September 10, 2010
TO:
School Employees’ Health Benefits Program Participating Local
Education Employers
FROM:
New Jersey School Employees’ Health Benefits Program
SUBJECT:
SEHBP Open Enrollment 2010 — Local Education Employers
The School Employees’ Health Benefits Program (SEHBP) Open Enrollment Period for local
education 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 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 SEHBP 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).
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.
New Jersey Is An Equal Opportunity Employer
z
Printed on Recycled and Recyclable Paper
Page 2 of 7
SEHBP Open Enrollment
September 10, 2010
•
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 SEHBP 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 SEHBP 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 SEHBP 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
SEHBP Open Enrollment
September 10, 2010
MINIMUM WORK HOURS FOR COVERAGE
A local education employee hired after May 21, 2010, is required to work a minimum of 25
hours per week* to be considered “full-time” and eligible for coverage under the SEHBP.
* Or more if required by contract.
An employees enrolled on or before May 21, 2010, is eligible for continued coverage under
the SEHBP based on the minimum work hour requirements of the local education entity that
were in place prior to May 21, 2010, provided there is no break in the employee’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 SEHBP RATES FOR EMPLOYERS
The School Employees’ Health Benefits Commission has approved medical and prescription
drug plan rates for the 2011 plan year. The State Health Benefits Commission has
approved dental 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, SEHBP plan rates for the Local Education Active Group will see
the following percentage of change.
MEDICAL PLAN RATE CHANGES FOR 2011
PLAN TYPE
RATE CHANGE
NJ DIRECT10
8.5%
NJ DIRECT15
8.5%
Aetna HMO
12%
CIGNA HealthCare HMO
11.5%
Prescription Drug Plan
4%
Page 4 of 7
SEHBP 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
2%
0%
Healthplex DPO
-5%
Horizon DPO
2%
1%
MEDICAL PLANS AND COPAYMENTS
The SEHBP currently offers local education employees a choice of one of four medical
plans.
•
NJ DIRECT10 — 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 $10 office visit copayment and out-of-network coverage subject to deductibles
and coinsurance; or
•
NJ DIRECT15 — a Preferred Provider Organizations 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 offering in-network coverage through a primary care
physician for a $10 office visit copayment.
A side-by-side comparison of medical plan benefits is available in the Plan Comparison
Summary for Local Education Employees, available for viewing or printing at the SEHBP
Web site: www.state.nj.us/treasury/pensions/health-benefits.shtml
PRESCRIPTION DRUG PLANS AND COPAYMENTS
Medco Health Solutions, Inc., of Franklin Lakes, NJ, is the pharmacy benefits manager for
the SEHBP.
The SEHBP offers two types of prescription drug plans to participating employers: The
Employee Prescription Drug Plan and a prescription drug plan based on medical plan
enrollment.
The Employee Prescription Drug Plan is offered to local education employers as a
freestanding prescription drug plan. If your employing entity has chosen to participate:
•
Copayments for a 30 day supply when purchased at a retail pharmacy are $3 for
generic drugs, $10 for brand name prescription drugs.
•
Mail order prescription drug copayments for up to a 90-day supply are $5 for generic
drugs, $15 for brand name drugs.
For more information, see the Employee Prescription Drug Plan Member Handbook.
Page 5 of 7
SEHBP Open Enrollment
September 10, 2010
Prescription Drug Plan based on medical plan enrollment
•
Subscribers in NJ DIRECT10 or NJ DIRECT15 are provided reimbursement of
prescription drug costs at 90% for prescriptions filled by an in-network pharmacy or
80% (NJ DIRECT10) or 70% (NJ DIRECT15) for prescriptions filled by an out-ofnetwork pharmacy.
•
Subscribers in Aetna HMO or CIGNA HealthCare HMO are provided a three tier
copayment benefit. Copayments for a 30 day supply when purchased at a retail
pharmacy are $5 for generic drugs, $10 for preferred brand name drugs, and $20 for
all other brand name drugs. Mail order copayments for up to a 90-day supply are $5
for generic drugs, $15 for preferred brand name drugs, and $25 for all other brand
name drugs.
Employer rate charts for medical plans — with either separate or medical plan based
prescription drug coverage — as well as Employee Prescription Drug Plan rates are included
in this mailing. Rate information is also available on the SEHBP Web site:
www.state.nj.us/treasury/pensions/health-benefits.shtml
WAIVING SEHBP COVERAGE
Local education employees are permitted to waive SEHBP medical and prescription
coverage if they have other employer-provided or retiree coverage, or other coverage as a
dependent.
Employers are permitted to offer an incentive to employees who waive SEHBP coverage.
