Employees eligible for the plan would include sole proprietors or those who work for small businesses of 50 employees or less. Eligible employees must work at least 20 hours per week and earn less than 300 percent of the Federal Poverty Level (FPL), or approximately $62,000/year for a family of four or $30,600/year for a single adult. Employees that earn more than the income cap are still eligible for coverage with the premiums split between the employer and employee.

The goal is to offer this segment of Georgia’s uninsured a variety of options for private health care coverage. The options vary based mostly on the level of premium the employee chooses to pay, such as:

• Benchmark benefit plan comparable to the plan offered to state employees
• Basic benefit package meeting the requirements of the Small Business Employee Choice of Benefits Health Insurance Plan Act: a basic employee health option authorized through SB 174 which went into effect July 1, 2005.
• High Deductible Health Plan with a Health Savings Account (HSA).

The employer must offer at least the Benchmark plan to its employees if they choose to participate. Employees will not qualify if he or she already has access to health insurance through an employer, a spouse’s employer, or qualifies for Medicaid or TRICARE. All participants must be a legal resident of Georgia.

Under Governor Perdue’s proposal, the plan will be funded by General Appropriations and federal funds. The Department of Community Health (DCH) will apply for a federal 1115 Waiver, which allows changes to benefits, reimbursement and coverage of expansion groups. Through the waiver process, the state will commit to a program that can be formally evaluated.