September 10, 2010
TO:
State Departmental Certifying Officers
State Departmental Human Resources Directors
State Biweekly Human Resources Representatives
FROM:
New Jersey State Health Benefits Program
SUBJECT:
SHBP Open Enrollment 2010 — State Biweekly Employers
The State Health Benefits Program (SHBP) Open Enrollment period for all State employees
will begin on October 1, 2010 and end on October 29, 2010. All changes to coverage
made during this open enrollment will be effective on January 1, 2011 for State employees
paid through the State Centralized Payroll Unit.
For changes made during this Open Enrollment, completed employer-certified Health Benefit
Applications and/or Dental Plan Applications should be forwarded to the Health Benefits
Bureau as soon as they are received from employees. The last day that certified applications
may arrive at the Health Benefits Bureau to be effective for the start of the new plan year is
November 5, 2010.
Note: Be sure to see the information on page 6 of this letter regarding important
changes in the distribution of Open Enrollment publications.
COVERAGE OF CHILDREN UNTIL AGE 26
Provisions of the federal Patient Protection and Affordable Care Act (PPACA) include the
coverage of children until age 26. Effective with the plan year beginning January 1, 2011,
the SHBP will extend the coverage of children until December 31 of the year a child turns
age 26 (or older if a disabled dependent child – see page 2)
Employers should note that the PPACA mandates that employers inform employees of
the provisions of this new legislation. In addition to an article in the Open Enrollment
edition of the Health Capsule newsletter, an informational flier is attached for distribution to
your enrolled employees.
Under the PPACA a “child” is defined as a subscriber’s child until age 26, regardless of the
child’s marital, student, or financial dependency status — even if the young adult no longer
lives with his or her parents. However, the extension of coverage is only available if the adult
child is not eligible to enroll in other employer-based coverage (aside from coverage through
the parent).
•
During the October Open Enrollment, parents may enroll/re-enroll children who
meet the above criteria and who will be under age 26 as of December 31, 2010. A
photocopy of the child's birth certificate that includes the covered employee’s name
must be submitted along with the application (additional supporting documentation is
required for a stepchild, foster child, or a legal guardianship – see page 2).
New Jersey Is An Equal Opportunity Employer
z
Printed on Recycled and Recyclable Paper
Page 2 of 7
SHBP Open Enrollment
September 10, 2010
•
Covered children who turn age 23 during 2010 do not need to enroll during
October to continue coverage in 2011. Coverage will be continued automatically.
•
Children ages 23 through 26 who are currently enrolled for extended SHBP
coverage under the provisions of Chapter 375, P.L. 2005, will need to be enrolled
during October for SHBP coverage as a child under age 26.
DOCUMENTATION REQUIREMENTS FOR OTHER DEPENDENTS
There are documentation requirements if a member is enrolling other dependents for
coverage (spouse, partner, step/foster child, disabled child over age 26). Along with the
employer-certified Health Benefit Applications and/or Dental Plan Application the following
documents are required to verify the dependent’s relationship to the member and eligibility
for coverage.
•
Employees who are enrolling a spouse in the SHBP for the first time are required to
provide a photocopy of the marriage certificate and a copy of the top half of the front
page of the employee’s most recently filed federal tax return (Form 1040*) that lists the
spouse.
•
An employee enrolling a civil union partner is required to provide a photocopy of
the NJ Civil Union Certificate — or a valid certification from another State of foreign
jurisdiction that recognizes same-sex civil unions (for an eligible domestic partner
provide a photocopy of the NJ Certificate of Domestic Partnership that is dated prior to
February 19, 2007, or a valid certification from another State of foreign jurisdiction that
recognizes same-sex domestic partnerships) and a photocopy of the top half of the
front page of the employee’s most recently filed NJ income tax return* that also lists
the partner.
*If the Form 1040 does not list the spouse or partner, the employee should provide a photocopy
of a recent (within 90 days of application) bank statement or utility bill that includes both name
of the employee and spouse/partner and is received at the same address. Employees may
black out all financial information and all but the last 4 digits of any Social Security numbers.
•
Employees who are enrolling a child in the SHBP for the first time are required to
provide a photocopy of the child’s birth certificate showing the employee’s name as a
parent.
For a stepchild provide a photocopy of the child’s birth certificate showing the
spouse/partner’s name as a parent and a photocopy of marriage/partnership
certificate showing the names of the employee and spouse/partner.
For a grandchild, foster child, or legal guardianship provide a photocopy of a Final
Court Order with the presiding judge’s signature and seal attesting to the legal
guardianship by the covered employee.
Note: Additional documentation requirements for the continuation of coverage for
children with disabilities over the age of 26 or for children until age 31 under Chapter
375, P.L. 2005, can be found on the SHBP Web site at:
www.state.nj.us/treasury/pensions/health-benefits.shtml
To ensure that the documentation submitted is properly matched to the employee’s record,
the Health Benefits Bureau requests that employers provide the employee’s Social Security
number and last name on the copy of the required documentation.
Page 3 of 7
SHBP Open Enrollment
September 10, 2010
MINIMUM WORK HOURS FOR COVERAGE
A State employee hired after May 21, 2010, is required to work a minimum of 35 hours per
week* to be considered “full-time” and eligible for coverage under the SHBP.
Similarly, after May 21, 2010, any newly appointed or elected officer is required to work a
minimum of 35 hours per week* to be eligible for coverage under the SHBP.
* Or more if required by contract.
An employee or appointed/elected officer of the State enrolled on or before May 21, 2010, is
eligible for continued coverage under the SHBP based on the minimum work hour
requirements in place prior to May 21, 2010, provided there is no break in the
employee’s/officer’s service or reduction in work hours.
MULTIPLE SHBP/SEHBP COVERAGE IS PROHIBITED
Chapter 2, P.L. 2010, effective May 21, 2010, specifically prohibits two members who are
each enrolled in SHBP/SEHBP plans from covering each other. Therefore, an eligible
individual may only enroll in the SHBP/SEHBP as an employee or retiree, or be covered as a
dependent.
In addition, eligible children may only be covered by one participating SHBP/SEHBP
subscriber.
MEDICAID AND CHILDREN’S HEALTH INSURANCE PROGRAMS NOTICE
The federal Children's Health Insurance Program Reauthorization Act requires that
employees receive annual notification of premium assistance for employer-sponsored health
coverage available through Medicaid and Children’s Health Insurance Programs (CHIP).
A sample Medicaid/CHIP Notice is included with this mailing that employers may distribute to
enrolled employees. The Medicaid/CHIP Notice will also be incorporated in the Division’s
annual mailing of HIPAA/COBRA information so the notices can be distributed in future
years.
2011 SHBP RATES FOR EMPLOYERS
The State Health Benefits Commission has approved medical, dental, and prescription drug
plan rates for the 2011 plan year. These rates are based upon the recommendation of the
Commission’s actuarial consultant, Aon Consulting.
