Joint Replacement Program

The State Health Plan is working with select high-quality orthopedic specialists to offer a joint replacement program for eligible employees in need of knee, hip or shoulder replacement surgery. The program simplifies the entire process – from pre-surgery consults and testing, to post-surgery follow-up and physical therapy, with one simple payment. 

The costs and services related to the joint replacement surgery will be billed together eliminating the hassles of multiple billing statements, which is often referred to as a bundled payment.

If member is deemed eligible for the program, by one of the participating providers below, they may be eligible for a single copay instead having their deductible and coinsurance applied to their surgery! 

If a member is eligible, there will be no deductible or coinsurance applied to bundled services. Instead, a member will only be responsible for paying a copay.

  • Enhanced PPO Plan (80/20) – Member only pays a $600.00 copay
  • Base PPO Plan (70/30) – Member only pays a $900.00 copay

The bundled payment includes the cost of the following medical charges:

  • Orthopedic surgeon visits
  • Hospital or surgical facility care
  • Anesthesia 
  • Physical Therapy visits
  • Emergency Room visits related to your surgery

Participating providers have agreed to coordinate care and billing related to a total knee, hip or shoulder replacement. Click here for a list of participating providers

Please Note: Not all provider locations may participate in this program. Check with the provider to confirm eligibility for bundled procedures as certain restrictions may apply.