Reporting
SHBP Changes
Each
month the Health Benefits Bureau sends to all local employers
and the monthly subgroups of the State a report listing the following:
- The total number of employees
covered under each coverage code, together with the total billing
amounts, and;
- The payment transmittal amounts,
listing the total premiums due for the employer and dependent
portions. The monthly report is sent to the employer on or about
the 20th of each month. To view a sample monthly report, click
here. Payment transmittal must be made through the Transmittal
Electronic Payment System, or TEPS, by the 15th of the following
month in order to guarantee continuation
of coverage for all employees.
Please recall that in order for
your payment to be timely, you must complete your call to the
TEPS program by 5:30 p.m. EST/EDT, one business day prior to the
day you wish to transfer the funds.
For further information about
the Transmittal Electronic Payment System, or TEPS, visit any
of the TEPS links listed below:
Each month the Health Benefits
Bureau will mail a completed alphabetical listing ("Alpha
List") to participating employers showing all
of the location's covered employees (and retirees, if the local
employer is paying for retiree coverage). To ensure accuracy of
coverage for employees and retirees, the lists generated by the
SHBP should be audited by the employer, and any discrepancies
reported immediately to the Health Benefits Bureau. Employers
are periodically requested to confirm enrollments of all eligible
employees to the Division.
All State biweekly employees covered
by the State Health Benefits Program are reported for coverage
through the State Health Benefits Bureau. All applications for
changes in coverage and new enrollment applications must be received
in the Health Benefits Bureau on the first Friday of the week
following the date that the member actually receives biweekly
pay. This is in accordance with the biweekly payroll date schedule
produced by Centralized Payroll.
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Forms
The following forms
are to be used for the submission of changes by the fifth of each
month:
-
Transmittal
of Deletions
This form is to be used for deletions due to death, termination,
and retirement. Instructions for its completion are printed
on the reverse side of the form.
-
Monthly
Change Summary
This form must be completed by employers each month and
should include the total number of applications for new enrollments,
coverage changes, and rejections of coverage being submitted,
as well as the total number of deletions reported for the
month.
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Collect
and Remit Premium Payments
Local
Group
The SHBP will bill Local Group
employers each month for the complete cost of health benefits
coverage and, if the employer elected to join the State program,
for prescription drug coverage for its employees and their eligible
family members. The SHBP will also bill for health benefits coverage
of eligible retirees, if the employer has opted to pay for them.
The employer is responsible for collecting
any required employee contributions, such as the cost of dependent
coverage or payments for coverage during a leave of absence. The
employer is also responsible for maintaining any separate accounting
for employee payments that it deems necessary.
Separate bills for active employees
and eligible retirees are mailed each month. Payment, made through
the Transmittal Electronic Payment System, or TEPS, is due on
the 15th of the month of coverage unless the employer has enrolled
in the Premium Delay program.
The bill includes information such
as the employer identification number, employer name, billing
date, payment due date, current coverage period, premium delay
information, and amounts due - past, current and total. To
view a sample bill, please click here.
If a past due amount has been paid,
but was not received by the SHBP before the bill was printed,
the employer may make adjustments and remit the corrected amount
due through TEPS.
Please recall that for your payment
to be timely, you must complete your call to the TEPS program
by 5:30 p.m. EST/EDT, one business day prior to the day you wish
to transfer the funds.
For further information about
the Transmittal Electronic Payment System, or TEPS, visit any
of the TEPS links listed below:
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State
Monthly Group
All State Monthly Group employers
(all State colleges and universities, Palisades Interstate Park
Commission, NJ State Library, NY-NJ Harbor Commission, NJ Commerce
and Economic Growth Commission) will be sent a billing statement
each month from the SHBP for the complete cost of their active
employees' health benefits, dental coverage, and prescription
drug coverage. The total cost listed in the billing statement
for each program is only for informational purposes, as funds
for the State share of the premiums are provided to the SHBP by
the State Office of Management and Budget. The employer is responsible
for collecting any required employees' contributions, such as
the health benefits Traditional and HMO premium shares, the 50%
dental premium employee share, and leave of absence payments.
The billing statements include information
such as the employer identification number, employer name, billing
date, current coverage period, and total cost. Employers must
remit a separate payment for each of the three programs (health,
dental, and prescription drugs) through TEPS, with each payment
amount representing total monthly collections from employees for
that program. Payments should include premium
shares, prepaid premiums, and leave of absence premiums.
Please recall that in order for
your payment to be timely, you must complete your call to the
TEPS program by 5:30 p.m. EST/EDT, one business day prior to the
day you wish to transfer the funds.
For further information about
the Transmittal Electronic Payment System, or TEPS, please visit
any of the TEPS links listed below:
State
Biweekly Group
Each biweekly pay period, the SHBP
will provide the State Centralized Payroll with the complete cost
of health benefits and dental and prescription drug coverage.
