Medical Plans

Choosing a health plan is an important decision, which requires careful consideration.  Each health plan offers a variety of services.  Some plans cover preventive and wellness services while others do not.  Because there is no single best plan, the State Heath Benefits Program (SHBP) offers a selection of several quality health plans, which include Preferred Provider Organization (PPO) plans, Health Maintenance Organization (HMO) plans, and High Deductible Health plans.

AVAILABLE MEDICAL PLANS:

  • PPO Plans:  NJ Direct15; NJ Direct1525; NJ Direct2030; NJ Direct2035; Aetna Freedom15; Aetna Freedom 1525; Aetna Freedom2030; Aetna Freedom2035.

  • HMO Plans: Aetna HMO; Aetna HMO1525; Aetna HMO2030; Aetna HMO2035; Horizon HMO; Horizon HMO1525; Horizon HMO2030; Horizon HMO2035.  Note:  The service areas for Horizon HMOs are limited to N.J., Delaware and bordering counties of Pennsylvania and New York.

  • High Deductible Health Plans: NJ Direct HD150; NJ Direct HD4000; Aetna Value HD1500; Aetna Value HD4000.

Detailed information about the SHBP’s medical plans is available through the Summaries of Benefits and Coverage posted online at: www.state.nj.us/treasury/pensions/hb-sbc-home.shtml  go to active employees and monthly to access the summaries.

PLAN RATES:

Plan rates are approved by the State Health Benefits Commission.  Rate charts for the State Monthly Group are posted online at: www.state.nj.us/treasury/pensions/health-benefits.shtml  you can also download forms or membership handbooks and the HIPAA Privacy Notice at this link. 

Pursuant to the Pension and Health Benefit Reform (Chapter 78 P.L. 2011), employees must pay a percentage of the medical/prescription plan premiums.  The amount of the contribution is calculated using the level of coverage selected and a scale of percentages that increase with the employee’s annual salary.  The appropriate percentage is multiplied by the premium cost of the medical/prescription drug plans selected.  The total contribution cannot be less than the 1.5% of annual salary required under Chapter 2, P.L. 2010.  Most employees are currently subject to a four-year phase-in of contribution rates, and pay at the “Year Three” contribution level.  “Year Three” contribution rates apply for the period of July 1, 2013 through June 30, 2014.  “Year Four” full contribution rates will become effective July 1, 2014 and thereafter.  

WAIVING SHBP COVERAGE:

State employees are permitted to waive SHBP medical/prescription drug coverage to avoid the required employee contribution, provided that they have other health care coverage.  To waive coverage a SHBP Waiver form and a Health Benefit Application must be completed.  Forms are available in the Human Resources Office.

OPEN ENROLLMENT:

The month of October is the annual Open Enrollment Period.  During Open Enrollment employees can make general changes (adding or deleting dependents, changing coverage levels, etc.) or enroll in a different medical plan.  All changes made during the Open Enrollment period become effective on January 1st of the following year.