Effective January 1, 2011, SHBP plan rates for the State Active Biweekly Group will see the
following percentage of change.
MEDICAL PLAN RATE CHANGES FOR 2011
PLAN TYPE
RATE CHANGE
NJ DIRECT15
Aetna HMO
CIGNA HealthCare HMO
Prescription Drug Plan
6.1%
9.4%
8.9%
5%
Page 4 of 7
SHBP Open Enrollment
September 10, 2010
DENTAL PLAN RATE CHANGES FOR 2011
PLAN TYPE
RATE CHANGE
Dental Expense Plan
Dental Provider Organizations (DPO)
(Aetna, CIGNA, Community)
BeneCare DPO
Healthplex DPO
Horizon DPO
2%
0%
1%
-5%
2%
MEDICAL PLANS, EMPLOYEE COSTS, AND COPAYMENTS
Most State employees contribute 1.5 percent of annual base salary for SHBP medical plan
and/or prescription drug plan coverage regardless of the medical plan, level of coverage
selected, salary level, or date of hire.
The SHBP currently offers these State employees a choice of one of three medical plans.
•
NJ DIRECT15 — a Preferred Provider Organization administered by Horizon Blue
Cross Blue Shield of New Jersey that offers a selection of both in-network coverage
with a $15 office visit copayment and out-of-network coverage subject to deductibles
and coinsurance; or
•
Aetna HMO or CIGNA HealthCare HMO — standard Health Maintenance
Organization (HMO) plans that offer in-network coverage through a primary care
physician for a $15 office visit copayment.
•
For each of the medical plans, the copayment for a visit to an emergency room is $50.
The emergency room copayment is waived if the member is admitted to the hospital.
A side-by-side comparison of medical plan benefits is available in the Plan Comparison
Summary for State Employees, available for viewing or printing at the SHBP Web site:
www.state.nj.us/treasury/pensions/health-benefits.shtml
PRESCRIPTION DRUG PLANS AND COPAYMENTS
Prescription drug coverage is offered to most eligible State employees through the
Employee Prescription Drug Plan. The plan has a three tier copayment design.
•
Copayments for a 30 day supply when purchased at a retail pharmacy are $3 for generic
drugs, $10 for brand name prescription drugs without generic equivalents, and $25 for
brand name drugs where a generic equivalent is available.
•
Mail order prescription drug copayments for up to a 90-day supply are $5 for generic
drugs, $15 for brand name drugs without generic equivalents, and $40 for brand name
drugs where a generic equivalent is available.
For more information, see the Employee Prescription Drug Plan Member Handbook.
Medco Health Solutions, Inc., of Franklin Lakes, NJ, is the pharmacy benefits manager for
the SHBP.
Page 5 of 7
SHBP Open Enrollment
September 10, 2010
WAIVING SHBP COVERAGE
State employees are permitted to waive SHBP medical and prescription coverage to avoid
the 1.5 percent health contribution from salary — provided the employee has other health
care coverage. To waive coverage a SHBP State Waiver form and a Health Benefit
Application must be completed and submitted by October 29, 2010. To waive coverage
effective January 1st, employees should indicate “Open Enrollment” on the waiver form;
otherwise, the waiver will be processed on a timely basis.
DENTAL PLANS AND EMPLOYEE COSTS
Dental coverage is offered to all eligible State employees through the Employee Dental
Plans. For plan year 2011, seven different dental plans are offered based on one of two
different plan designs — Dental Plan Organizations (DPO) and a Dental Expense Plan.
•
Six DPOs are available: Aetna DMO; BeneCare; CIGNA DHMO; Community
Dental Associates; Healthplex; and Horizon Dental Choice. DPOs contract with a
network of providers for dental services. When you use a DPO dentist, diagnostic and
preventive services are covered in full. Most other eligible expenses require a small
copayment. You must use providers participating with the DPO you select to receive
coverage. Be sure you confirm that the dentist or dental facility you select is taking
new patients and participates with the SHBP Employee Dental Plans, since DPOs
also service other organizations.
•
The Dental Expense Plan is an indemnity type plan administered by Aetna that
allows members to obtain services from any dentist. After satisfying an annual
deductible (no deductible for preventive services), members are reimbursed a
percentage of the reasonable and customary charges for most services.
The employee cost for coverage under a dental plan is 50 percent of the actual dental
plan premium. Therefore, the employee cost varies depending on which dental plan an
employee chooses; however, the rate for coverage under a DPO remains considerably less
expensive than the Dental Expense Plan. Rate charts for dental coverage and Fact Sheet
#37, Employee Dental Plans — with a side-by-side comparison of dental plan benefits — are
available on our Web site: www.state.nj.us/treasury/pensions/health-benefits.shtml
Employees must remain enrolled in a dental plan for a minimum of 12 months before
they will be allowed to change plans. This means that if an employee was not enrolled in
a dental plan as of January 2, 2010, they will not be permitted to change dental plans during
this Open Enrollment.
TAX$AVE AND THE SHBP
The State Employees’ Tax Savings Program (Tax$ave) Open Enrollment Period runs from
October 1 until October 31, 2010 (concurrent with the SHBP Open Enrollment Period).
Tax$ave is a benefit program available to full-time State employees who are eligible for the
SHBP. Tax$ave can save your employees tax money by paying health and dental benefit
premiums and eligible unreimbursed medical and/or dependent care expenses from beforetax dollars.
Separate Tax$ave Open Enrollment materials were distributed to employers and contain
more information about these valuable benefits. Please also note the items detailed below
that relate to both Tax$ave and SHBP medical and dental plan enrollment.
Page 6 of 7
SHBP Open Enrollment
September 10, 2010
•
Limitations on Plan Changes if Enrolled in POP — Internal Revenue Service (IRS)
rules require that for an employee covered by the Premium Option Plan, payroll
deductions for health and dental plan benefits remain the same for the entire plan year.
Therefore, no coverage level changes can be made which result in a change in the
amount of an employee’s health and/or dental plan deduction unless a Qualifying Event
has occurred.
•
Tax$ave, Civil Unions, and Domestic Partners — SHBP members need to be aware
of the possible federal tax implications of adding a civil union partner or domestic partner
to SHBP benefits. Since the federal tax code does not view civil union or domestic
partners in the same manner as spouses, an employer may have to treat the civil union
or domestic partner SHBP benefit as taxable to the employee and withhold federal
income, Social Security, and Medicare taxes on its value. Similarly, since the partner's
coverage is a federally taxable benefit, an employee who participates in the Tax$ave
Premium Option Plan cannot make pre-tax payments for the cost of a civil union or
domestic partner's coverage. Pre-tax dollars may still be used to pay for the employee's
portion of the cost of his or her own and dependent children's coverage. If an employee
wants to claim a federal tax dependency exemption for a civil union or domestic partner,
he or she should contact the Internal Revenue Service or see IRS Tax Topic 354 —
Dependents for more details.
