Georgia Health Insurance - Affordable Health Insurance Quotes in Georgia
Summary Notice
This booklet is your Summary Plan Description (SPD), and describes the provisions of the State Health Benefit Plan (SHBP), which is also referred to in this booklet as the "Plan". Use this SPD as a reference tool to help you understand the Plan and maximize your coverage.
A thorough understanding of your coverage will enable you to use your benefits wisely. Please read this SPD Booklets carefully. If you have any questions about your benefits as presented in this SPD Booklets, please contact the Claims Administrator's Customer Service Department.
This SPD Booklets makes up the Covered Services provisions of the Health Plan Document. Its purpose is to help you understand your coverage and to provide an explanation of the benefits that the Employer offers. Further terms and conditions of the health care coverage and other benefits are contained in the Health Plan Document. A copy of the Health Plan Document is held by your Employer; however, this SPD Booklet provides the health benefits for easy reference.
Important: This is not an insured benefit plan. The benefits described in this SPD Booklet or any rider attached hereto are self-insured by SHBP which is responsible for their payment. Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. provides claim administration services to the Plan, but Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. does not insure the benefits described.
All care must be received from or coordinated through your Primary Care Physician. A Participant has Direct Access to some specified In-Network providers without a Primary Care Physician Referral. Such providers include a gynecologist for obstetrical or gynecological-related conditions; a dermatologist, a chiropractor; and an optometrist or ophthalmologist for medical conditions only. There are no benefits for providers who are not participating with your BlueChoice HMO through the State Health Benefit Plan.
All In-Network primary care must be received from your Primary Care Physician.
A female Participant may refer herself directly to a BlueChoice Healthcare Plan gynecologist for obstetrical or gynecological-related conditions; a Primary Care Physician Referral is not required.
A Participant may go directly to a BlueChoice Healthcare Plan dermatologist; a Primary Care Physician Referral is not required.
Mental Health Care or Substance Abuse Treatment may be obtained by calling 1-800-292- 2879; a Primary Care Physician Referral is not required.
A Participant who seeks eye care may obtain such service directly from a BlueChoice Healthcare Plan ophthalmologist or optometrist who is licensed to provide eye care. This self-referral is for medical conditions only, not routine vision care.
When You Are Away From Home
If you are away from the Service Area on business or pleasure, you still have coverage for
Medical Emergencies. If you have a Medical Emergency, go to the nearest Hospital emergency
room for treatment. If you are outside of the Service Area, you will have to pay for any treatment
you receive. You will be reimbursed except for any required Copayment or Out-of-Pocket
amount. You will need a copy of any bills. Call Customer Service as soon as it's convenient and
one of the representatives will tell you what you should do.
Should your treatment require you to be hospitalized, call the Customer Service Department or have someone call for you within 48 hours.
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