Under Chapter 2, P.L. 2010, the incentive amount for waivers filed on or after May 21, 2010,
is limited to 25 percent of the amount saved by the employer or $5,000, whichever is less.
In addition, because Chapter 2, P.L. 2010, prohibits multiple coverage under the
SHBP/SEHBP (see page 3), waiver incentives are only payable if the other coverage is
through a non-SHBP/SEHBP plan.
To waive coverage a SEHBP Waiver Form for Local Employees 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.
EMPLOYEE DENTAL PLANS
The Employee Dental Plans are offered to local education employers as a freestanding
dental plan. If your employing entity has chosen to participate there are seven different
dental plans 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.
Page 6 of 7
SEHBP Open Enrollment
September 10, 2010
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 1, 2010, they will not be permitted to change dental plans during
this Open Enrollment.
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. Rate information is also posted to the Web site at:
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.
Employees should be informed to access the Health Capsule online or be provided the PDF
version via e-mail attachment or your Departmental Intranet.
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*.
Page 7 of 7
SEHBP Open Enrollment
September 10, 2010
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.)
* Note: The online Unified Provider Directory (UPD) is no longer available.
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 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 SEHBP 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 SEHBP 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 SEHBP 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 SEHBP Open Enrollment Period a success for
your employees.
Enclosures:
SEHBP Open Enrollment Milestone Chart
Medical Plan 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
(LOCAL EDUCATION – MILESTONE – 2010)
FALL 2010 SEHBP OPEN ENROLLMENT MILESTONE CHART
for Participating Local Education Employers
Note: If the event is underlined, you should be accomplishing the event.
PROJECTED
DATE
EVENT
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
SEHBP Open Enrollment Begins.
October 29
SEHBP Open Enrollment Ends.
November 5
Employer certified applications due at the Health Benefits
Bureau.
January 1, 2011
SEHBP Open Enrollment changes effective.
FH-0278-0810X
GREEN
GREEN
FOR EMPLOYERS WHO OFFER THE EMPLOYEE PRESCRIPTION DRUG PLAN OR A PRIVATE PLAN
DEPARTMENT OF THE TREASURY - DIVISION OF PENSIONS AND BENEFITS
NEW JERSEY SCHOOL EMPLOYEES' HEALTH BENEFITS PROGRAM
LOCAL MONTHLY ACTIVE GROUP - EDUCATION EMPLOYERS
RATES EFFECTIVE 1/1/2011 to 12/31/2011
PLAN/COVERAGE
DESCRIPTION
EMPLOYER
SINGLE COST
DEPENDENT
COST
TOTAL
$475.83
$477.50
$478.11
$476.56
------$593.08
$711.43
$189.58
$475.83
$1,070.58
$1,189.54
$666.14
$499.83
$501.50
$502.11
$500.56
------$623.09
$747.45
$199.17
$499.83
$1,124.59
$1,249.56
$699.73
$487.38
$489.05
$489.66
$488.11
------$607.56
$728.81
$194.23
$487.38
$1,096.61
$1,218.47
$682.34
$490.05
$491.72
$492.33
$490.78
------$610.91
$732.81
$195.30
$490.05
$1,102.63
$1,225.14
$686.08
$135.20
$135.20
$135.20
$135.20
------$169.00
$202.80
$54.08
$135.20
$304.20
$338.00
$189.28
NJ DIRECT15 - #150
Single
Member & Spouse/Partner
Family
Parent & Child
NJ DIRECT10 - #050
Single
Member & Spouse/Partner
Family
Parent & Child
AETNA, INC. - #019
Single
Member & Spouse/Partner
Family
Parent & Child
CIGNA HealthCare HMO - #020
Single
Member & Spouse/Partner
Family
Parent & Child
PRESCRIPTION DRUG PROGRAM - #201
Single
Member & Spouse/Partner
Family
Parent & Child
FH-0279-0810X
PINK
PINK
FOR EMPLOYERS WHO OFFER PRESCRIPTION DRUGS THROUGH THE SHBP BASED ON THE MEDICAL
PLAN THE SUBSCRIBER IS ENROLLED
DEPARTMENT OF THE TREASURY - DIVISION OF PENSIONS AND BENEFITS
NEW JERSEY SCHOOL EMPLOYEES' HEALTH BENEFITS PROGRAM
LOCAL MONTHLY ACTIVE GROUP - EDUCATION EMPLOYERS
RATES EFFECTIVE 1/1/2011 to 12/31/2011
PLAN/COVERAGE
DESCRIPTION
EMPLOYER
SINGLE COST
NJ DIRECT15 - #150 WITH PRESCRIPTION DRUG #211
Single
Member & Spouse/Partner
Family
Parent & Child
DEPENDENT
COST
TOTAL
------$712.04
$854.18
$227.65
$570.98
$1,284.69
$1,427.44
$799.36
------$748.04
$897.39
$239.17
$599.79
$1,349.50
$1,499.46
$839.69
------$772.06
$926.20
$246.86
$618.98
$1,392.71
$1,547.46
$866.57
------$776.32
$931.30
$248.23
$622.37
$1,400.36
$1,555.95
$871.33
1
$570.98
$572.65
$573.26
$571.71
NJ DIRECT10 - #050 WITH PRESCRIPTION DRUG #2101
Single
Member & Spouse/Partner
Family
Parent & Child
$599.79
$601.46
$602.07
$600.52
AETNA, INC. - #019 WITH PRESCRIPTION DRUG #2122
Single
Member & Spouse/Partner
Family
Parent & Child
$618.98
$620.65
$621.26
$619.71
CIGNA HealthCare HMO - #020 WITH PRESCRIPTION DRUG #213
Single
Member & Spouse/Partner
Family
Parent & Child
$622.37
$624.04
$624.65
$623.10
2
1
Subscribers in NJ DIRECT10 and NJ DIRECT15 are provided drug reimbursement plan administered by Medco.
