PEBA administers the State Health Plan. Participating public employers offer the Plan's health insurance coverage to employees. To see if you are eligible for State Health Plan insurance coverage, visit our Eligibility page.
The State Health Plan includes three health insurance plans. It also offers a supplemental plan for members of the military community.
As a self-funded plan, the State Health Plan does not pay premiums to an insurance company. Instead, employee premiums and employer contributions are held in a trust fund. Claims and administrative expenses are paid from this fund. Any interest earned from this account helps fund the plan.
Grandfathered status under the ACA
PEBA believes the State Health Plan is a “grandfathered health plan” under the Patient Protection and Affordable Care Act (ACA). The ACA allows grandfathered health plans to preserve certain basic health coverage in effect at the time of the law's enactment. Because of this, the State Health Plan may not include certain ACA consumer protections that apply to other plans. An example is the ACA requirement that a plan provide preventive health services without any cost sharing. Grandfathered health plans must comply with certain other ACA consumer protections. An example is the elimination of lifetime limits on benefits.