Eligibility Definitions and Required Documentation Chart Adobe PDF ( 23 kb)

DEVA Information for Employers (December 5, 2008)

DEVA — Frequently Asked Questions

DEVA — SHBP/SEHBP Member's Letter about the Dependent Eligibility Verification Audit - Adobe PDF (59 kb)

COBRA and the American Recovery and Reinvestment Act

Employee Notification of Extended COBRA Benefits under the ARRA (April 9, 2009)

Summary of the COBRA Premium Reduction Provisions under the ARRA Adobe PDF (70 kb)

COBRA-ARRA Questions and Answers

Revised COBRA Application

COBRA-ARRA Extended Benefits Forms and Subsidy Rates

Announcement to Employers of Extended COBRA Benefits under the ARRA
     State Employers; Local and Education Employer

Horizon Hospital Contracts

Horizon BCBSNJ Contract Settlement with Helene Fuld Medical Center October 9, 2009

Retired Group News

Medicare Part D Creditable Coverage Letter for plan year 2010 and Medicare Part D Questions & Answers

Retiree Wellness Program Information — for State retirees who attained 25 years of service after June 30, 2007.

Other News and Information

Notice of Award: T-2679 Pharmacy Benefit Management (September 10, 2009)

Information for State Employees remaining in NJ PLUS

GENERAL INFORMATION

Program Descriptions and Eligibility

Health Benefits Summary Program Description for Plan Year 2009 Adobe PDF (464k) — An overview of SHBP/SEHBP eligibility and the medical, prescription drug, and dental plans

Plan Comparison Summaries for Plan Year 2009 — Medical plan information, benefit comparison charts, phone numbers, and Web site addresses.

Documentation requirements when enrolling dependents for coverage Adobe PDF (33K) — NEW!

Employee Prescription Drug Plan — (retiree prescription coverage included with medical plan)

Dental Plans for State Employees, participating Local Government/Education Employees, and Retirees

Health Benefits Resources for Active employees, Retired members, and COBRA enrollees

Medical Plans

Medical Plan Web Addresses and Phone Numbers

NJ DIRECT15 and NJ DIRECT10 Member Handbook for Plan Year 2009 Adobe PDF (367 kb)

— NJ DIRECT Claim Form for Out-of-Network claims Adobe PDF (204 kb)

Aetna HMO Member Handbook (includes Aetna Medicare Open Plan) for Plan Year 2009 Adobe PDF (310 kb)

CIGNA HealthCare HMO Member Handbook for Plan Year 2009 Adobe PDF (295 kb)

Information for State Employees remaining in NJ PLUS

Provider Information — Find a participating doctor or hospital

The Unified Provider Directory was discontinued as of January 2009
To find a participating doctor or hospital please contact your medical plan directly:
NJ DIRECT10 and 15, Aetna HMO, Aetna Medicare Open Plan, CIGNA HealthCare HMO

Privacy Practices

HIPAA Notice of Privacy Practices — and HIPAA Forms

New Jersey Civil Unions and Domestic Partnerships
See dependent enrollment documentation requirements Adobe PDF (33K) — NEW!

CIVIL UNIONS
New Jersey Civil Union Information
Fact Sheet #75, Civil Unions Adobe PDF (51K)

Determining Imputed Income for Civil Union Partners
Civil Union Partner Imputed Taxable Income Charts

DOMESTIC PARTNERS
Fact Sheet #71, Benefits Under the Domestic Partnership Act Adobe PDF (56K)
Domestic Partner Adopting Employers

Determining Imputed Income for Domestic Partners
Domestic Partner Imputed Taxable Income Charts

Over Age Children to Age 31 (Chapter 375, P.L. 2005)

Fact Sheet #74, Health Benefits Coverage of Children to Age 31 Under Chapter 375
Application for Chapter 375 Coverage Adobe PDF (27 kb)
Chapter 375 dependent documentation requirements Adobe PDF (31K) — NEW!

