• Medical
• Dental
• Prescription Drug

As an UMDNJ employee, your medical, dental and prescription drug benefits are provided through the State Health Benefits Program (SHBP). We offer excellent benefits health plan options that will suit the needs of you and/or your household.

Plan Eligibility: Effective after May 21, 2010, the current minimum State Health benefits requirement of 20 hours per week changed to 35 hours per week for newly hired staff members and .88 FTE for newly hired faculty members. Employees hired on/or prior to May 21, 2010, who work less than 35 hours per week or less than .88 FTE will continue to receive their health benefits provided there is no break in service or their hours are not reduced below the minimum of 20 hours per week for staff or .5 FTE for faculty.

NOTE: Part time staff members who work less than 20 hours and faculty members who work less than.5 FTE and who are enrolled in a pension plan are eligible to enroll in any SHBP plan. The employees must pay the full cost of the health plan coverage.

Medical Plans 

Preferred Provider Organization (PPO)
Uses own network of providers and offers out of network benefits

Plan Highlights:

• Administered by Aetna and Horizon BCBSNJ
• Provides both in and out-of-network care
• Health care contribution is a percentage of the premium based on your salary, plan and level of coverage. Please refer to the Premium Share Percentage Worksheet to determine your bi-weekly premium.
• A medical insurance card is issued

In Network:

• No primary care physician is required
• No referrals are required for in-network providers
• Preventive care/eligible charges are covered in full
• Co-pays for emergency room visits vary depending on plan enrolled, there is no charge if admitted
• No deductible is required
• No filing of claim forms when using in-network services
• Medical Plan Websites (listing of primary care physicians and specialists)

Out of Network:

• Permitted to choose any physician outside the network
• Does not cover most well-care and preventative services
• Deductibles apply per person up to the applicable maximum family deductible
• After the deductible is met, the plan pays 70% coinsurance of what is a “reasonable and customary” expense. The employee is responsible for the remaining balance.
• Claim forms are filed by the member and sent directly to the insurance company.

Health Maintenance Organizations (HMOs)
Uses own network of providers and does not offer out-of-network coverage

Plan Highlights:

• Administered by both Aetna and Horizon BCBSNJ
• Required to select a primary care physician
• “In Network” services only
• Referrals required for most specialists
• Health care contribution of is a percentage of the premium based on your salary, plan and level of coverage. Please refer to the Premium Share Percentage Worksheet to determine your bi-weekly premium.
• Preventative care/eligible charges are covered in full
• Co-pay charge for emergency room visit varies depending on HMO plan selection, there is no charge if admitted
• No bill or claim forms
• Medical insurance cards issued
• Medical Plan Websites (listing of primary care physicians and specialists)

High Deductible Health Plans (HDHP)

Plan Highlights:

• Administered by Horizon BCBSNJ and Aetna
• Healthcare contribution is a percentage of premium based on your salary, plan and level of coverage. Please refer to the Premium Share Percentage Worksheet to determine your bi-weekly premium
• Option to select $1,500 or $4,000 deductible; if enrolled in a member/spouse, parent/child(ren) level of coverage, the deductible is doubled
• After deductible is met, the plans pay the applicable co-insurance of reasonable and customary expenses
• Prescription drugs are subject to the applicable deductible
• There is a Health Savings Account (HSA) available at time of enrollment

Please refer to the following SHBP member handbooks and related links for additional detailed information:
NJDirect member handbook
Aetna Health SHBP member handbook
Premium Share Percentage Worksheet
Summary of Benefits and Coverage
SHBP Summary Program Description
SHBP Plan Designs Comparison Chart

Dental Plans 

The New Jersey State Employee Group Dental Program consists of the Dental Expense Plan and the Dental Plan Organizations (DPOs).

Members must remain in the designated dental plan for twelve (12) months from the effective date of coverage.

Dental Expense Plan

Plan Highlights:

• Administered by Aetna Dental
• $50 deductible per person; $150 deductible per family applies to in-network services only
• $75 deductible per person; $200 deductible per family applies to out-of-network services only
• Annual dollar maximum: $3,000 per member for services rendered in-network; $2,000 annual dollar maximum per member for services rendered out-of-network
• Claim forms are required
• Eligible expenses: basic preventive, periodontics, prosthedontics
• Eligible expenses covered at percentage of reasonable and customary charges after deductible has been met
• Not eligible: Supplies for home use, charges that are more than reasonable and customary
• Orthodontic eligibility:
  • Plan enrollment for ten (10) months
  • Dependents under age nineteen (19) qualify
  • Not available for procedures started prior to coverage being effective
  • $1,000 individual lifetime benefit maximum for in-network; $750 individual lifetime benefit maximum for out-of-network
• Biweekly premium

Please refer to the SHBP Employee Dental Plans Member Handbook for additional detailed information.

Dental Provider Organization (DPOs)

Plan Highlights:

• Coverage restricted to DPO providers in-network only
• No benefits maximum
• Preventive/routine care services are covered at 100%
• Co-payment for specialist care
• No claim form is required
• Dental ID card(s) are issued
• Biweekly premiums deducted from pay
• Orthodontic eligibility:
  • Patients under age 18 (at the start of treatment) – co-pay is $1,000 or 50% of reasonable and customary charges, whichever is less
  • Patients over age 18 or over (at the start of treatment) – co-pay is $1,750 or 50% of reasonable and customary charges, whichever is less

Please refer to the SHBP Employee Dental Plans Member Handbook for additional detailed information.

Prescription Drug Plan 

Plan Highlights:

• Administered by Express Scripts
• Prescription Drugs are available through a participating retail pharmacy or through Express Scripts mail order service
• Express Scripts Prescription Drug Plan is not available with any of the High Deductible Health Plans (HDHP)

Source of purchase	Amount of supply	Cost
Retail pharmacy	30 - day	Co-pays vary depending on plan selection and drug tier
Mail order	90 - day	Co-pays vary depending on plan selection and drug tier

Please refer to the Prescription Drug Plan Member Handbook for additional detailed information.

* NOTE: The contribution amount will change any time there is a change in an employee's annual base salary.