computer with a webcam.
Benefits at a Glance
Important Contacts 3 of 3
1 LiveHealth Online Psychology appointments are available 7 days a week, 7 a.m. to 11 p.m. coast-to-coast, for adults and children age 10 or older. Psychiatrist appointments are subject to availability.
14 2 Prescription availability is defined by physician judgment and state regulations.Administered by
SHBP
State Health Benefit Plan
A Division of the Georgia Department of Community Health
HE ALTH SOL UT IONS
Introduction and Overview
Useful Terms
Personal Health Solutions
It helps to have someone by your side to help you achieve your health goals. Our Personal Health Programs
Network & Resources
— available with every plan and at no additional cost— will help you manage your health and follow your doctor’s
care plan. Learn more and enroll by calling 866-901-0746, available from 8 a.m. to 6 p.m. ET Monday to Friday.
To-do List
A team that delivers
Plan Comparisons
Registered Nurses Pharmacists
Well-being Incentives
who guide you in managing your who understand the medicines used to treat
condition and reaching your health goals health conditions and their side effects
Digital and Online Access
Health Solutions
Exercise physiologists Social workers
who give expert help on setting fitness who can assist with community
goals in line with your doctor’s care plan resources and support services
Benefits at a Glance
Important Contacts Registered Dietitians Respiratory therapists
who offer nutritional education who can provide sleep apnea education,
and dietary expertise training for respiratory equipment,
or assist with smoking cessation 1 of 3
15HE ALTH SOL UT IONS
Administered by
SHBP
State Health Benefit Plan
A Division of the Georgia Department of Community Health
Help with managing chronic health conditions
If you or one of your covered dependents lives with a chronic health condition, Anthem’s
experienced Personal Health Coaches can help you manage symptoms to improve your quality
of life. Our program is designed to help members with the following conditions:
• Asthma • High cholesterol • Heart failure (HF)
Introduction and Overview
• Low-back pain • Chronic obstructive • Vascular or musculoskeletal
• Diabetes pulmonary disease (COPD) diseases
Useful Terms
• High blood pressure • Certain types of cancer • Coronary artery disease (CAD)
Network & Resources
Case management
To-do List After surgery or a stay in the hospital, our Personal Health Coach Program will contact
you to review your doctor’s care plan. Follow-up care, medication review, and personal
lifestyle coaching are some of the services they can provide to members.
Plan Comparisons
Well-being Incentives Pharmacy Co-Pay/Co-Insurance Waiver Program
Eligible SHBP members can receive certain prescription drugs for asthma, diabetes, coronary
Digital and Online Access artery disease (CAD), or agents for chemical dependency at no additional cost.
Health Solutions
Behavioral Health
When experiencing stress or depression, our licensed health professionals can offer
Benefits at a Glance
confidential support to alleviate your pain. They can also coordinate the services of
your other health care providers and provide local and online resources.
Important Contacts
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Continued on next page
16HE ALTH SOL UT IONS
Administered by
SHBP
State Health Benefit Plan
Applied Behavioral Analysis (ABA) Therapy
A Division of the Georgia Department of Community Health
Anthem’s Personal Health Coaches are available to provide telephonic support, education and
resources, and provider outreach to those diagnosed with Autism Spectrum Disorder.
Introduction and Overview
24/7 NurseLine
Useful Terms The Registered Nurses at 24/7 NurseLine offer answers to your health questions, health-related
educational materials and information about helpful tools/programs. They are available anytime of the
Network & Resources day or night, including weekends, at 866-787-6361.
To-do List
Future Moms
Plan Comparisons This program gives soon-to-be mothers the tools and information they need
to support a healthier, happier pregnancy. The program includes:
Well-being Incentives
• A Personal Health Coach Maternity Nurse during pregnancy and after birth.
• Specialized care for high-risk pregnancies.
Digital and Online Access
• Access to dietitians, pharmacists, social workers, and more.
Health Solutions
Through a partnership with LiveHealth Online, Future Moms offers breastfeeding
support from the comfort of your own home, including video visits with a certified
Benefits at a Glance
lactation consultant, counselor, or Registered Dietitian at no extra cost to you.
