|
Health Plans
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 changes to 35 hours per week for new hires. Employees hired on/or prior to May 21, 2010, who work less than 35 hours per week 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
NOTE: Part time employees who work under .5 FTE and who are enrolled in a pension plan are eligible to enroll in NJ DIRECT15 only. The employee must pay the full cost of the health plan coverage.
Medical Plans
NJ DIRECT15 is a Preferred Provider Organization (PPO)
Uses own network of providers and offers out of network benefits
Plan Highlights:
- Administered by Horizon Blue Cross/Blue Shield of NJ
- Provides both in and out-of-network care
- Health care contribution is 1.5% of annual base salary for non-union employees and union represented members who have settled contracts.
Please refer to the Health Benefits Deductions Chart to determine when you will be required to begin deductions.
- 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 covered in full with a $15.00 co-pay per office visit
- Co-pay charge for emergency room visit will be $50.00, 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
- Deductible applied is $100.00 per person up to a maximum family deductible of $250.00
- After the deductible is met, NJ DIRECT15 pays 70% of what is “reasonable and customary” expenses. 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)
Plan Highlights:
- Home address/zip code determines eligibility
- Required to select a primary care physician
- “In Network” services only
- Referrals required for most specialists
- Health care contribution of 1.5% of annual base salary for non-union employees and union represented members who have settled contracts.
Please refer to the Health Benefits Deductions Chart to determine when you will be required to begin deductions.
- Preventative care/eligible charges covered in full with a $15.00 co-pay per office visit
- Co-pay charge for emergency room visit will be $50.00, 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)
Please refer to the following SHBP member handbooks and related links for additional detailed information:
NJ Direct15 member handbook
Aetna Health SHBP member handbook
CIGNA HealthCare member handbook
Premium Rates Summary Chart
SHBP Plan Comparison Summary
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
- $50.00 deductible per person; $150.00 deductible per family
- Annual dollar maximum: $3,000 per member
- 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
- 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 Medco
- Prescription Drugs are available through a participating retail pharmacy or through Caremark mail order service
- No cost for union members and union represented members who have settled contract or expired contract
- Non-union employees and union members (with settled contract) who waive medical but elect prescription will pay 1.5% of their annual salary
Source of purchase |
Amount of supply |
Cost |
Retail pharmacy |
30 - day |
$3.00 - generic
$10.00 - brand name w/o generic equivalents
$25.00 brand name w/generic equivalent |
Mail order |
90 - day |
$5.00 - generic
$15.00 - brand name w/o generic equivalents
$40.00 - brand name w/generic equivalent |
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.
|