ONLINE DISTRIBUTION OF OPEN ENROLLMENT MATERIALS
Please Note: In compliance with State initiatives to provide paperless services, the Health
Capsule newsletter and most other Open Enrollment informational materials will only be
available in electronic format for this year’s Open Enrollment.
Access to Open Enrollment publications are available through links at the Division of
Pensions and Benefits Web site: www.state.nj.us/treasury/pensions/health-benefits.shtml or
as PDF attachments provided with the distribution of this letter.
Employers should inform employees to access the Open Enrollment information online or
provide the PDF versions via e-mail attachment or your Departmental Intranet.
For cases where online or e-mail notification is not possible, a paper flier giving instructions
on accessing the Open Enrollment publications is provided with this letter and can be copied
and distributed as required.
MILESTONES — Enclosed is a milestone chart that lists the critical dates of the Open
Enrollment period and outlines the efforts being made to educate employees. Please use this
chart as a checklist to guide your activities during open enrollment.
RATE CHARTS — Enclosed you will find employer rates for medical, prescription drug, and
dental plans.
Because most State employees pay a contribution of 1.5 percent of salary rather than a set
premium, employee rate charts for medical plans and the Employee Prescription Drug Plan
are no longer provided.
Dental premium rate charts for employees are posted to the SHBP Web site:
www.state.nj.us/treasury/pensions/health-benefits.shtml
HEALTH CAPSULE — The Health Capsule newsletter announces the SHBP Open
Enrollment to employees, lists important changes, and provides other information that may
affect employee benefit selection. A sample is enclosed for your review.
Page 7 of 7
SHBP Open Enrollment
September 10, 2010
Employees should be informed to access the Health Capsule online or be provided the PDF
version via e-mail attachment or your Departmental Intranet.
CHECK MESSAGES — Beginning September 17, and through the end of the Open
Enrollment, paycheck messages will be provided to employees paid through the State
Centralized Payroll Unit. A copy of the message text is enclosed.
HEALTH PLAN CONTACTS — A list of medical and dental plans, telephone contact
information, Web site addresses, and service areas is enclosed. Please copy and provide
this information to your employees for obtaining detailed plan information, inquiries about
claims, or to find participating medical or dental providers*.
* Note: The online Unified Provider Directory (UPD) is no longer available.
A separate list of employer marketing contacts for the medical and dental plans is also
enclosed. Use these contacts to obtain plan specific literature. (These telephone numbers
are not for member services. Please do not give these telephone numbers to your
employees.)
HEALTH AND DENTAL PLAN APPLICATIONS — The medical plans (including prescription
drug coverage) and the Employee Dental Plans use two different applications. The health
and dental applications are available for printing from the SHBP Web site at:
www.state.nj.us/treasury/pensions/health-benefits.shtml
SUMMARY PROGRAM DESCRIPTION (SPD) BOOKLET, PLAN HANDBOOKS, AND
HEALTH PLAN COMPARISON SUMMARY CHARTS — The Summary Program
Description, Member Handbooks for the individual plans, and SHBP Plan Comparison
Summary charts are being revised. Updates — where needed — will be online for the start of
the 2011 plan year.
These publications are available as online, printer friendly documents on the SHBP Web site
at: www.state.nj.us/treasury/pensions/health-benefits.shtml
Please encourage your
employees to access these materials online. Bulk supplies of print copies are no longer
available.
ADDITIONAL INFORMATION
If you have any questions about the SHBP Open Enrollment Period or the information in this
letter, please contact our Office of Client Services at (609) 292-7524 to speak with an
Employer Group representative or send an e-mail to: pensions.nj@treas.state.nj.us
Thank you for your assistance in making the SHBP Open Enrollment Period a success for
your employees.
Enclosures:
SHBP Open Enrollment Milestone Chart
Open Enrollment Check Messages
Medical and Dental Plan Rates
Health Capsule Newsletter
Open Enrollment Flier for Online Access to Publications
Coverage of Children Until Age 26 flier
Medicaid/CHIP Notice
Medical/Dental Plan Employee Contact Information
Medical/Dental Plan Marketing Contacts
(STATE BIWEEKLY – MILESTONE – 2010)
FALL 2010 SHBP OPEN ENROLLMENT MILESTONE CHART
for State Biweekly Employers
Note: If the event is underlined, you should be accomplishing the event.
PROJECTED
DATE
EVENT
September 17
First paycheck message to employees paid through the State
Centralized Payroll Unit announcing Open Enrollment to start
October 1, 2010.
Late-September
Employers should inform employees to access the Health
Capsule newsletter online or provide the publication directly via
the PDF attachments to the Certifying Officers’ Open Enrollment
Announcement Letter.
October 1
SHBP Open Enrollment Begins.
“Reminder” paycheck message to employees paid through
State Centralized Payroll.
October 29
Open Enrollment “last chance” paycheck message to employees
paid through State Centralized Payroll.
SHBP Open Enrollment Ends.
November 5
Employer certified applications due at the Health Benefits
Bureau.
December 4
Begin any required dental plan deductions for employees paid
through Centralized Payroll (start of pay period #26 – check date
December 23).
January 1, 2011
SHBP Open Enrollment changes effective for State employees
paid through State Centralized Payroll.
Revised – 9/1/2010
SHBP and TAX$AVE
Fall 2010 Open Enrollment check messages
Pay Period #19 (September 17). Open Enrollment announcement
The Open Enrollment for the State Health Benefits Program (SHBP), and State
Employees Tax Savings Program (Tax$ave) begins October 1, 2010. As part of
the State’s “green initiative”, watch for electronic distribution of Open Enrollment
information from your benefits administrator — or employees can get Open
Enrollment literature online at: www.state.nj.us/treasury/pensions
PP #20 (October 1). Reminder announcement
The Open Enrollment for the SHBP and Tax$ave has begun. You can enroll in or
change SHBP health, prescription drug, and dental plans or add dependents.
Since participation in a Tax$ave FSA Plan must be renewed annually, you must
act if you want to participate in an FSA Plan during 2011. Employees can get
Open Enrollment literature online at: www.state.nj.us/treasury/pensions
PP #22 (October 29). Last chance announcement
The Open Enrollment for the SHBP and Tax$ave is ending. Act now to enroll in
or change health, prescription drug, and dental plans, or add dependents. Health
benefit applications are due to your benefits administrator by October 29, 2010.
