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September 25, 2013

RE:   SHBP Approves Mental Health Parity Plan

Dear Mayor:

Recently the State Health Benefits Program (SHBP) Plan Design Committee unanimously approved the implementation of Mental Health Parity in the benefits it provides, as well as a new Wellness Program that will offer employees financial incentives of up to $250 a year to encourage them to maintain healthy lifestyles, and four new lower-cost health plan options.  All the changes will take effect in Plan Year 2014.

The approved changes, based on information we have received from Treasury, are as follows:

Mental Health Parity

Currently, coverage for biologically-based mental illness is treated like any other illness under the SHBP.  Mental Health Parity requires that non-biologically-based mental illness, such as Anxiety Disorders, Adjustment Reaction, Depressive Disorder, Eating Disorder, Hyperkinetic Syndrome or Delays in Development, is treated the same as any other illness.  However, the benefits are subject to medical necessity.  

Wellness Program

The Wellness Program will provide incentives to both employees and their covered spouse/partners and employers.  Employees and their covered spouses/partners can voluntary participate in the SHBP Wellness Program.  Wellness Program participants will be entitle to incentive rewards (gift cards) based on the number of points (viewable online) earned in a given calendar year.  Employers will be entitled to a reduction in their premium rate based on employee participation and average points achieved by their employees.  Employers will be eligible for this incentive beginning in plan year 2016 based on employee activity in 2015. SHBP vendors will be responsible for tracking points earned by program participants in their plans.

The program is phased in over 3 years and begins with “know your numbers”.  The first year will be focused on building individual health awareness and “knowing your numbers,” by participants completing Health Assessments and Biometric Screenings.    Employees and their spouses/partners will each be eligible up to a $100 incentive for achieving these two tasks

The second year of the phase-in will focus on taking action and engaging the employee and their spouse/partners.  In addition to the Health Assessments and Biometric Screenings employees and their covered spouses/partners will be able to receive points for flu shots, age and gender appropriate screenings (i.e. physicals, mammograms, and colon cancer screenings), online coaching, online activities and telephonic wellness/disease management coaching.  Employees and their spouses/partners will be eligible for up to a $200 incentive.  Employers whose total number of members in the SHBP average 300 or more points will see their premium rate reduced by 1% the following year.

The third year of the phase-in will focus on continuous engagement and higher reward thresholds based on engagement and adherence for employees and spouses/partners. 

New Plan Options for 2014

There will be four new health plan options for active SHBP members that will offer them a choice of 2035 Preferred Provider Organization (PPO) and Health Maintenance Organization (HMO) plans from both Aetna and Horizon. The new plans will carry higher copays and deductibles than other coverage options but could reduce employees annual premium costs by as much as 15 percent compared to the lowest cost plan currently offered.  The HMO plan will not cover out-of-network benefits.

We will continue to provide information on these new changes as the Division of Pension and Health Benefits releases information.

Very truly yours,

William G. Dressel, Jr.
Executive Director



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