Medical Plans
Recent labor agreements and Chapter 103, P.L. 2007, required that new medical plans be offered to active and retired members of the New Jersey State Health Benefits Program (SHBP). This letter outlines the new plan designs for State active employees and State retirees.
NEW MEDICAL PLANS
The SHBP is offering two types of medical plans, Preferred Provider Organizations (PPO) and Health Maintenance Organizations (HMO). The new PPO plans will be known as NJ DIRECT10, which is the successor plan to the Traditional Plan, and NJ DIRECT15 which replaces NJ PLUS. (Please note that certain labor agreements have not been settled and others do not expire until 2008; for employees covered by these groups, the Traditional Plan and NJ PLUS will continue until the agreements are ratified.)
In May 2007, the SHBP released a Request for Proposal to obtain bids for the administration of the new plans. In November 2007, the bidding process concluded with the PPO contract awarded to Horizon Blue Cross Blue Shield of New Jersey and HMO contracts awarded to Aetna and CIGNA.
- For State Monthly employees and retirees, the effective date for the start of the NJ DIRECT and HMO plans is April 1, 2008.
- For State Biweekly employees, the effective date of coverage will be March 29, 2008.
Additional dates significant to the rollout of the NJ DIRECT and HMO plans are discussed later in this letter.
NJ DIRECT and the HMOs are managed-care plans. Managed-care plans provide coverage for preventive care such as annual checkups and screening tests, well-baby visits, and immunizations, in the hope of avoiding serious illness and more costly treatment. Services are monitored for medical necessity and appropriate levels of care.
Plan Rates
Most State employees, as required under recent labor agreements, pay a health contribution of 1.5% of salary for SHBP medical and/or prescription drug plan coverage. Therefore, the payroll deduction of a State employee is the same regardless of which plan is chosen or the level of coverage that is selected.
Premium rates will be released in January 2008 after approval by the State Health Benefits Commission. The SHBP will contact retirees directly to provide them with information about the new plans and retired group rates when it is available. Employers should watch the SHBP Web site at: www.state.nj.us/treasury/pensions/shbp.htm for retiree rate information.
EMPLOYEE ELIGIBILITY
State Active employees covered under labor agreements effective July 2007 are eligible for enrollment in NJ DIRECT15, Aetna HMO, or CIGNA HMO.
Most State retirees are eligible to enroll in either NJ DIRECT 10, NJ DIRECT 15, Aetna HMO, or CIGNA HMO.
Participating Providers
NJ DIRECT and both HMOs are available nationwide. Employees should check with the medical plans to determine provider participation.
The SHBP is also in the process of updating the online Unified Provider Directory with information about providers in New Jersey and neighboring states who participate in the new plans. The Unified Provider Directory is available from a link on the SHBP home page.
Provider directories will not be available in printed form but are available online at the plan administrator Web sites.
PLAN IMPLEMENTATION
The SHBP and Division of Pensions and Benefits will provide State Employers with follow-up mailings as new information becomes available.
SPECIAL OPEN ENROLLMENT
The SHBP will hold a Special Open Enrollment for employees from January 28 through February 15, 2008. Detailed plan information for distribution to employees will be shipped to employers by the end of January.
The current SHBP plans — NJ PLUS, the Traditional Plan, and three HMO plans: AmeriHealth, Health Net, and Oxford Health Plans — will no longer be available to employees effective March 28, 2008 for Biweekly State employees and March 31, 2008 for State Monthly employees and retirees. As noted previously, certain labor agreements have not been settled and others do not expire until 2008. For employees covered by these groups, the Traditional Plan and NJ PLUS will continue until the agreements are ratified. However, AmeriHealth, Health Net, and Oxford Health Plans will terminate for ALL employees and retirees effective March 31, 2008 (March 28th for State Biweekly employees) regardless of union affiliation.
Current subscribers will be automatically transferred to the new plan offerings as outlined below unless they submit a SHBP Application choosing another plan.
- State Employees enrolled in NJ PLUS or the Traditional Plan will be automatically transferred to NJ DIRECT15.
- State Employees enrolled in Aetna HMO or CIGNA HMO will remain in the HMO in which they are currently enrolled.
- All employees enrolled in AmeriHealth, Health Net, or Oxford Health Plans must choose another health plan or they will automatically be transferred to NJ DIRECT15.
- The Special Open Enrollment is for medical plan changes only. Members will not be permitted to add dependents to coverage, change coverage levels, or make changes to dental or prescription drug plans.