Politics & Government

Amid Outcry, State Seeks Vendors to Administer Health Plan

The Georgia Department of Community Health is looking to add second third party administrator for the State Health Benefit Plan.

After thousands of teachers and other state employees denounced changes to the State Health Benefit Plan, the Georgia Department of Community Health has announced additional plans to increase the number of vendors to administer the plan. 

The agency on Tuesday said it's releasing an invitation for proposals to qualified vendors who could administer the plan, as well as plans to expand its current plan options to its customers.

DCH is seeking proposals for a second statewide third-party administrator and a fully insured, in-network only plan for the metro Atlanta area. The administrator would offer plan members the option of a High Deductible Health Plan (HDHP), a Medicare Advantage option for retirees and a statewide HMO option.

Blue Cross Blue Shield of Georgia would continue to offer the gold, silver and bronze Health Reimbursement Arrangements (HRAs), Medicare Advantage to retirees and would also add a statewide HMO option for 2015. 

The announcement comes on the heels of changes that went into effect earlier this year that implemented a single vendor — Blue Cross and Blue Shield of Georgia — to provide medical care to its customers. 

The change, which eliminated the tradition of state employees of having the ability to choose various plans from multiple companies, left many plan participants wondering how they could afford the co-payments just to visit the doctor or specialist. 

The changes propelled Canton resident Ashley Cline to form the Facebook group Teachers Rally Against Georgia Insurance Changes, or known as TRAGIC.

The group serves as a resource for those to share their experiences with the changes, how its impacted their household and budget and for employees to ask questions about various aspects of the SHBP. 

The proposals will be reviewed by an agency evaluation team, which will also include a teacher per an executive order signed by Gov. Nathan Deal on Tuesday. Selected vendors will be announced by the agency on July 1 for the 2015 plan year.

After that announcement, the state will then finalize 2015 plan design and member rates. These designs and rates are expected to be presented to and adopted by the board in August. Open enrollment will start in either late October or early November, and Jan. 1, 2015, will signify the start date of the new plan. 

The ultimate lineup being considered for the 2015 plan year are:

  • Blue Cross Blue Shield of Georgia – Gold, Silver, Bronze HRA (exclusively), statewide HMO, Medicare Advantage
  • Second Statewide TPA – HDHP (exclusively), statewide HMO, Medicare Advantage
  • Third Vendor – fully insured in-network-only for metro Atlanta service area
  • The current Pharmacy Benefit Manager contract with Express Scripts Inc. and the current Wellness contract with Healthways Inc. would be renewed for the 2015 plan year.
The State Health Benefit Plan serves about 650,000 state employees, whose collective outcry of the changes forced the Department of Community Health to reinstate a co-pay system for plan members.

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