Tax$ave FSA Plan applications must be submitted online or postmarked no later
than October 31, 2010. Get Open Enrollment literature online at:
www.state.nj.us/treasury/pensions
DEPARTMENT OF THE TREASURY - DIVISION OF PENSIONS AND BENEFITS
NEW JERSEY STATE HEALTH BENEFITS PROGRAM
STATE BIWEEKLY ACTIVE GROUP
RATES EFFECTIVE 1/01/2011 to 12/30/2011
For Employees Paying Contribution of 1.5% of Salary for Any Plan or Coverage Level;
NJ DIRECT15 and HMO office visit copayment $15
PLAN/COVERAGE
DESCRIPTION
TOTAL
NJ DIRECT15 - #150
Single
Member & Spouse/Partner
Family
Parent & Child
$229.92
$517.33
$574.82
$321.90
AETNA, INC. - #005
Single
Member & Spouse/Partner
Family
Parent & Child
$236.34
$531.75
$590.84
$330.86
CIGNA HealthCare HMO - #006
Single
Member & Spouse/Partner
Family
Parent & Child
$237.61
$534.62
$594.02
$
$332.64
PRESCRIPTION DRUG PROGRAM - #203
Single
Member & Spouse/Partner
Family
Parent & Child
$62.46
$140.55
$156.16
$87.45
DEPARTMENT OF THE TREASURY - DIVISION OF PENSIONS AND BENEFITS
NEW JERSEY STATE HEALTH BENEFITS PROGRAM
DENTAL PLAN RATES
STATE BIWEEKLY ACTIVE GROUP
RATES EFFECTIVE 1/01/2011 to 12/30/2011
DESCRIPTION
OF COVERAGE
STATE
CONTRIBUTION
EMPLOYEE
CONTRIBUTION
TOTAL
$9.91
$17.20
$28.15
$20.85
$9.89
$17.20
$28.14
$20.84
$19.80
$34.40
$56.29
$41.69
$5.86
$10.18
$16.65
$12.33
$5.85
$10.16
$16.63
$12.32
$11.71
$20.34
$33.28
$24.65
$5.54
$9.62
$15.73
$11.65
$
$5.52
$9.61
$15.72
$11.64
$
$11.06
$19.23
$31.45
$23.29
$
$4.98
$8.65
$14.14
$10.48
$4.96
$8.63
$14.13
$10.47
$9.94
$17.28
$28.27
$20.95
$4.50
$7.80
$12.77
$9.46
$4.48
$7.80
$12.76
$9.45
$8.98
$15.60
$25.53
$18.91
$4.60
$7.98
$13.07
$9.68
$4.59
$7.98
$13.05
$9.67
$9.19
$15.96
$26.12
$19.35
$4.82
$8.39
$13.71
$10.17
$4.81
$8.38
$13.71
$10.15
$9.63
$16.77
$27.42
$20.32
DENTAL EXPENSE PLAN - #399
Single
Member & Spouse/Partner
Family
Parent & Child
DENTAL PROVIDER ORGANIZATIONS (DPO)
BENECARE (DPO #301)
Single
Member & Spouse/Partner
Family
Parent & Child
COMMUNITY DENTAL (DPO #302)
Single
Member & Spouse/Partner
Family
Parent & Child
CIGNA (DPO #305)
Single
Member & Spouse/Partner
Family
Parent & Child
HEALTHPLEX (DPO #307)
Single
Member & Spouse/Partner
Family
Parent & Child
HORIZON DENTAL CHOICE (DPO #317)
Single
Member & Spouse/Partner
Family
Parent & Child
AETNA DMO (DPO #319)
Single
Member & Spouse/Partner
Family
Parent & Child
N e w J e r s e y Sta t e H e a l t h B e n e f i ts P r o g r a m
SH
BP
Health Capsule
The Division of Pensions and Benefits For State Employees Issue #26
SHBP Open Enrollment Begins October 1
pen Enrollment is your annual opportunity to closely review your medical, prescription drug, and dental benefits. The State Health Benefits Program
(SHBP) will be holding the Open Enrollment period for
Plan Year 2011 for State employees from October 1 through
October 29, 2010. Any changes made to your coverage during Open Enrollment will become effective on January 1,
2011 for State employees paid through the State's
Centralized Payroll Unit and all other State employees.
O
During the Open Enrollment
During the Open Enrollment period you may:
• Enroll in the SHBP if you have not previously done so;
• Change to a different medical plan and/or dental plan
(see article on page 4 for more dental information);
• Add eligible dependents you have not previously
enrolled. (Please note that the maximum age for covering children has been raised to age 26. To learn more,
see page 2 that explains the new provision.); or
• Remove dependents from your coverage.
To make a change to your coverage, contact your human
resources representative or benefits administrator to obtain
an application. Medical and prescription drug coverage
changes are made on the same application. Dental coverage
changes are made on a separate application. Completed
applications must be returned to your human resources representative or benefits administrator by October 29, 2010.
Do not send the application directly to the Division of
Pensions and Benefits.
Health Plan Premiums and Copayments
Health plan premiums and copayments will remain the
same for 2011. Most State employees are required to contribute 1.5 percent of their annual base salary regardless of
the medical plan or level of coverage that is selected. Your
health contribution changes any time there is a change in
your base annual salary.
The copayment for SHBP medical plans (NJ DIRECT,
Aetna HMO, and CIGNA HealthCare HMO) for primary
doctor visits and visits to a specialist is $15 and the copayment for a visit to an emergency room is $50. The emergency room copayment is waived if you are admitted.
For More Information
For questions about specific plan benefits, contact the
plan directly or see the Plan Comparison Summary, available on the Division of Pensions and Benefits Web site at:
www.state.nj.us/treasury/pensions/health-benefits.shtml
Federal Health Care Reform and Your SHBP Plan
he SHBP considers itself a “grandfathered health plan” under the Patient Protection and Affordable Care Act
(Affordable Care Act). As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain
basic health coverage that was already in effect when that law was enacted. Being a grandfathered health plan
means that your plan may not include certain consumer protections of the Affordable Care Act that apply to other plans,
for example, the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act, for example, the
elimination of lifetime limits on benefits.
T
2
Health Capsule — State Edition — Fall 2010
New! Coverage of Children Until Age 26
rovisions of the federal Patient Protection and Affordable Care Act (Affordable Care Act) include the coverage of
children until age 26. Currently the State Health Benefits Program (SHBP) permits the coverage of dependent children until age 23. Under the Affordable Care Act, the extended coverage until age 26 is effective for the plan year
to begin after September 2010 and will, therefore, apply to the SHBP for the plan year beginning January 2011.
P
Is Your Child Eligible?
Under the Affordable Care Act:
• A “child” is defined as an enrollee’s child until age 26, regardless of the child’s marital, student,or financial dependency status — even if the young adult no longer lives with his or her parents.
• Coverage will be extended to eligible children through December 31 of the year they turn age 26.
• However, until 2014, the extension of coverage is only available if the adult child is not eligible to enroll in employer-based coverage (aside from coverage through the parent).
Enrolling Your Child
October 2010 has been set aside by the SHBP as the period when parents may enroll/re-enroll children who meet the
above criteria and who will be under age 26 as of December 31, 2010.
• Employees may submit a Health Benefits Application, through their employer, between October 1 and 29, 2010 to
enroll, or re-enroll, an eligible child.