Chapter 375 Rate Charts for Plan Year 2010
State Employees and Retirees Adobe PDF (8 kb)
Local Government Employees and Retirees Adobe PDF (8 kb)
Local Education Employees and Retirees Adobe PDF (8 kb)

Chapter 375 Rate Charts for Plan Year 2009
State Employees and Retirees Adobe PDF (8 kb)
Local Government Employees and Retirees Adobe PDF (8 kb)
Local Education Employees and Retirees Adobe PDF (8 kb)

Cost Comparison — Chapter 375 vs. COBRA

Health Benefit Bills

	Retiree Bill Sample	COBRA Bill Sample	Employer Bill Sample
	Billing "lockbox" payment address information for Retirees and COBRA members

Other Resources

NJ DIRECT Managed Network Summary for 2009 (May 18, 2009)

SHBP and SEHBP Rate Renewal Reports Plan Year 2009; Plan Year 2010

NJ Hospital Performance Report — NJ Department of Health

SHBP and Consultant Review Adobe PDF (2.1 mb)

ACTIVE GROUP — Information Specific to Active Group Members (State, Local Participating Government or Education Employers)

Health Benefits Summary Program Description for Plan Year 2009 Adobe PDF (464 kb) — An overview of SHBP/SEHBP eligibility and the medical, prescription drug, and dental plans

Plan Comparison Summaries for Plan Year 2009 — Medical plan information, benefit comparison charts, phone numbers, and Web site addresses.

Health Benefits Enrollment Applications for Active Employees
See dependent enrollment documentation requirements Adobe PDF (33K) — NEW!

Health Benefits Application for State Employees, Local Government Employees, and Local Education Employees Adobe PDF (31 kb)   The Health Benefits Application must be certified by your employer before sending it to the Division of Pensions and Benefits.

Other Groups
Health Benefits Application for Part-time Employees Adobe PDF (31 kb)
Health Benefits Application for Intermittent State Employees Adobe PDF (31 kb)

Applications for State Employees remaining in NJ PLUS

Prescription Drug Benefits

Effective January 1, 2010, Medco Health Solutions will administer pharmacy benefits for the State Health Benefits Program and School Employees’ Health Benefits Program.

Notice of Award: T-2679 Pharmacy Benefit Management (September 10, 2009)

Employee Prescription Drug Plan information

Newsletters

Health Capsule Fall 2009 Adobe PDF (104 kb) - For State Employees

Health Capsule Fall 2009 Adobe PDF (100 kb) - Local Government and Local Educational Employees

Guide to Choosing a Medical Plan - An overview of the new medical plans for employees and retirees Adobe PDF (43 kb)

State Active Group Rates — State Monthly and Biweekly Active Employee Group Rates

State Employer Group — NJ DIRECT15 and HMOs — Plan Year 2010
State Biweekly Employers Adobe PDF (9KB)
State Monthly Employers Adobe PDF (9KB)
State Part-Time Chapter 172 Employees Adobe PDF (7KB)

Most State Employees pay 1.5% of salary regardless of Medical Plan or Coverage Level selected.

Rates for State Employees remaining in NJ PLUS — Plan Year 2010

State Employer Group Rate Charts — for Plan Year 2009
State Biweekly Employees Adobe PDF (8 kb)
State Monthly Employees Adobe PDF (10 kb)
State Part-Time Chapter 172 Employees Adobe PDF (7 kb)

Most State Employees pay 1.5% of salary regardless of Medical Plan or Coverage Level selected. View Medical Plan Contacts and Dental Contacts/Rate Charts for Plan Year 2009
State Biweekly Employees Adobe PDF (17 kb)
State Monthly Employees (12 Pays) - (24 Pays) - (26 Pays) Adobe PDF (37 kb)

Rates for State Employees remaining in the Traditional Plan and NJ PLUS — Plan Year 2009

Local Government Active Group Rates — Local Government Employers

Local Employer Group Rates — for Plan Year 2010
County and Municipal Government Adobe PDF (17 kb)

Local Employer Group Rates — for Plan Year 2009
County and Municipal Government Adobe PDF (17 kb)

Local Education Active Group Rates — Local Education Employers

Local Employer Group Rates — for Plan Year 2010
Local Boards of Education Adobe PDF (16 kb)
Local Part-Time Chapter 172 Employees Adobe PDF (8 kb)

Local Employer Group Rates — for Plan Year 2009
Local Boards of Education Adobe PDF (16 kb)
Local Part-Time Chapter 172 Employees Adobe PDF (8 kb)

RETIRED GROUP — Information for Retired Group Members (from the State, participating Local Government Employers, or Local Education Employers)

Medical Plans

Enrolling in Health Benefits Coverage at Retirement — Fact Sheet #11

SHBP Retiree Wellness Program Information — For State retirees who attained 25 years of service
after June 30, 2007

Health Benefits Summary Program Description for Plan Year 2009 Adobe PDF ( 464k) — An overview of SHBP/SEHBP eligibility and the medical, prescription drug, and dental plans

Plan Comparison Summary for Plan Year 2009 — Medical plan information, benefit comparison charts, phone numbers, and Web site addresses.