2
Subscribers in Aetna HMO or CIGNA HealthCare HMO are provided a three tier copayment benefit administered by Medco.
DEPARTMENT OF THE TREASURY - DIVISION OF PENSIONS AND BENEFITS
NEW JERSEY STATE DENTAL PROGRAM
LOCAL MONTHLY ACTIVE GROUP
LOCAL GOVERNMENT AND EDUCATION EMPLOYERS
RATES EFFECTIVE 1/1/2011 to 12/31/2011
DESCRIPTION
OF COVERAGE
DENTAL EXPENSE PLAN - #399
Single
Member & Spouse/Partner
Family
Parent & Child
MONTHLY BILLING RATE
MAXIMUM EMPLOYEE
CONTRIBUTION (50%)
TOTAL MONTHLY
RATE
$21.50
$37.37
$61.14
$45.29
$43.01
$74.74
$122.28
$90.58
$12.71
$22.09
$36.15
$26.77
$25.43
$44.18
$72.30
$53.55
$12.01
$20.88
$34.16
$25.30
$24.02
$41.77
$68.32
$50.60
$10.79
$18.77
$30.70
$22.75
$21.59
$37.55
$61.41
$45.51
$9.75
$16.95
$27.73
$20.54
$19.50
$33.90
$55.46
$41.08
$9.98
$17.34
$28.37
$21.01
$19.96
$34.68
$56.74
$42.03
$10.46
$18.21
$29.79
$22.07
$20.93
$36.43
$59.58
$44.15
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
DEPARTMENT OF THE TREASURY - DIVISION OF PENSIONS AND BENEFITS
NEW JERSEY SCHOOL EMPLOYEES' HEALTH BENEFITS PROGRAM
CHAPTER 172 PART-TIME LOCAL MONTHLY ACTIVE GROUP
RATES EFFECTIVE 1/1/2011 to 12/31/2011
PLAN/COVERAGE
DESCRIPTION
PART-TIME
EMPLOYEE MONTHLY RATE
NJ DIRECT15 - #150
Single
Member & Spouse/Partner
Family
Parent & Child
$523.41
$1,177.63
$1,308.49
$732.75
PRESCRIPTION DRUG PROGRAM - #201
Single
Member & Spouse/Partner
Family
Parent & Child
$148.72
$334.62
$371.80
$208.20
N e w J e r s e y D i v i s i o n o f P e n s i o n s a n d B e n e f i ts
Health Capsule
For Local Government Employees and School Employees Issue #26
SHBP/SEHBP 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) and School Employees’ Health Benefit Program
(SEHBP) will be holding the Open Enrollment period for
Plan Year 2011 for employees from October 1 through
October 29, 2010. Any changes made to your coverage during Open Enrollment will become effective on January 1,
2011.
O
During the Open Enrollment
During the Open Enrollment period you may:
• Enroll in the SHBP or SEHBP if you have not previously done so;
• Change to a different medical plan and/or (if your
employer participates) dental plan. See page 4 for more
dental plan 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
(if you are eligible) 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 Contributions
The recent passage of Chapter 2, P.L. 2010, made numerous changes to the SHBP and the SEHBP, including health
plan contributions. On May 21, 2010, or on the expiration
of any applicable labor agreement in force on that date,
most employees are required to contribute a minimum of
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. See your benefits administrator or
human resources representative regarding your contribution
amount.