• For all enrollments a photocopy of the child's birth certificate that includes the covered parent’s name must be submitted along with the application (or other supporting documentation for foster or stepchildren).
• Covered children who turn age 23 during 2010 do not need to enroll during October to continue coverage in 2011.
Coverage will be continued automatically.
More about this provision of the Affordable Care Act is available on the U.S. Department of Health and Human Services
Web site at: www.hhs.gov/ociio/regulations/adult_child_fact_sheet.html
Coverage for Children Ages 26 to 31
Chapter 375, P.L. 2005, provides for the continuation of health coverage to children past the age of 26 until age 31. The
cost of Chapter 375 coverage is paid by the member-parent or over age child.
A child by blood or law who previously "aged-out" of a plan and does not currently receive coverage or have coverage
under COBRA, provided he or she meets certain requirements for dependent status, may elect continued coverage — even
if there has been a gap in coverage. The eligibility requirements are outlined as follows:
1. be 30 years of age or younger at the time of application;
2. be unmarried;
3. have no dependent(s) of his or her own;
4. be a resident of New Jersey or enrolled as a full-time student at an accredited public or private institution of higher
education;
5. have no other coverage as a named subscriber, insured, enrollee, or covered person under any other group or individual health benefits plan, church plan, or health benefits plan, or entitled to benefits under Medicare; and
6. provide proof of previous credible coverage.
An over age child is eligible for coverage until age 31 in the medical and/or prescription drug plan that is identical to the
plan in which the parent is enrolled. The application for over age children must be signed by both the child and parent
responsible for paying for the cost of coverage. In order to enroll for the 2011 plan year, you must complete a Chapter 375
Enrollment Application and return it to the Division of Pensions and Benefits, Health Benefits Bureau, PO Box 299,
Trenton, NJ 08625 by October 30, 2010.
Health Capsule — State Edition — Fall 2010
3
Multiple SHBP or SEHBP Coverage Prohibited
ffective May 21, 2010, Chapter 2, PL 2010, prohibits multiple coverage under the SHBP or School Employees’
Health Benefits Program (SEHBP). This means that an employee (or retiree) cannot be eligible for coverage as both
a subscriber and a dependent under the SHBP and/or SEHBP.
In June, a notification was sent to those members who were identified as having multiple coverage. In order to comply
with the law and retain your current and future eligibility for SHBP coverage, members were asked to either waive coverage as a subscriber (employee) OR terminate other coverage as a retiree or dependent. If you did not take action by submitting an application to the Division of Pensions and Benefits by September 1, 2010, one of your coverages will be
automatically terminated.. Please check your account information through the Member Benefit Online System (MBOS).
E
HIPAA Notice for 2010
he federal Health Insurance Portability and Accountability Act (HIPAA) of 1996 requires group health plans to
implement several provisions contained within the law to annually notify its membership of any provisions for
which they file an exemption. For plan year 2010, all health plans meet or exceed the federal requirements, with the
exception of mental health parity for NJ DIRECT/NJ PLUS.
The State Health Benefits Commission filed an exemption from the area of mental health parity for non-biologically
based mental illness with the federal Centers for Medicare and Medicaid Services for calendar year 2010 for NJ
DIRECT/NJ PLUS. These limitations are outlined in the NJ DIRECT Member Handbook or contact NJ DIRECT/NJPLUS
at 1-800-414-SHBP (7427) for more information.
T
Find Open Enrollment and Plan Information Online
n compliance with State initiatives to provide paperless services, Open Enrollment informational materials, plan comparison charts, and SHBP plan member handbooks are only available in electronic format. Most publications are provided in AdobeTM PDF format for user friendly viewing or printing. Access to SHBP publications is available on the
Division of Pensions and Benefits Web site: www.state.nj.us/treasury/pensions/health-benefits.shtml
I
Participating SHBP Medical Plans
MEDICAL PLANS
NJ DIRECT*
WEB ADDRESS
PHONE#
www.horizonblue.com/shbp
1-800-414-7427
*Administered by Horizon Blue Cross Blue Shield of New Jersey
Aetna HMO
CIGNA HealthCare
www.aetna.com/statenj
1-877-STATE NJ
www.cigna.com
1-800-564-7642
All plans are available nationwide. There are no longer specific service areas in different states; however, you should
check with your medical provider to verify his or her plan participation.
PRESCRIPTION DRUG PLAN
Medco Health Solutions
WEB ADDRESS
PHONE#
www.medco.com/statenj
1-866-220-6512
4
Health Capsule — State Edition — Fall 2010
Employee Dental Plans
M
New Jersey SHBP
embers who enroll in the Employee Dental Plans may choose from two types of
dental plans: one of six Dental Plan Organizations (DPO) or the Dental Expense
Plan.
Dental Plan Organizations
Health Capsule
Division of Pensions
and Benefits
(609) 292-7524
www.state.nj.us/treasury/pensions
The Dental Plan Organizations contract with a network of providers for dental services.
There are six DPOs participating in the SHBP from which you may choose: Aetna DMO,
Atlantic Southern Dental, CIGNA DHMO, Community Dental Associates, Horizon
Healthcare Dental, and International Health Care Services.
You must use providers participating with the DPO you select to receive coverage. Since
DPOs also service other organizations, be sure to confirm that the dentist or dental facility
you select is taking new patients and participates with the SHBP Employee Dental Plans.
Dental Expense Plan
The Dental Expense Plan is a traditional indemnity plan that allows you to obtain services from any dentist. After you satisfy the $50 annual deductible (no deductible applies for
preventive services), you are reimbursed a percentage of the reasonable and customary
charges for the services that are covered under the Dental Expense Plan up to the annual
plan maximum of $3,000. The Dental Expense Plan is administered for the SHBP by Aetna.
Find Out More
For more information contact your benefits administrator or human resources representative, or see the Employee Dental Plans Member Handbook that is available on the Division’s
Web site at: www.state.nj.us/treasury/pensions/health-benefits.shtml
Participating Employee Dental Plans
DENTAL PLAN NAME
WEB ADDRESS AND
MEMBERSHIP SERVICES
PHONE NUMBER
SERVICE AREA
BeneCare
(Atlantic Southern
Dental Foundation)
www.benecare.com
1-800-843-4727
All of New Jersey
(Except Hunterdon, Morris, Passaic,
Salem, Somerset, Sussex & Warren
Counties)
Community Dental
Associates
www.cdaplan.com
(856) 451-8844
Cumberland County
CIGNA Dental Health, Inc.
www.cigna.com/stateofnj
1-800-367-1037
All of New Jersey and Eastern
Pennsylvania (Except Cape May
County)
Healthplex (International
Health Care Services)
www.healthplex.com
1-800-468-0600
All of New Jersey, Bucks County, and
Philadelphia, Pennsylvania
(Except Cape May, Glouster,
Hunterdon, Salem, Sussex & Warren
Counties)
Horizon Dental Choice
www.horizonblue.com
1-800-433-6825
All of New Jersey
(Except Salem County)
Aetna DMO
www.aetna.com/statenj
1-800-843-3661
All of New Jersey and Eastern
Pennsylvania
Dental Expense Plan
(Administered by Aetna)
www.aetna.com/statenj
1-877-238-6200
Unrestricted
Health Capsule is published
periodically for State employees and is designed to keep
employees informed about
developments in their health
benefits program. The newsletter addresses issues affecting
your health and prescription
benefits and includes articles
on new or proposed legislation,
New Jersey Administrative
Code changes, decisions of the
State Health Benefits Commission, and national issues
affecting our programs.
