Medical and Prescription Drug Plans
Kean University employees participate in the State Health Benefits Program (SHBP) through the Division of Pensions and Benefits of the State of New Jersey.
Full-time employees, spouses, civil-union partners, certain same-sex domestic partners and dependent children are eligible for health insurance coverage.
Generally, employees and their eligible dependents may be covered after 60 days of continuous employment. Full-time faculty members whose appointments start on September 1 may be covered as of the beginning of the academic year. Faculty members that begin employment on other dates are eligible for health benefits following a 60 day waiting period.
The cost of the plans is determined according to the employee's base salary and level of coverage selected. For more details, please review the following documents that contain medical plan descriptions, costs and comparison charts.
SELECTING THE RIGHT PLAN FOR YOU
Below you will find helpful resources and information to help you make an informed decision regarding your health benefits. Please note that additional information and guidance may be found by logging into Benefitsolver, a new website designed for employees to enroll in their benefits, make plan changes, add new dependents, and upload documentation.
Employees who want to make plan changes will be able to access Benefitsolver through the myNewJersey portal. Those who do not have a myNewJersey account must create one in order to access Benefitsolver.
For Managers, IFPTE & AFT (Faculty and Professional Staff)
- Select Employee type: state union negotiated
- Select coverage type: family, single, etc.
- Select prescription plan: shbp employee prescription drug plan
This will generate annual costs for available plans. 10 month faculty member may divide the sum by 22 to obtain an estimate of the biweekly employee deduction. 12 month employees may divide by 26.
Schedule 2, for HMO & HDHP Plans
Schedule 3, for Tiered Network Plans
For CWA Members
CWA - Cost of Coverage Calculator
- Select Employee type: state cwa
- Select coverage type: family, single, etc.
- Select prescription plan: shbp employee prescription drug plan
This will generate annual costs for available plans. CWA 12 month employees may divide by 26 to obtain the biweekly employee contribution.
CWA - Rx – Plan Comparison Chart
CWA - Schedule 1, for PPO Plans
CWA - Schedule 2, for HMO & HDHP Plans
CWA - Schedule 3, for Tiered Network Plans
Police Unit Employees (NJSPBA, NJLESA, NJSOLEA)
- Select Employee type: state all other
- Select coverage type: family, single, etc.
- Select prescription plan: shbp employee prescription drug plan
Medical Plan Side-by-Side Comparisons
https://www.state.nj.us/treasury/pensions/documents/hb/oe2023/2023-shbp-state-overview.pdf
Prescription Drug – Comparison Charts
https://www.state.nj.us/treasury/pensions/documents/hb/oe2023/ha1059.pdf
https://www.state.nj.us/treasury/pensions/documents/hb/oe2023/ha1035.pdf
https://www.state.nj.us/treasury/pensions/documents/hb/oe2023/ha0895.pdf
Additional Resources
Medical Plans - Web Addresses & Phone Numbers
Horizon Doctor and Hospital Finder
Horizon Medical Health Insurance Claim Form
Summary of Benefits and Coverage
Plan Year 2023 - Summary of Benefits and Coverage
R-Health:
INCENTIVE PROGRAM FOR THE TIERED NETWORK PLAN
The Incentive Program for Horizon OMNIA will be extended for State employees. The program will offer a financial incentive of $1,000 to first-time enrollees who remain enrolled for one year for all coverage levels (i.e., Single, Member and Spouse, Parent and Child, or Family coverage). The incentive is paid by gift card no later than the end of the current tax year and is deemed reportable income for tax purposes. The incentive shall be forfeited and returned to the SHBP if the subscriber fails to remain enrolled in the Tiered-Network Plan for at least one plan year.
How do I check if my doctor is in network with Horizon?
Click on the Horizon Doctor & Hospital Finder. Then, enter the appropriate zip code and plan prefix code. See below for details.
- The card prefix is NJX for all of the PPO plans [All NJ DIRECT plans; CWA Unity DIRECT plans], including the NJ DIRECT High Deductible Health plans].
- The card prefix is SNJ for all of the Horizon HMO plans.
- The card prefix is NJO for OMNIA.
PRESCRIPTION DRUG PLAN
The Employee Prescription Drug Plan is a separate drug plan for active employees. OptumRx is the current pharmacy benefits administrator. For further information regarding the Prescription Drug Plan, please click here.
OptumRx: https://www.optumrx.com/oe_sonjactiveee/landing
What to know about over-the-counter(OTC) at-home COVID-19 test coverage: https://www.optumrx.com/content/rxmember/default/en_us/angular-free/optumrx/Information-Center/test-reimbursement.html?is=orxrd:orx:covidtest
OptumRx - Medication Home Delivery
Employees will no longer be able to select different levels of Medical and Prescription Plan Coverage. For example, a member may not elect to have Single Medical coverage and Member/Spouse Prescription coverage. The level of coverage must be the same for both plans.
Members also must elect to enroll in both Medical and Prescription. If a member wishes to waive coverage, both Medical and Prescription coverage must be waived.
ENROLL/MAKE CHANGES TO YOUR HEALTH BENEFITS
The State Health Benefits Program holds its annual open enrollment each fall (usually in October). During open enrollment, employees may change plans or add dependents to their coverage. Contact the Office of Human Resources for the specific dates of open enrollment.
Changes in health coverage due to life events, such as marriage, birth of a child, divorce, may be made within 60 days of the event date. Employees must advise the Office of Human Resources immediately of any change in personal status which might affect the employee's benefits coverage. You may drop your coverage at any time.
All Health Benefit election changes must be submitted through Benefitsolver, a new website designed for employees to enroll in their benefits, make plan changes, add new dependents, and upload documentation.
Employees who want to make plan changes will be able to access Benefitsolver through the myNewJersey portal. Those who do not have a myNewJersey account must create one in order to access Benefitsolver. Click here for instructions.
Benefitsolver - login here
The Company Key is SHBP/SEHBP (all capital letters)
Employee Guide to Logging into Benefitsolver
If you have questions regarding your benefits, please contact benefits@kean.edu.