PEBA administers the State Health Plan, which provides health insurance coverage to employees who work for an employer that participates in the plan. To find out if you are eligible for State Health Plan insurance coverage, see our Eligibility page.
State Health Plan is self-funded
The State Health Plan is a self-funded health plan. As such, the State Health Plan does not pay premiums to an insurance company, but rather collects member premiums and employer contributions, holding the funds in trust to be used to pay claims and administrative expenses. Any interest earned from this account is used to help fund the plan.
PEBA is responsible for the prudent fiscal stewardship of the funds and for helping to ensure that the State Health Plan remains an affordable yet comprehensive option for your employer and you. We are also accountable to you as a member of this plan and are committed to providing you with the best value and service possible.
The State Health Plan administers three health insurance plans and offers a supplemental plan for members of the military community. Check out the information at the links below to learn more about each plan, find out which plans you’re eligible for and which plan you think best meets your needs.
Notification of grandfathered status under the ACA
PEBA offers “grandfathered health plans” under the Affordable Care Act (ACA). As a grandfathered plan, PEBA will be able to minimize the increase in State Health Plan premiums while it assesses the future financial impact of the act. As permitted by the ACA, a grandfathered health plan can preserve certain basic health coverage that was already in effect when the law was enacted.
Being a grandfathered health plan means that the plan may not include certain consumer protections of the ACA that apply to other plans, such as the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in the ACA, such as the elimination of lifetime limits on benefits.
Questions regarding which protections apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health plan status can be directed to our Customer Contact Center. You may also contact the U.S. Department of Health and Human Services at www.healthcare.gov.
About your coverage
Under the Affordable Care Act, all group health plan and health insurance issuers offering group health coverage must provide their subscribers with a summary of benefits and coverage. To comply with this requirement, PEBA posts the Summaries of Benefits and Coverage (SBCs) to its website before October each year. You may view and print the SBCs for the State Health Plan’s Standard Plan and Savings Plan here.