The selections in this publication are for information purposes only and, while every
attempt at accuracy is made, it
cannot be guaranteed.
If you would like to see any
particular health benefits issue
addressed, please forward your
ideas to Health Capsule,
Division of Pensions and
Benefits, Office of Client
Services, P.O. Box 295,
Trenton, NJ 08625-0295.
Florence J. Sheppard
Acting Director
Division of Pensions
and Benefits
•
Steven R. Stokley
Senior Editor
Publications
•
Helen C. Benjamin
Editor
Publications
•
Kathleen M. Marsala
Graphic Artist
Publications
HA-0862-0910
STATE OF NEW JERSEY — DIVISION OF PENSIONS AND BENEFITS
STATE HEALTH BENEFITS PROGRAM (SHBP) and STATE EMPLOYEES TAX SAVINGS PROGRAM (Tax$ave)
OPEN ENROLLMENT FOR PLAN YEAR 2011
October is the SHBP and Tax$ave Open Enrollment period — your annual opportunity to review
SHBP and Tax$ave coverage and make any changes for you and/or your dependents for the 2011 plan
year. During the Open Enrollment you may:
• Enroll in SHBP plans if you have not previously done so, change to a different SHBP medical plan
and/or dental plan, and add eligible dependents – including children up to age 26* under federal
health care reform changes – see the Health Capsule newsletter for details.
• Enroll, or renew enrollment, in Tax$ave Flexible Spending Account plans for the coming plan year.*
See the Tax$ave News for new reimbursement limits on over-the-counter medications and eligibility of children up to the age of 26.
STARTING THIS YEAR, OPEN ENROLLMENT PUBLICATIONS ARE ONLY AVAILABLE ONLINE.
See the Health Capsule and Tax$ave Newsletter and fliers for detailed Open Enrollment information.
Go to: www.state.nj.us/treasury/pensions/ and click the Open Enrollment links under “Special Announcements”
• To change or enroll in SHBP plans, contact your human resources representative or benefits administrator
to obtain an application. Medical and prescription drug coverage changes are made on the same application.
Dental coverage changes are made on a separate application.
• To change or enroll in Tax$ave plans, see the information on the Tax$ave Open Enrollment Web site.
• Changes made during this Open Enrollment will be effective on January 1, 2011 for all employees.
*Optional coverage for dependent children until age 31 is available under the provisions of Chapter 375, P.L. 2005.
**Re-enrollment is required each year for continued participation in a Tax$ave FSA plan.
Print 2-up and Cut
HA-0862-0910
STATE OF NEW JERSEY — DIVISION OF PENSIONS AND BENEFITS
STATE HEALTH BENEFITS PROGRAM (SHBP) and STATE EMPLOYEES TAX SAVINGS PROGRAM (Tax$ave)
OPEN ENROLLMENT FOR PLAN YEAR 2011
October is the SHBP and Tax$ave Open Enrollment period — your annual opportunity to review
SHBP and Tax$ave coverage and make any changes for you and/or your dependents for the 2011 plan
year. During the Open Enrollment you may:
• Enroll in SHBP plans if you have not previously done so, change to a different SHBP medical plan
and/or dental plan, and add eligible dependents – including children up to age 26* under federal
health care reform changes – see the Health Capsule newsletter for details.
• Enroll, or renew enrollment, in Tax$ave Flexible Spending Account plans for the coming plan year.*
See the Tax$ave News for new reimbursement limits on over-the-counter medications and eligibility of children up to the age of 26.
STARTING THIS YEAR, OPEN ENROLLMENT PUBLICATIONS ARE ONLY AVAILABLE ONLINE.
See the Health Capsule and Tax$ave Newsletter and fliers for detailed Open Enrollment information.
Go to: www.state.nj.us/treasury/pensions/ and click the Open Enrollment links under “Special Announcements”
• To change or enroll in SHBP plans, contact your human resources representative or benefits administrator
to obtain an application. Medical and prescription drug coverage changes are made on the same application.
Dental coverage changes are made on a separate application.
• To change or enroll in Tax$ave plans, see the information on the Tax$ave Open Enrollment Web site.
• Changes made during this Open Enrollment will be effective on January 1, 2011 for all employees.
*Optional coverage for dependent children until age 31 is available under the provisions of Chapter 375, P.L. 2005.
**Re-enrollment is required each year for continued participation in a Tax$ave FSA plan.
HB-0859-1010w
State Health Benefits Program and
School Employees' Health Benefits Program
HEALTH COVERAGE OF CHILDREN UNTIL AGE 26
Under the Patient Protection and Affordable Care Act
Provisions of the federal Patient Protection and Affordable Care Act (PPACA) include the coverage of
children until age 26.
Currently the State Health Benefits Program (SHBP) and School Employees’ Health Benefits Program
(SEHBP) permit the coverage of dependent children until age 23. Under the PPACA, the extended
coverage until age 26 is effective for the plan year beginning January 2011.
ELIGIBILITY
Under the PPACA:
•
A “child” is defined as an enrollee’s child until age 26, regardless of the child’s marital,
student, or financial dependency status — even if the young adult no longer lives with his
or her parents.
•
Coverage will be extended to eligible children through December 31 of the year they turn
age 26.
•
The extension of coverage is only available if the adult child is not eligible to enroll in other
employer-based coverage (aside from coverage through the parent).
ENROLLMENT
October 2010 has been set aside by the SHBP/SEHBP as the period when parents may
enroll/re-enroll children who meet the above criteria and who will be under age 26 as of
December 31, 2010.
•
Employees will receive enrollment information from their employers as part of the regular
SHBP and SEHBP Open Enrollment communications and may submit a Health Benefits
Application through their employer between October 1 and October 29, 2010.*
•
Retirees will be contacted by direct mail and those wishing to enroll/re-enroll an eligible
adult child must submit a SHBP/SEHBP Retired Change of Status Application to the
Health Benefits Bureau of the Division of Pensions and Benefits between October 1 and
October 29, 2010.*
•
For all enrollments a photocopy of the child's birth certificate that includes the covered
parent’s name must be submitted along with the application.
For a stepchild provide a photocopy of the child’s birth certificate showing the
spouse/partner’s name as a parent and a photocopy of marriage/partnership certificate
showing the names of the employee and spouse/partner.
