Key Updates for Georgia Commercial Health Plan Providers
Georgia commercial health plan providers should review important updates regarding out-of-network services, non-covered services, balance billing requirements, and new prescribing rules for SHBP members effective February 2026.
Out-of-network referrals
- Use in-network providers whenever possible.
- Use out-of-network providers only for emergencies, or when an out-of-network referral/prior authorization is specifically required.
- When out-of-network is needed, follow the administrative guide section:
“Nonparticipating health care providers (all commercial plans)”.
Non-covered services and balance billing
Before providing a non-covered service:
- Tell the member the service is not covered, and they may have to pay out of pocket.
- Get the member’s agreement in advance using the Member Advance Notice form.
This helps prevent unexpected charges and keeps documentation in order.
Weight-loss medication rule for SHBP (Effective 01 February 2026)
For Georgia State Health Benefit Plan (SHBP) members enrolled in a UnitedHealthcare HMO or a high-deductible health plan (HDHP):
- Only 9amHealth providers can prescribe weight-loss medications
- This rule does not apply to diabetic GLP-1 medications such as Ozempic and Mounjaro
- Prior authorisations or prescriptions from any other providers will not be accepted
If an SHBP member currently has an active prior authorization for a weight-loss medication, they will be instructed to enroll with 9amHealth once that authorization ends. Please direct members who need weight-loss medications to:
- join9am.com/shbp
- 888-870-9542
Note: SHBP has already notified affected members and asked them to enroll with 9amHealth. Please remind members as needed, so their treatment continues without delays.