Important Contacts
3 of 3
17BENEFITS AT A GLANCE
Administered by
2021 Anthem health plan options
SHBP
State Health Benefit Plan
A Division of the Georgia Department of Community Health
HMO 1 HRA—GOLD 1 HRA—SILVER 1 HRA—BRONZE 1
IN-NETWORK IN-NETWORK OUT-OF-NETWORK IN-NETWORK OUT-OF-NETWORK IN-NETWORK OUT-OF-NETWORK
DEDUCTIBLE (The deductible can be satisfied by any combination of covered family members, but an individual would never have to pay more than their own individual deductible.)
YOU $1,300 $1,500 $3,000 $2,000 $4,000 $2,500 $5,000
Introduction and Overview YOU + SPOUSE $1,950 $2,250 $4,500 $3,000 $6,000 $3,750 $7,500
YOU + CHILD(REN) $1,950 $2,250 $4,500 $3,000 $6,000 $3,750 $7,500
YOU + FAMILY $2,600 $3,000 $6,000 $4,000 $8,000 $5,000 $10,000
Useful Terms CO-INSURANCE (Applies after deductible is met.)
PL AN PAYS 80% after deductible 85% after deductible 60% after deductible 80% after deductible 60% after deductible 75% after deductible 60% after deductible
MEMBER PAYS 20% after deductible 15% after deductible 40% after deductible 20% after deductible 40% after deductible 25% after deductible 40% after deductible
Network & Resources
OUT-OF-POCKET
MAXIMUM 2 (The out-of-pocket maximum can be satisfied by any combination of covered family members, but an individual would never have to pay more than their own individual out-of-pocket maximum.)
YOU $4,000 $4,000 $8,000 $5,000 $10,000 $6,000 $12,000
To-do List YOU + SPOUSE $6,500 $6,000 $12,000 $7,500 $15,000 $9,000 $18,000
YOU + CHILD(REN) $6,500 $6,000 $12,000 $7,500 $15,000 $9,000 $18,000
YOU + FAMILY $9,000 $8,000 $16,000 $10,000 $20,000 $12,000 $24,000
Plan Comparisons MEDICAL (The percentage listed is the percent the plan pays.)
Preventive care3 100% 100% Not covered 100% Not covered 100% Not covered
Physician office services 4 (illness/injury) 100% after $35 co-pay Co-insurance after deductible Co-insurance after deductible Co-insurance after deductible
Specialist office services (illness/injury) 100% after $45 co-pay Co-insurance after deductible Co-insurance after deductible Co-insurance after deductible
Well-being Incentives LiveHealth Online 100% after $35 co-pay Co-insurance, no deductible Co-insurance, no deductible Co-insurance, no deductible
Chiropractic visit (20 visits per plan year) 100% after $45 co-pay Co-insurance after deductible Co-insurance after deductible Co-insurance after deductible
Eye exam—routine (limited to one exam
100% 100% Not covered 100% Not covered 100% Not covered
every 24 months; not subject to deductible)
Hospital services (inpatient/outpatient) Co-insurance after deductible Co-insurance after deductible Co-insurance after deductible Co-insurance after deductible
Digital and Online Access Maternity care 100% after $35 co-pay Co-insurance after deductible Co-insurance after deductible Co-insurance after deductible
Physician routine prenatal care, delivery and postnatal
Outpatient rehabilitation therapy
Physical, speech, cardiac, occupational, pulmonary 100% after $25 co-pay Co-insurance after deductible Co-insurance after deductible Co-insurance after deductible
therapy (40 visits per therapy per plan year)
Health Solutions Emergency room care—hospital 100% after $150 co-pay Co-insurance after deductible Co-insurance after deductible Co-insurance after deductible
Urgent care visit/retail health clinic 100% after $35 co-pay Co-insurance after deductible Co-insurance after deductible Co-insurance after deductible
WELL-BEING HMO 6
(Completion of all 2021 GOLD BASE
GOLD TOTAL
(Gold base + completion of all SILVER BASE
SILVER TOTAL
(Silver base + completion of all BRONZE BASE
BRONZE TOTAL
(Bronze base + completion of all
Benefits at a Glance INCENTIVE CREDITS 5 well-being incentive actions) CONTRIBUTION 2021 well-being incentive actions) CONTRIBUTION 2021 well-being incentive actions) CONTRIBUTION 2021 well-being incentive actions)
YOU 480 400 880 200 680 100 580
YOU + SPOUSE 960 600 1,560 300 1,260 150 1,110
YOU + CHILD(REN) 480 600 1,080 300 780 150 630
YOU + FAMILY 960 800 1,760 400 1,360 200 1,160
Important Contacts
1 Out-of-network coverage is not available for the HMO plan except for emergency care. If you use an out-of-network provider on the HRA 6 If you are on the HMO plan and redeem your well-being incentive points as credits, they will go into your MyIncentive Account, which is a
plans you could be balance billed. standalone account offered alongside the HMO plan.