For a grandchild, foster child, or legal guardianship provide a photocopy of Affidavits of
Dependency and a Final Court Order with the presiding judge’s signature and seal
attesting to the legal guardianship of the covered employee.
•
Covered children who turn age 23 during 2010 do not need to enroll during October to
continue coverage in 2011. Coverage will be continued automatically.
•
Children ages 23 through 26 who are currently enrolled for extended SHBP/SEHBP
coverage under the provisions of Chapter 375, P.L. 2005, will need to be enrolled during
October for SHBP/SEHBP coverage as a child under age 26.
*Applications submitted prior to October 1, 2010 will not be accepted.
HB-0858-1010w
Medicaid and the Children’s Health Insurance Programs (CHIP)
Offer Free or Low-Cost Health Coverage to Children and Families
If you are eligible for health coverage from your employer, but are unable to afford the premiums, some States have
premium assistance programs that can help pay for coverage. These States use funds from their Medicaid or CHIP
programs to help people who are eligible for employer-sponsored health coverage, but need assistance in paying
their health premiums.
If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, you can
contact your State Medicaid or CHIP office to find out if premium assistance is available.
If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your
dependents might be eligible for either of these programs, you can contact your State Medicaid or CHIP office or
dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, you can ask the State if
it has a program that might help you pay the premiums for an employer-sponsored plan.
Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP,
your employer’s health plan is required to permit you and your dependents to enroll in the plan – as long as you
and your dependents are eligible, but not already enrolled in the employer’s plan. This is called a “special
enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for
premium assistance.
If you live in one of the following States, you may be eligible for assistance paying your employer health
plan premiums. The following list of States is current as of April 16, 2010. You should contact your State
for further information on eligibility.
COLORADO – Medicaid and CHIP
ALABAMA – Medicaid
Medicaid Web site:
http://www.colorado.gov/
Web site: http://www.medicaid.alabama.gov
Phone: 1-800-362-1504
Medicaid Phone: 1-800-866-3513
ALASKA – Medicaid
CHIP Web site: http://www.CHPplus.org
Web site: http://health.hss.state.ak.us/dpa/
programs/medicaid/
CHIP Phone: (303) 866-3243
FLORIDA – Medicaid
Phone (Outside of Anchorage): 1-888-3188890
Web site: http://www.fdhc.state.fl.us/
Medicaid/index.shtml
Phone (Anchorage): (907) 269-6529
Phone: 1-866-762-2237
ARIZONA – CHIP
GEORGIA – Medicaid
Web site: http://www.azahcccs.gov/
applicants/default.aspx
Web site: http://dch.georgia.gov/
Phone: 1-877-764-5437
Click on Programs, then Medicaid
ARKANSAS – CHIP
Phone: 1-800-869-1150
Web site: http://www.arkidsfirst.com/
IDAHO – Medicaid and CHIP
Phone: 1-888-474-8275
Medicaid Web site:
www.accesstohealthinsurance.idaho.gov
CALIFORNIA – Medicaid
Medicaid Phone: 1-800-926-2588
Web site:
ttp://www.dhcs.ca.gov/services/Pages/
TPLRD_CAU_cont.aspx
CHIP Web site: www.medicaid.idaho.gov
CHIP Phone: 1-800-926-2588
Phone: 1-866-298-8443
1
HB-0858-1010w
NEBRASKA – Medicaid
INDIANA – Medicaid
Web site:
http://www.dhhs.ne.gov/med/medindex.htm
Web site: http://www.in.gov/fssa/2408.htm
Phone: 1-877-438-4479
Phone: 1-877-255-3092
IOWA – Medicaid
NEVADA – Medicaid and CHIP
Web site: www.dhs.state.ia.us/hipp/
Medicaid Web site: http://dwss.nv.gov/
Phone: 1-888-346-9562
Medicaid Phone: 1-800-992-0900
KANSAS – Medicaid
CHIP Web site:
http://www.nevadacheckup.nv.org/
Web site: https://www.khpa.ks.gov
Phone: 1-800-766-9012
CHIP Phone: 1-877-543-7669
KENTUCKY – Medicaid
NEW HAMPSHIRE – Medicaid
Web site: http://chfs.ky.gov/dms/default.htm
Web site:
http://www.dhhs.state.nh.us/DHHS/
MEDICAIDPROGRAM/default.htm
Phone: 1-800-635-2570
LOUISIANA – Medicaid
Phone: 1-800-852-3345 Ext. 5254
Web site:
http://www.la.hipp.dhh.louisiana.gov
NEW JERSEY – Medicaid and CHIP
Medicaid Web site:
http://www.state.nj.us/humanservices/dmah
s/clients/medicaid/
Phone: 1-888-342-6207
MAINE – Medicaid
Web site: http://www.maine.gov/dhhs/oms/
Medicaid Phone: 1-800-356-1561
Phone: 1-800-321-5557
CHIP Web site:
http://www.njfamilycare.org/index.html
MASSACHUSETTS – Medicaid and CHIP
CHIP Phone: 1-800-701-0710
Medicaid & CHIP Web site:
http://www.mass.gov/MassHealth
NEW MEXICO – Medicaid and CHIP
Medicaid & CHIP Phone: 1-800-462-1120
Medicaid Web site:
http://www.hsd.state.nm.us/mad/index.html
MINNESOTA – Medicaid
Medicaid Phone: 1-888-997-2583
Web site: http://www.dhs.state.mn.us/
Click on Health Care,
then Medical Assistance
CHIP Web site:
http://www.hsd.state.nm.us/mad/index.html
Click on Insure New Mexico
Phone: 1-800-657-3739
CHIP Phone: 1-888-997-2583
MISSOURI – Medicaid
NEW YORK – Medicaid
Web site:
http://www.dss.mo.gov/mhd/index.htm
Web site: http://www.nyhealth.gov/
health_care/medicaid/
Phone: (573) 751-6944
Phone: 1-800-541-2831
MONTANA – Medicaid
NORTH CAROLINA – Medicaid
Web site:
http://medicaidprovider.hhs.mt.gov/
clientpages/clientindex.shtml
Web site: http://www.nc.gov
Phone: (919) 855-4100
Phone: 1-800-694-3084
2
HB-0858-1010w
VERMONT– Medicaid
NORTH DAKOTA – Medicaid
Web site: http://ovha.vermont.gov/
Web site: http://www.nd.gov/dhs/services/
medicalserv/medicaid/
Phone: 1-800-250-8427
Phone: 1-800-755-2604
VIRGINIA – Medicaid and CHIP
OKLAHOMA – Medicaid
Web site: http://www.insureoklahoma.org
