As you
know, the State Health Benefits Plan (SHBP) is changing
in 2008. Effective April 1, 2008, Traditional and NJPlus
will be replaced by a PPO plan called NJDirect. Also effective
April 1, 2008, Cigna and Aetna HMOs will be available while
AmeriHealth, HealthNet, and Oxford HMOs will be eliminated.
These changes will
affect the following on April 1, 2008:
- ALL State executive branch workers (active and retired)s
- County government workers in the State Health Benefits
Plan
- Municipal government workers in the State Health Benefits
Plan
County and municipal
government workers who are NOT in the State health
plan will NOT be affected by the change. For questions regarding
your benefits, please consult your contract and/or your
steward or staff representative.
Other workers including
the following, are affected differently by the plan change:
- NJ Judiciary workers
- Corrections, police, and other units still in negotiations
These employees who are currently in the Traditional or
NJPlus plans will remain in those plans until their contract
negotiations are completed. They will not switch to one
of the replacement PPOs. However, those employees from these
groups that are in AmeriHealth, HealthNet or Oxford will
change plans to NJPlus or one of the HMOs effective April
1, 2008 because their current HMO will no longer be available.
Contact your payroll/benefits office for more information.
Links
What
are the changes to the SHBP?
When
is open enrollment and what can I change?
How
do I find whether my doctor is in the network?
Where
do I find official information from the State?
Where
do I find more information from Horizon, Aetna or Cigna?
What
are the changes to the SHBP? | top
Traditional and NJPlus are being replaced and AmeriHealth,
HealthNet, and Oxford HMOs are being eliminated effective
4/1/08.
The new plan options
for employees will be the following:
- NJDirect 10 (PPO plan) replaces the Traditional plan.
Active State employees will not have the option of NJDirect
10. Retirees currently eligible for Traditional, and active
employees who are eligible for Traditional in retirement
per a collective bargaining agreement, will have NJDirect
10 available in retirement. The coverage levels, out of
pocket maximums, deductibles, and "out of network"
costs are the same as Traditional. (more on NJDirect 10)
- NJDirect 15 (PPO plan) replaces NJPlus. All active State
employees will have the option of enrolling in NJDirect
15. The coverage levels, out of pocket maximums, deductibles,
and "out of network" costs are the same as NJPlus.
(more info on NJDirect15)
- Cigna HMO continues as it is now.
- Aetna HMO continues as it is now.
There are two important
differences between the NJDirect PPO and NJPlus.
First, there is no gatekeeper
in the NJDirect plan. You will not need to designate a primary
care physician (PCP) and you will not need referrals from
your PCP to see a specialist. (You may need precertification
for certain procedures like x-rays, MRIs, etc. the same
as you did under NJPlus.)
Second, the NJDirect
PPO network is nation-wide while the NJPlus network is limited
to a few states. This nation-wide network means that you
can find in network providers in every state, which is especially
important for retirees moving out of state.
When
is open enrollment and what can I change?
| top
There is an open enrollment period from January 28 through
February 15, 2008 during which employees can select
which of the new plans - NJDirect 15, Cigna HMO, or Aetna
HMO - they want. You can not change coverage or add dependents
during this open enrollment - you can only select a new
plan.
If you do nothing during
the open enrollment, you will enrolled automatically as
follows:
- NJPlus now = enrolled in NJDirect 15
- Traditional now = enrolled in NJDirect 15
- AmeriHealth, HealthNet, Oxford now = enrolled in NJDirect
15
- Aetna HMO now = continue to be enrolled Aetna HMO
- Cigna HMO now = continue to be enrolled in Cigna HMO
If you want to act during
open enrollment to select a plan, you must complete an enrollment
form. You can find enrollment forms for the different plans
online here. (http://www.nj.gov/treasury/pensions/shbp_forms.htm).
How
do I find whether my doctor is in the network?
| top
The network for NJDirect 10 and NJDirect 15 is the same
network as NJPlus. If your doctor is in NJPlus now,
he/she will be in NJDirect. The provider network for NJDirect
is called the "Horizon Blue Card" network.
For current Aetna and
Cigna enrollees, the network isn't changing.
For AmeriHealth, HealthNet,
and Oxford enrollees, you will need to check whether the
NJDirect or Aetna or Cigna networks meet your needs.
You can find a provider
directory online:
- Aetna: http://www.aetna.com/statenj.htm or 1-877-STATE
NJ
- Cigna: http://www.cigna.com or 1-800-564-7642
- NJDirect (Horizon): http://www.horizonblue.com/shbp/provider_directory.asp
or 1-800-414-7427
(go to the Horizon website above, click on NJPlus link,
then click the drop down for "Select Your Plan"
and select NJDirect 10/15)
If your doctor is currently
in the Traditional plan network, you can check whether he/she
also participates in the NJPlus or NJDirect network. If
not, you can contact your doctor and ask them to join. If
your doctor is not in NJDirect, you can still go to him/her
as an "out of network" provider but you will be
responsible for payingthe
out of network costs.
How
can I get more information from Horizon, Cigna, or Aetna?
| top
Horizon, Cigna and Aetna are preparing for the open enrollment
and for handling the plans now. They have representatives
available to answer your questions. You can go online or
can call the plans directly for more information about the
network, health care providers, questions about whether
you need precertification for any services, etc.
- Aetna: http://www.aetna.com/statenj
or 1-877-STATE NJ
- Cigna: http://www.cigna.com
or 1-800-564-7642
- NJDirect (Horizon): http://www.horizonblue.com/shbp
or 1-800-414-7427
Where
can I find official information from the State?
| top
The official website for everything having to do with the
State Health Benefits Plan - http://www.state.nj.us/treasury/pensions/shbp.htm.
You can find the application
forms to enroll in a plan, documents explaining the new
plans, and more information.
If
you have any questions, you can contact us at information@cwa1034.org
or contact your staff representative.
