The Office of Human Resources at Kean University would like to inform you that the State Health Benefits Program (SHBP) Open Enrollment period for full-time Kean University employees will extend from October 1, 2015 through November 2, 2015.
During the Open Enrollment period employees can make general changes (adding or deleting dependents, changing coverage levels, etc.) or enroll in a different medical or dental plan. All changes to coverage made during this Open Enrollment period will be effective on January 1, 2016.
Changes for Plan Year 2016
For employees covered under the SHBP, the selection of medical plans will change for Plan Year 2016. Both Aetna and Horizon Blue Cross Blue Shield of New Jersey (Horizon) will offer a new tiered network plan design. These tiered network plans will replace the HMO1525, HMO2030 & HMO2035 products and will be offered to active employees only. Participants in those plans will be automatically transferred to the new tiered network plan or they can choose another plan by November 2. Aetna HMO1525/2030/2035 members will be placed in the Aetna tiered network plan called the Aetna Liberty Plan and Horizon HMO1525/2030/2035 members will be placed in the Horizon OMNIA Health Plan tiered network plan.
The following describes the tiered network plan design:
- The Aetna Liberty Plan and Horizon’s OMNIA Health Plan will give members the flexibility to visit high-quality practitioners in the carrier’s managed care network, significant premium share reductions and no referrals are required. There will be lower member cost sharing and copays as low as $5.00 for an office visit, when utilizing Tier 1 providers. Tier 1 refers to specific doctors, hospitals and other health care professionals who offer high-quality, cost-effective care. Tiered Network plan members also have the flexibility to see any Tier 2 provider included in the managed care network, but with slightly higher cost sharing. There is no out-of-network coverage with the Tiered Plans.
Aetna Liberty Plan — Members can use DocFind™ to search for participating Tier 1 and Tier 2 providers at http://www.aetnastatenj.com/ starting in October.
Horizon’s OMNIA Health Plan — Members will be able to identify Tier 1 and Tier 2 providers on the Horizon online Doctor & Hospital finder at http://shbp.horizonblue.com/ in early September.
Other changes taking effect with Plan Year 2016 include the following:
- Payment for Out-Of-Network Chiropractic and Acupuncture visits will be limited to $35 for chiropractic and $60 for acupuncture, or 75% of the in-network cost per visit, whichever is less. That’s the full amount the provider will receive from the carriers for the visit, not just member co-insurance. This means that, if the chiropractor charges more than $35 for an office visit, the member will have to pay the difference out of his/her pocket. Aetna and Horizon both have extensive provider networks, so members should consider switching to an in-network practitioner.
- Emergency room co-pays will increase by $25 where the co-pay is currently less than $100. This does not apply to dependents under age 19 or members referred to the ER by a physician.
2016 Plan Designs
The same Preferred Provider Organization (PPO) plans, two Health Maintenance Organization (HMO) plans, two new Tiered Network Plans, and the same High Deductible Health Plans will be offered for Plan Year 2016.
The medical plans available to employees are:
- New! Tiered Network Plans: Aetna Liberty Plan; Horizon’s OMNIA Health Plan
- PPO Plans: Aetna Freedom15; Aetna Freedom1525; Aetna Freedom2030; Aetna Freedom2035; NJ DIRECT15; NJ DIRECT1525; NJ DIRECT2030; NJ DIRECT2035.
- HMO Plans: Aetna HMO; Horizon HMO;
- High Deductible Health Plans: Aetna Value HD1500; Aetna Value HD4000; NJ DIRECT HD1500; NJ DIRECT HD4000.
Note: The service area for Horizon HMO is limited to New Jersey, Delaware, and bordering counties of Pennsylvania and New York.
There are no dental plan changes for Plan Year 2016. Dental coverage is offered to all eligible employees through the Employee Dental Plans. Six different dental plans are offered based on one of two different plan designs — Dental Plan Organizations (DPO) and a Dental Expense Plan (DEP).
- Five DPOs are available: Aetna DMO; CIGNA DHMO; Healthplex; Horizon Dental Choice; and MetLife.
DPOs contract with a network of providers for dental services. When an employee or dependent uses a DPO dentist, diagnostic and preventive services are covered in full. Most other eligible expenses require a small copayment. Members must use a provider that participates with the DPO selected to receive coverage. Be sure to confirm that the dentist or dental facility selected is taking new patients and participates with the SHBP Employee Dental Plans, since DPOs also service other organizations.
- The Dental Expense Plan is a preferred provider organization plan that allows members to obtain services from any dentist; however, using an in-network provider will reduce an employee’s costs. After satisfying an annual deductible (no deductible for preventive services), members are reimbursed a percentage of the reasonable and customary charges for eligible 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.
NJWELL WELLNESS PROGRAM
NJWELL is open to employees who are enrolled in the SHBP. Spouses and eligible partners can also participate, as long as they are covered by the SHBP plan.
The Wellness Plan Year 2015 will be coming to a close on October 31. In 2015, employees and their covered spouses or partners can receive a gift cards worth up to $200 for earning anywhere from 300 to 500 or more points by October 31!
Important: If you have completed your biometric screening and your health assessment already for this year, you need to earn an additional 50 points in order to receive an initial gift card worth $100. To continue to earn rewards, login to the Aetna or Horizon online member portal.
EMPLOYEE CONTRIBUTIONS FOR SHBP COVERAGE
Pursuant to the Pension and Health Benefit Reform (Chapter 78, P.L. 2011), employees must pay a percentage of the medical and prescription plan premiums. Percentage of premium contribution worksheets and online calculators will be revised for 2016 rates, and will be available on the Division of Pensions and Benefits’ website. An e-mail will be sent to employees when this information becomes available.
WAIVING SHBP COVERAGE
State employees are permitted to waive SHBP medical and prescription coverage — and avoid the required employee contribution — provided that they have other health care coverage. To waive coverage a SHBP State Waiver form and a Health Benefit Application must be completed during Open Enrollment.
Open Enrollment For Tax Savings Program (Tax$ave 2016) - For FullTime Employees Only
The annual open enrollment for the calendar year 2016 New Jersey State Employees Tax Savings Program, including the Unreimbursed Medical Flexible Spending Account and the Dependent Care Flexible Spending Account, will begin October 1 and end on November 2, 2015.
Enrolling in a Flexible Spending Account
Employees have three ways of enrolling in the Tax$ave FSA accounts during the Open Enrollment: mail, fax, and Internet:
Internet: Employees can enroll in the Unreimbursed Medical and/or Dependent Care FSA plans over the Internet at: www.wageworks.com. The deadline for enrollment over the Internet is midnight, November 2, 2015.
Fax: FSA Enrollment Forms may be faxed by the employee to 1-866-672-4780. The deadline for accepting faxed enrollment forms is midnight, November 2, 2015.
Mail: FSA Enrollment Forms can be mailed by the employee directly to WageWorks, Enrollment Processing, PO Box 1840, Tallahassee, FL, 32302-1840. To be accepted, enrollment forms must be postmarked no later than November 2, 2015. Forms postmarked after November 2, 2015 will be returned without action.
For further details on Tax$ave 2016, please visit http://www.nj.gov/treasury/pensions/taxsave.shtml.
Stay connected to the Division throughout Open Enrollment via their social media accounts listed below:
If you have questions regarding Open Enrollment, please feel free to contact Yrelys Tapanes, Managing Assistant Director – Benefits, at 908-737-3313 or email@example.com.