Medicaid Web site:
http://www.dmas.virginia.gov/rcp-HIPP.htm
Phone: 1-888-365-3742
Medicaid Phone: 1-800-432-5924
CHIP Web site: http://www.famis.org/
OREGON – Medicaid and CHIP
CHIP Phone: 1-866-873-2647
Medicaid & CHIP Web site:
http://www.oregonhealthykids.gov
WASHINGTON – Medicaid
Medicaid & CHIP Phone: 1-877-314-5678
Web site: http://hrsa.dshs.wa.gov/
premiumpymt/Apply.shtm
PENNSYLVANIA – Medicaid
Phone: 1-877-543-7669
Web site: http://www.dpw.state.pa.us/
partnersproviders/medicalassistance/
doingbusiness/003670053.htm
WEST VIRGINIA – Medicaid
Web site:
http://www.wvrecovery.com/hipp.htm
Phone: 1-800-644-7730
RHODE ISLAND – Medicaid
Phone: (304) 342-1604
Web site: www.dhs.ri.gov
WISCONSIN – Medicaid
Phone: (401) 462-5300
Web site: http://dhs.wisconsin.gov/
medicaid/publications/p-10095.htm
SOUTH CAROLINA – Medicaid
Phone: 1-800-362-3002
Web site: http://www.scdhhs.gov
WYOMING – Medicaid
Phone: 1-888-549-0820
Web site: http://www.health.wyo.gov/
healthcarefin/index.html
TEXAS – Medicaid
Web site: https://www.gethipptexas.com/
Phone: (307) 777-7531
Phone: 1-800-440-0493
UTAH – Medicaid
Web site: http://health.utah.gov/medicaid/
Phone: 1-866-435-7414
To see if other States have added a premium assistance program since April 16, 2010, or for more information on
special enrollment rights, contact:
U.S. Department of Labor
Employee Benefits Security Administration
www.dol.gov/ebsa
1-866-444-EBSA (3272)
U.S. Department of Health and Human Services
Centers for Medicare & Medicaid Services
www.cms.hhs.gov
1-877-267-2323, Ext. 61565
3
SHBP State Employee Contacts-0910
NEW JERSEY STATE HEALTH BENEFITS PROGRAM
FALL 2010 ANNUAL OPEN ENROLLMENT PERIOD
MEDICAL AND DENTAL PLAN CONTACT INFORMATION
The annual Open Enrollment period for the State Health Benefits Program (SHBP) is scheduled for October 1 to October 31, 2010. During this
period, eligible employees have the opportunity to enroll in or change existing health coverage. The chart below provides SHBP medical plan and
Employee Dental Plans contact numbers and coverage areas. If you decide to change medical or dental plans, see your Human Resources
Representative to obtain a Health Benefits Application or Dental Plan Application and return it to your employer no later than October 30, 2010.
Changes made during this Open Enrollment period will be effective January 1, 2011 for all State employees.
AVAILABLE MEDICAL PLANS
Unit #
Health Plan Name
Member Services Telephone Number
Web Site Address
150
NJ DIRECT15
1-800-414-SHBP (1-800-414-7427)
www.horizonblue.com/shbp
005
Aetna HMO
1-877-STATE NJ (1-877-782-8365)
www.aetna.com/statenj
006
CIGNA HealthCare HMO
1-800-564-7642
www.cigna.com/stateofnj
AVAILABLE DENTAL PLANS
Service Area
Member Services
Telephone Number
Web Site Address
301 Atlantic Southern Dental (BeneCare)
1-800-843-4727
www.benecare.com
302 Community Dental Associates
(856) 451-8844
www.cdaplan.com
Cumberland County NJ
305 CIGNA DHMO
1-800-367-1037
www.cigna.com/stateofnj
Parts of NJ, Eastern PA
307 Healthplex (International Health Care Srvs.)
1-800-468-0600
www.healthplex.com
317 Horizon Dental Choice
1-800-433-6825
www.horizonblue.com
All of NJ
(except Salem and Hunterdon Co.)
319 Aetna DMO
1-800-843-3661
www.aetna.com/statenj
All of NJ, Eastern PA
1-877-238-6200
www.aetna.com/statenj
Unrestricted
Unit# Dental Plan Name
399 Dental Expense Plan
(administered by Aetna Dental)
(contact the dental plan to verify
available providers in your county)
Parts of NJ
Parts of NJ
(MEDICAL - 2010)
NEW JERSEY STATE HEALTH BENEFITS PROGRAM MEDICAL PLANS
MARKETING MATERIAL CONTACTS*
2010 OPEN ENROLLMENT
PLAN NAME
NJ DIRECT10
NJ DIRECT15
Administered by Horizon Blue Cross
Blue Shield of New Jersey
PLAN #
PHONE
NUMBER
050
150
Fax: (973) 466-6452
(973) 466-6666
CONTACT PERSON
Bella Bustamante
HEALTH MAINTENANCE ORGANIZATIONS
PLAN NAME
HMO #
005
(State Employees)
Aetna HMO
019
PHONE
NUMBER
(215) 775-0434
Fax: (215) 775-0080
CONTACT PERSON
Lisa Marie Hopkins
E-mail: hopkinsl@aetna.com
(Local Govt. & All Retirees)
006
(State Employees)
CIGNA HealthCare
(201) 533-7758
020
Kathy Reed
E-mail: kathy.reed@cigna.com
(Local Govt. & All Retirees)
*These phone numbers are for Human Resource Representatives to use in contacting the medical plans to obtain booklets/plan literature for
employee distribution. The numbers are NOT for membership services – please do not provide them to your employees.
(9/10)
(DENTAL - 2010)
NEW JERSEY STATE HEALTH BENEFITS PROGRAM DENTAL PLANS
MARKETING MATERIAL CONTACTS*
2010 OPEN ENROLLMENT
PLAN NAME
UNIT/
DPO #
PHONE
NUMBER
CONTACT PERSON
Atlantic Southern Dental Foundation (Benecare)
301
(215) 440-1020
Fax: (215)440-1021
Lisa Conaway
E-mail: lconaway@benecare.com
Community Dental Associates
302
(856) 692-4670
Fax: (856) 692-3068
Dr. Gorsen
CIGNA DHMO
305
(201) 533-7758
Kathy Reed
E-mail: kathy.reed@cigna.com
International Health Care Services (Healthplex)
307
(516) 542-2208
Fax: (516) 794-3186
Patricia Mastandrea
E-mail: PatriciaM@Healthplex.com
Horizon Healthcare Dental, Inc.
317
(973) 466-6666
Fax: (973) 466-6452
Bella Bustamante
Aetna DMO
319
(215) 775-0434
Fax: (215) 775-0080
Lisa Marie Hopkins
E-mail: hopkinsl@aetna.com
Dental Expense Plan – Administered by Aetna Dental
399
(215) 775-0434
Fax: (215) 775-0080
Lisa Marie Hopkins
E-mail: hopkinsl@aetna.com
*These phone numbers are for Human Resource Representatives to use in contacting the dental plans to obtain booklets/plan literature for
employee distribution. The numbers are NOT for membership services – please do not provide them to your employees.
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