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/SEHBP Plan
he SHBP/SEHBP considers themselves “grandfathered health plans” 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 — Local Government and School Employees 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 SHBP and SEHBP permit 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 and SEHBP 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 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 — Local Government and School Employees 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 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 or SEHBP 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.
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.
These limitations are outlined in the NJ DIRECT Member Handbook or contact NJ DIRECT 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/SEHBP 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/SEHBP publications is
available on the Division of Pensions and Benefits Web site: www.state.nj.us/treasury/pensions/health-benefits.shtml
I
Participating SHBP and SEHBP 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 — Local Government and School Employees Edition — Fall 2010
Employee Dental Plans
New Jersey SHBP/SEHBP
f your employer is a participates in the Employee Dental Plans, you may choose from
two types of dental plans: one of six Dental Plan Organizations (DPO) or the Dental
Expense Plan.
I
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
To find out if you are eligible for the plan, contact your benefits administrator or human
resources representative. General information about the Employee Dental Plans can be
found in the Employee Dental Plans Member Handbook that is available on our Web site at:
www.state.nj.us/treasury/pensions/health-benefit.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 local government and school employees
and is designed to keep
employees informed about
developments in the health
benefits
programs.
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 or
School Employees’ Health
Benefit 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-0863-0910
STATE OF NEW JERSEY — DIVISION OF PENSIONS AND BENEFITS
STATE HEALTH BENEFITS PROGRAM (SHBP) and SCHOOL EMPLOYEES’ HEALTH BENEFITS PROGRAM (SEHBP)
OPEN ENROLLMENT FOR PLAN YEAR 2011
October is the SHBP and SEHBP Open Enrollment period — your annual opportunity to review health
benefits 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/SEHBP plans if you have not previously done so;
• Change to a different SHBP/SEHBP medical plan and/or (if provided) dental plan;
• Add eligible dependents – including children up to age 26* under federal health care reform changes
– see the Health Capsule newsletter for details.
STARTING THIS YEAR, OPEN ENROLLMENT PUBLICATIONS ARE ONLY AVAILABLE ONLINE
See the Health Capsule 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/SEHBP 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.
• 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-0863-0910
STATE OF NEW JERSEY — DIVISION OF PENSIONS AND BENEFITS
STATE HEALTH BENEFITS PROGRAM (SHBP) and SCHOOL EMPLOYEES’ HEALTH BENEFITS PROGRAM (SEHBP)
OPEN ENROLLMENT FOR PLAN YEAR 2011
October is the SHBP and SEHBP Open Enrollment period — your annual opportunity to review health
benefits 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/SEHBP plans if you have not previously done so;
• Change to a different SHBP/SEHBP medical plan and/or (if provided) dental plan;
• Add eligible dependents – including children up to age 26* under federal health care reform changes
– see the Health Capsule newsletter for details.
STARTING THIS YEAR, OPEN ENROLLMENT PUBLICATIONS ARE ONLY AVAILABLE ONLINE
See the Health Capsule 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/SEHBP 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.
• 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. *Optional coverage for
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
Local Education Contacts-0910
NEW JERSEY SCHOOL EMPLOYEES’ HEALTH BENEFITS PROGRAM
FALL 2010 ANNUAL OPEN ENROLLMENT PERIOD
MEDICAL AND DENTAL PLAN CONTACT INFORMATION
The annual Open Enrollment period for the School Employees’ Health Benefits Program (SEHBP) 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 SEHBP
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.
AVAILABLE MEDICAL PLANS
Unit #
Health Plan Name
Member Services Telephone Number
Web Site Address
050
NJ DIRECT10
1-800-414-SHBP (1-800-414-7427)
www.horizonblue.com/shbp
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 Ed)
NEW JERSEY SCHOOL EMPLOYEES’ 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 #
050
150
PHONE
NUMBER
(973) 466-6666
Fax: (973) 466-6452
CONTACT PERSON
Bella Bustamante
HEALTH MAINTENANCE ORGANIZATIONS
HMO #
PHONE
NUMBER
Aetna HMO
019
(215) 775-0434
Lisa Marie Hopkins
E-mail: hopkinsl@aetna.com
CIGNA HealthCare
020
(201) 533-7758
Kathy Reed
E-mail: kathy.reed@cigna.com
PLAN NAME
CONTACT PERSON
*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 Ed)
EMPLOYEE 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
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
Lisa Marie Hopkins
E-mail: hopkinsl@aetna.com
Dental Expense Plan – Administered by Aetna Dental
399
(215) 775-0434
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.
(9/10)