Georgia SHBP Retirees – Review plan benefits
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Review plan benefits & costs

Get a quick overview of your plan options and their benefits and costs. You can also review more detailed information about additional coverage and benefit services the plans offer.

UnitedHealthcare® Group Medicare Advantage
(PPO) - Standard and Premium Plan

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Benefits and costs UnitedHealthcare® Group Medicare Advantage (PPO) Standard Plan UnitedHealthcare® Group Medicare Advantage (PPO) Premium Plan
Annual medical deductible None None
Annual  out-of-pocket maximum $3,500 $2,500
Office and clinic visits $25 copay primary care
$30 copay specialist visit
$15 copay primary care
$25 copay specialist visit
Hospital services (inpatient) 20% coinsurance per admit 20% coinsurance per admit
Hospital services (outpatient) $95 copay (observation room)
$25 copay (PCP)
$30 copay (SPC)
$50 copay (observation room)
$15 copay (PCP)
$25 copay (SPC)
Urgent care $25 copay $20 copay
Emergency $50 copay $50 copay
Prescription drug coverage

Tier 1
$0 copay select generic drugs
$15 copay (30-day retail)
$37.50 copay (90-day mail-order)

Tier 2
$45 copay (30-day retail)
$112.50 copay (90-day mail-order)

Tier 3
$85 copay (30-day retail)
$212.50 copay (90-day mail-order)

Tier 4
$85 copay (30-day retail)
$212.50 copay (90-day mail-order)

Tier 1
$0 copay select generic drugs
$15 copay (30-day retail)
$37.50 copay (90-day mail-order)

Tier 2
$45 copay (30-day retail)
$112.50 copay (90-day mail-order)

Tier 3
$85 copay (30-day retail)
$212.50 copay (90-day mail-order)

Tier 4
$85 copay (30-day retail)
$212.50 copay (90-day mail-order)

Questions? We're here to help.
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Georgia State Health Benefit Plan


Group retiree benefits for the State Health Benefit Plan (SHBP)

This is not my group.
Back to uhcretiree.com »

IMPORTANT DATES

2022 Retiree Option Change Period (ROCP)

Begins: October 18, 2021,
at 12:00 a.m. ET

Ends: November 5, 2021,
11:59 p.m. ET



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Virtual Education Center 


It’s all the information you need to help you understand and access your MAPD plan benefits — in one place, at any time, from your favorite device. Let’s get started.

Need to RSVP for a meeting?

RSVP to reserve your space for one of the ROCP meetings

1-855-477-4455
TTY users, call: 711
8:00 a.m. - 8:00 p.m. local time
Monday through Friday

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Last updated: 09.17.2021 at 12:01 AM CT  H2001_091721JMR