The State Centralized Payroll is responsible for collecting, through
payroll deductions, any required employee contributions, such
as the health benefits Traditional Plan and HMO medical plan premium
share and the 50% dental employee share. Centralized Payroll will
collect premiums due from payroll benefits administrators or clerks
for all employees required to pay premiums when employees are
on leaves of absence and off the State payroll.
Centralized Payroll will initiate
the transfer of funds from the State of New Jersey General Fund
account to the corresponding bank accounts for each of the benefits
programs. A breakdown of all fund transfers is to be provided
to the SHBP.
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Individual
Retirees
The Division will deduct from monthly
pension allowances the cost of health benefits coverage for any
State or local retiree who is enrolled in the State Health Benefits
Program but is not eligible for local employer-paid or State-paid
health coverage. If the retirees do not receive a pension allowance
from the Division or the allowance is insufficient to cover the
premium, the SHBP will send them a monthly bill. The bill includes
the retiree's name, Social Security number, payment due date,
billing date, current coverage period, and amounts due—past,
current and total. The lower portion of the bill is a payment
stub, which includes the return address, that should be returned
with the retiree's payment to a SHBP lockbox account maintained
by our bank, in the window envelope provided. Payment is due on
the 15th of the month of coverage and is payable to the New Jersey
State Health Benefits Program (NJSHBP).
State Part-time Employees and
Part-time Faculty Members Employed at NJ Public Institutions of
Higher Education (NJ State Colleges, State Universities, and County
Community Colleges)
The Division will mail the eligible
employee a monthly bill for the cost of the coverage selected
by the employee. The bill includes information such as the member's
name, Social Security number, billing date, payment due date,
current coverage period, past and current amounts due for each
of the programs in which the member is enrolled, and the total
amount due. The lower portion of the bill is a payment stub, with
return address, which should be mailed with the member's payment
in the window envelope provided, to a SHBP lockbox account maintained
by the Division's bank (State of New Jersey Health Benefits Program,
PO Box 19519, Newark, NJ 07195-0519). Payment is due on the 15th
of the month of coverage and is payable to the New Jersey State
Health Benefits Program (NJSHBP).
Upon retirement, part-time State
employees and part-time faculty members who are enrolled in the
SHBP under the provisions of Chapter 172, P.L. 2003, are permitted
to enroll in retired group NJ PLUS coverage, provided that they
continue to pay the full cost of their retiree coverage. Prescription
drug coverage for these retirees is provided through NJ PLUS —
they are not eligible for the Employee Prescription
Drug Plan.
COBRA
Members
A member or dependent of a member
eligible to enroll under the provisions of
COBRA for the medical benefits and/or the dental, prescription
drug, and vision care programs, will receive a monthly bill. The
bill includes information such as the member's name, Social Security
number, billing date, payment due date, current coverage period,
past and current amounts due for each of the programs in which
the member is enrolled, and the total amount due. The lower portion
of the bill is a payment stub, with return address, which should
be mailed, with the member's payment, to a SHBP lockbox account
maintained by the Division's bank in the window envelope provided
(State of New Jersey Health Benefits Program, PO Box 19519, Newark,
NJ 07195-0519). Payment is due on the 15th of the month of coverage
and is payable to the New Jersey State Health Benefits Program
(NJSHBP).
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Overpayments
and Shortages
When an employer, retiree, or COBRA
member remits an amount that is more than the required payment,
the overpayment will be credited to the account and will be used
to reduce the following month's total payment due. If a direct
refund is desired instead of the payment application to the following
month's bill, a request in writing should be forwarded to the
SHBP.
When there is a payment shortage
of an employer bill for active employees that is not paid during
the 15 day grace period for that bill, a past due amount plus
an interest penalty for the payment shortage will be included
in the following month's bill. Interest is calculated at the rate
of 1% above the average rate of return on State Cash Management
Fund investments for the most recent fiscal year.
There is no interest charged for
payment shortages on an employer's retiree bill, an individual
retiree bill, or a COBRA member bill.
Failure to Pay by Retirees
If a retiree fails to pay the required
premiums for two consecutive months, coverage can and will be
terminated. A letter notifying the retiree of pending termination
is sent to the retiree when payment is late, and a second notice
is given if no response is received.
Coverage can be reinstated if the
retiree pays the premium in full within a reasonable time (two
to three months). If the retiree contacts the Division of Pensions
and Benefits, SHBP Retired Group, and pays all premiums owed to
date, coverage will be reinstated. Each case is handled separately,
and the date of reinstatement depends upon the circumstances that
caused nonpayment (i.e., illness, incapacitation, etc.).
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Local
Employer Late Payments
An interest penalty is added to the
employer bill for employees when payment is not received within
15 days of the due date. Interest is calculated at the rate of
1% above the average rate of return on State Cash Management Fund
investments for the most recent fiscal year.
Premium
Delay
The State Health Benefits Commission
allows participating local employers the option to elect a 30-
or 60-day delay in remitting payments for their active employee
bills. The local employer is required to complete a
premium delay resolution form provided by the SHBP.