2 Pharmacy costs count toward your out-of-pocket maximum.
3 Services must be properly coded as preventive care under the Patient Protection and Affordable Care Act and provided by an in-network This is a high-level summary of benefits. It does not describe all benefits and does not describe exclusions and limitations. The plan
doctor. documents posted on www.shbp.georgia.gov include the full details. Dollar amounts, visit limitations, medical co-pays (HMO), co-insurance,
4 Physician office services is defined as family practice, general practice, internal medicine, pediatrics, and OB/GYN. deductible, and out-of-pocket limits are based on January 1 – December 31, 2021, plan year. All covered medical services are subject to
5 Completing your well-being incentive actions with Sharecare will earn you well-being incentive points. You can choose to redeem these deductible except preventive care, LiveHealth Online visits, ABA therapy, and hearing aids. Note: Medical co-pays (HMO) do not count
points as well-being incentive credits (indicated in this chart) to use on covered medical and pharmacy expenses or the Visa Reward toward the deductible but do count toward the out-of-pocket maximum. The plan pays a percentage of the maximum allowed amount for
Card option. Visit BeWellSHBP.com for more information. covered services performed by out-of-network providers.
18IMPORTANT CONTACTS
Administered by
Important contact information
SHBP
State Health Benefit Plan
A Division of the Georgia Department of Community Health
Anthem Blue Cross and Blue Shield (Anthem) 855-641-4862 Call our Member Services line or visit our website to find
8 a.m. to 8 p.m. ET, Mon. – Fri. answers to your benefit questions, check your HRA or MIA credit
anthem.com/shbp balance, or get detailed information about your plan.
Introduction and Overview Anthem 866-787-6361 Registered Nurses can answer your health
24/7 NurseLine 24 hours a day/7 days a week questions any time of the day or night.
Useful Terms
Anthem 866-901-0746 • Future Moms maternity program
Personal Health 8 a.m. to 6 p.m. ET, Mon. – Fri. • Pharmacy Co-Pay/Co-Insurance
Coach Programs
Network & Resources Waiver Program
Anthem 855-679-5722 • Depression • Anxiety disorders
To-do List
Behavioral Health Resource Center 24 hours a day/7 days a week • Bipolar disorder • Eating disorders
• Alcohol/drug abuse
Plan Comparisons
Be Well SHBP 888-616-6411 • Complete well-being incentive actions
well-being program, administered by Sharecare 8 a.m. to 8 p.m. ET, Mon. – Fri. • Help with improving health through lifestyle changes
bewellshbp.com
Well-being Incentives
CVS Caremark 844-345-3241 Pharmacy benefits—retail and mail order.
Digital and Online Access 24 hours a day/7 days a week
info.caremark.com/shbp
Health Solutions
LiveHealth Online 24 hours a day/7 days a week Connect with a provider 24 hours a day
livehealthonline.com on your computer or mobile device.
Benefits at a Glance
SHBP 800-610-1863 Questions about eligibility.
Member Services 8:30 a.m. to 5 p.m. ET, Mon. – Fri.
Important Contacts
Anthem Blue Cross and Blue Shield is the trade name of Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Independent licensee of the
Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc.
LiveHealth Online is the trade name of Health Management Corporation, a separate company providing telehealth services on behalf of Anthem Blue Cross and Blue Shield.
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