The following has been brought to the Unions attention in regards to Open Enrollment
The State Health Benefits Program (SHBP) Open Enrollment period for Local Government employees begins on October 2, 2017, and ends on October 31, 2017.
Open Enrollment allows employees to 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, 2018.
There are no medical plan changes for Plan Year 2018. The medical plans available to Local
Government employees for Plan Year 2018 are:
Tiered-Network Plans: Aetna Liberty Plan; Horizon OMNIA Health Plan
PPO Plans: Aetna Freedom1525; Aetna
Freedom2030; Aetna Freedom2035; 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 areas for Horizon HMO are limited to New Jersey and bordering
counties of Pennsylvania, Delaware, and New York.
DENTAL & PRESCRIPTION PLANS
There are no changes for Plan Year 2018, however the City plans to implement a self-insured prescription plan sometime during the middle of 2018. For additional information about the dental plans, please see the attached guide. Both dental and prescription plans remain through the City of Newark.
EMPLOYEE CONTRIBUTIONS FOR SHBP COVERAGE
Pursuant to Pension and Health Benefit Reform (P.L. 2011, c. 78) and with the expiration, renewal, or extension of collective negotiations agreements, employees must pay a percentage
of the cost of the medical and prescription plans. Percentage of premium contribution worksheets and online calculators are revised for 2018 rates.
AVAILABILITY OF SUMMARY HEALTH INFORMATION
Your health coverage through the State Health Benefits Program (SHBP) offers protection to you and your family in the case of illness or injury.
Choosing a health plan is an important decision. To help you make an informed choice, the SHBP provides Summaries of Benefits and
Coverage — which contain important information about health coverage options in a standard format designed to help you compare plans.
Summaries for SHBP/SEHBP plans offered in 2018 can be viewed online or printed at: www.nj.gov/treasury/pensions/hb-sbc-home.shtml
You may request a paper copy, free of charge, by calling the Division of Pensions & Benefits
at (609) 292-7524 between 7:00 a.m. and 4:30 p.m., Monday through Friday (except State Holidays).
DENTAL PLAN OPTIONS
City of Newark employees have three dental plans to choose from. Coverage is administered by Horizon Blue Cross Blue Shield of New Jersey Dental Programs, a powerful regional dental organization poised to meet the challenges of the ever-changing dental care market and Group Dental Health Associates.
Horizon Dental Choice Plan E
Horizon Dental Choice Plan E is a Dental Maintenance Organization type of program. There are no deductibles to satisfy and there is NO annual maximum. When you utilize the services of an in-network dentist, most routine eligible services are covered at 100% while the more extensive services are paid at 100% after payment of the specified copay. Orthodontic benefits are included. A primary care dentist will facilitate all of your dental care and service needs. He/she will also provide you with the needed referral when the services of a specialist are required. This plan has no out-of-network benefits. Please note that if you have dental work in progress under the Group Dental Health Administrators Plan, you must wait until the work is completed and until the next open enrollment period to enroll in the Horizon Dental Choice Plan E.
Horizon Dental Option Plan
Horizon Dental provides both in and out-of-network benefits. Benefits are reimbursed at 100%, 80% or 50% depending upon the type of services you receive. Network providers are required to accept Horizon’s fee allowance. Since the fee allowance is typically significantly less than the prevailing or billed charge, you will save money by using an in-network dentist. Out-of-network dentists are reimbursed at 80% of the Usual, Customary, and Reasonable (UCR) allowance. Members are responsible for the coinsurance and the difference between billed charges and the UCR allowance.
Group Dental Administrators
Please note Group Dental will offer you a very high level of benefits when you use a network provider. There is no out of network coverage. Group Dental Health Associates provides coverage when using their in-network providers. Offices are currently located in Newark, East Brunswick, Toms River and Union. This plan does not include an annual maximum limit. Group Dental provides 100% coverage for many services and up to 80% for other eligible procedures. Eligible dependents may be covered up to age 26. Please review the dental plan comparison chart to obtain additional information.
Please note that dependent limiting age varies for each union. If you are unsure as to which level of benefits you are entitled to please contact the Employee Benefits Unit.