The premium delay will be effective
on the first bill 60 days after the resolution is received by
the SHBP. If an employer with a premium delay terminates from
the program, all premiums become due and payable before the termination
effective date.
Review
and Reconcile Reports
Local and State monthly employers
are provided with a monthly member report, listed alphabetically.
The report includes information such as member name, spouse name,
member Social Security number, date of birth, insurance carrier
code, coverage level, effective date, and the corresponding monthly
premium for each of the programs. The employer should review the
list and inform the SHBP of any information that may need to be
changed.
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Part
B Medicare Premium Reimbursements
Reimbursements are made to certain
retired members who have met the following criteria:
-
State employees
who attained 25 years of service credit or retired under a
disability retirement prior to July 1, 1997;
-
Employees of State
universities and colleges and others who have 25 or more years
of credited service;
-
Members of TPAF
with 25 or more years of service credit; or
-
School board or
County college employees enrolled in the PERS or ABP who retire
with 25 or more years of service credit, or who retire under
a disability retirement.
Part B reimbursement is added directly
to the retirement allowance of those retirees who are members
of a State-administered pension fund.
When a member receives a retirement
allowance from a non-State-administered pension fund, a check
from the SHBP is automatically mailed to the retiree between the
1st and 15th of the month. Non-State-administered pension funds
include the Alternate Benefits Program, Rutgers retirees covered
under the Federal Employees retirement system, NJIT retirees receiving
Prudential annuities, UMDNJ retirees of the Employees' Retirement
Fund of the City of Newark, and the Board of Education Employees'
Pension Fund of Essex County.
When retroactive Medicare enrollment
coverage is processed, the reimbursement for prior months will
be added to the retirement allowance or the monthly check paid
to the member. Retroactive Medicare reimbursement is limited to
a maximum of 12 months.
The amount of Part B reimbursement
paid to State retirees may be subject to a current monthly maximum
amount of $46.10 per member, or $92.20 for a member and spouse
when both are on Medicare, based on union contracts or regulations
in effect at the time the member qualified for the reimbursement
in retirement. This level of reimbursement may change over time.
Local employers who have agreed to
reimbursement of Part B Medicare premiums to their retirees are
responsible for establishing their own procedures to do so.
Part
A Medicare Premium Reimbursements
Chapter 447, Public Law 1987, provides
that the State shall reimburse retirees of the State Police Retirement
System and their spouses who pay the full monthly premium charges
for Hospital Insurance (Part A) under the Federal Medicare Program.
A claim form is provided by the SHBP to the retiree, who is required
to complete and submit the claim form at the end of every quarter.
Proof of payment made to the Federal Medicare Program for Part
A coverage, such as copies of the canceled check or check stub,
should be included when submitting the claim form to the SHBP.
The reimbursement is paid three to four weeks after the completed
claim form is received by the SHBP.
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Local
Employer Payment of Retiree Coverage under Chapter 48
If the local employer opts to pay
for retiree coverage under the provisions of Chapter 48, and establishes
conditions that the SHBP can program for, the SHBP will bill the
employer for the retiree benefits. If the Chapter 48 resolution
adopted by the employer cannot be programmed by the SHBP, then
the SHBP will deduct the full cost of coverage from the retiree's
pension allowance, or bill the retiree for the cost of coverage.
The employer must then establish procedures to reimburse the retiree
for the coverage it has agreed to provide.
Chapter
88 and Chapter 436 Resolutions
Chapter
48 Resolution
How
Plan Rates Are Set
The SHBP is required to contract
with independent actuaries to provide consulting services to the
program. Seven months prior to the effective date of the new plan
rates, all participating claims administrators and insurance carriers
are required to submit their rate proposals to our consultants.
The consultants perform a review of the claims, administrative
expenses, and other financial and statistical information for
each plan, prepare cost projections for current and upcoming periods,
determine the adequacy of funding levels, and submit their recommendation
on the plan rates for adoption by the State Health Benefits Commission.
The Commission hears testimony about the proposed rate actions
and approves rates it deems appropriate for the SHBP.
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Surcharge
for Nonparticipating School Districts
Chapter 8, Public Law 1993, provides
for insurers of school districts that do not participate in the
SHBP to pay an annual surcharge to the program. The surcharge
is determined by the State Treasurer and is based on a percentage
of the total claims paid for the coverage of employees of the
nonparticipating school districts. The surcharge is to compensate
the SHBP for the excess cost of the health coverage of the school
district's eligible retirees (25 or more years of credited service
in a State-administered pension fund, or retired on disability
with fewer years of service), who are covered in the SHBP.
Every November 1, a survey is sent
to each nonparticipating school district requesting the name and
address of their health benefits insurance carrier. A response
is required by the end of November. The SHBP sends a surcharge
payment request form on December 1 to the insurance carrier. The
insurance carrier will complete the surcharge form and forward
the form and payment to the SHBP by December 31. The surcharge
form includes information such as adjustments from prior year
payment, total claims paid, the surcharge rate and the amount
to be remitted.
The surcharge rates are shown
in the chart below.