Health Benefits Enrollment Applications for Retirees
See dependent enrollment documentation requirements Adobe PDF (33K) — NEW!

Retired Coverage Enrollment Application — New enrollees ONLY Adobe PDF (39 kb)

Retiree Change of Status Application — For retirees making a plan change Adobe PDF (39 kb)

Newsletter

Health Reporter Winter 2009 Adobe PDF (193 kb)

Retired Group Plan Rates

Medical Plan Rates for Plan Year 2010

If you worked for the State, click here Adobe PDF (8 kb)
If you worked for a Local Government employer (county, municipal, etc.), click here Adobe PDF (8 kb)
If you worked for a Local Education employer, click here Adobe PDF (8 kb)

If enrolled in Medicare Part D — click here

Rates for State Retirees who share the cost of their coverage with the State

If you worked for the State and attained 25 years on or after July 1, 2007, or retired on a disability retirement on or after August 1, 2007, and are enrolled in NJ DIRECT15, Aetna HMO, or CIGNA HealthCare, click here

If you worked for the State and attained 25 years — or retired on a disability retirement — prior to July 1, 2007, and share the cost of NJ DIRECT10 coverage with the State, click here Adobe PDF (29 kb)

If enrolled in Medicare Part D — click here

Premium Sharing Labor Bargaining Groups — for retired State employees enrolled in NJ DIRECT10 who attained 25 years of service between 7/1/2003 - 6/30/2007 or who retired on a disability retirement 8/1/2003 - 7/1/2007

Chapter 330 Rates

If you are a former law enforcement officer covered under Chapter 330, click here Adobe PDF (11 kb)

If enrolled in Medicare Part D — click here

Medical Plan Rates for Plan Year 2009

If you worked for the State, click here Adobe PDF (9 kb)
If you worked for a Local Government employer (county, municipal, etc.), click here Adobe PDF (7 kb)
If you worked for a Local Education employer, click here Adobe PDF (7 kb)

If enrolled in Medicare Part D — click here

Rates for State Retirees who share the cost of their coverage with the State

If you worked for the State and attained 25 years on or after July 1, 2007, or retired on a disability retirement on or after August 1, 2007, and are enrolled in NJ DIRECT15, Aetna HMO, or CIGNA HealthCare, click here

If you worked for the State and attained 25 years — or retired on a disability retirement — prior to July 1, 2007, and share the cost of NJ DIRECT10 coverage with the State, click here Adobe PDF (43 kb)

If enrolled in Medicare Part D — click here

Premium Sharing Labor Bargaining Groups — for retired State employees enrolled in NJ DIRECT10 who attained 25 years of service between 7/1/2003 - 6/30/2007 or who retired on a disability retirement 8/1/2003 - 7/1/2007

Chapter 330 Rates

If you are a former law enforcement officer covered under Chapter 330, click here Adobe PDF (13 kb)

If enrolled in Medicare Part D — click here

Retiree Prescription Drug Coverage — Included with retired group medical plan

Effective January 1, 2010, Medco Health Solutions will administer pharmacy benefits for the State Health Benefits Program and School Employees’ Health Benefits Program.

Notice of Award: T-2679 Pharmacy Benefit Management (September 10, 2009)

Plan Year 2010
Prescription drug benefits through NJ DIRECT15 or NJ DIRECT10
     State and Local Government Retirees
     Local Education Retirees

Prescription drug benefits through Aetna HMO or CIGNA HealthCare HMO
     State and Local Government Retirees
     Local Education Retirees

Plan Year 2009
Prescription drug benefits through NJ DIRECT15 or NJ DIRECT10
     State and Local Government Retirees
     Local Education Retirees

Prescription drug benefits through Aetna HMO or CIGNA HealthCare HMO
     State and Local Government Retirees
     Local Education Retirees

Medicare Part D Information for Retired Group Members

Medicare Part D Creditable Coverage Letter for Plan Year 2010
        (Archived Letters for Plan Years 2009, 2008, or 2007)
Medicare Part D Questions and Answers

Medical Plan Rates for retirees enrolled in Medicare Part D who pay the full cost of their coverage and worked for a State Department or Agency, a Local Government, or a Local Education employer are mailed to eligible retirees, or are available on request to the Division's Office of Client Services.

Retiree Dental Plan

Retiree Dental Expense Plan General Information

Retiree Dental Expense Plan Member Handbook for Plan Year 2009 Adobe PDF (211 kb)

Retiree Dental Expense Plan Rates for Plan Year 2010 Adobe PDF (7 kb)

Retiree Dental Expense Plan Rates for Plan Year 2009 Adobe PDF (8 kb)

EMPLOYEE PRESCRIPTION DRUG PLAN — Available to employees of the State and participating local government and education employers (click for Retiree Prescription Drug Coverage information)

Employee Prescription Drug Plan Member Handbook for Plan Year 2009 Adobe PDF (268 kb)

Prescription Drug Plan Copayments

Third Tier Copayment Exception — for State Employees

Employee Prescription Drug Plan Administrator

Effective January 1, 2010, Medco Health Solutions will administer pharmacy benefits for the
Employee Prescription Drug Plan.

Notice of Award: T-2679 Pharmacy Benefit Management (September 10, 2009)

CVS/Caremark Claim Forms for Plan Year 2009
CVS/Caremark Mail Service Order Form Adobe PDF (81 kb)
CVS/Caremark Prescription Reimbursement Standard Claim Form Adobe PDF (141 kb)

DENTAL PLANS — Available to employees of the State including State colleges and universities, Retirees, and employees of participating local employers.

Active Employee Dental Plans

Employee Dental Plans for Active Employees — Dental plan names, coverage areas, phone numbers, and Web site addresses

Summary description of dental plans for Active Employees

Employee Dental Plans Member Handbook for Plan Year 2009 Adobe PDF (235 kb)

State and Local Employee Dental Application Adobe PDF (41 kb)

Dependent enrollment documentation requirements Adobe PDF (33K) — NEW!

Employee Dental Expense Plan Claim Form Adobe PDF (149 kb)

Employee Dental Plan Rates for Plan Year 2010
State Biweekly Adobe PDF (8 kb); State Monthly Adobe PDF (8 kb);
Local Government Participating Employers Adobe PDF (8 kb); and
Local Education Participating Employers Adobe PDF (8 kb)

Employee Dental Plan Rates for Plan Year 2009
State Biweekly Adobe PDF (8 kb); State Monthly Adobe PDF (8 kb);
Local Government Participating Employers Adobe PDF (8 kb); and
Local Education Participating Employers Adobe PDF (8 kb)

Retiree Dental Expense Plan

Retiree Dental Expense Plan

Retiree Dental Expense Plan Member Handbook for Plan Year 2009 Adobe PDF (211 kb)

Retiree Dental Expense Plan Claim Form Adobe PDF (149 kb)

Retiree Dental Expense Plan Rates for Plan Year 2010 Adobe PDF (7 kb)

Retiree Dental Expense Plan Rates for Plan Year 2009 Adobe PDF (8 kb)

COBRA

COBRA Information for members and dependents
COBRA Program and Medicare
Employer responsibilities under COBRA
Extended COBRA Benefits under the American Recovery and Reinvestment Act Adobe PDF (22 kb)

COBRA Rates

COBRA Rates for Plan Year 2010
COBRA Active Group Rates
State Group; Local Government; and Local Education Groups Adobe PDF (67 kb)
COBRA Dental Rates
State Group; Local Government/Education Group Adobe PDF (65 kb)
COBRA Part-Time Chapter 172 Rates
State Part-Time; Local Part-Time COBRA Rates Adobe PDF (20 kb)
COBRA Retiree Rates
State Group; Local Government; and Local Education Groups Adobe PDF (16 kb)

COBRA Rates for Plan Year 2009
COBRA Active Group Rates
State Group; Local Government; and Local Education Groups Adobe PDF (67 kb)
COBRA Dental Rates
State Group; Local Government/Education Group Adobe PDF (65 kb)
COBRA Part-Time Chapter 172 Rates
State Part-Time; Local Part-Time COBRA Rates Adobe PDF (20 kb)
COBRA Retiree Rates
State Group; Local Government; and Local Education Groups Adobe PDF (16 kb)

COBRA Applications
See dependent enrollment documentation requirements Adobe PDF (33K) — NEW!

COBRA Application For State and Local Employees Adobe PDF ( 63 kb)
COBRA Applications must be certified by your employer before sending it to the Division of Pensions and Benefits.
COBRA Application, for Part-time Employees Adobe PDF ( 63 kb)
COBRA Application, for Intermittent State Employees Adobe PDF (63 kb)

COBRA-ARRA Subsidy Forms and Information

COBRA-ARRA Assistance Eligibility Request Adobe PDF (45 kb)

COBRA-ARRA Assistance Eligibility Waiver Adobe PDF (28 kb)

Summary of the COBRA Premium Reduction Provisions under the ARRA Adobe PDF (70 kb)

COBRA-ARRA Questions and Answers

COBRA-ARRA Rate Charts — Plan Year 2009
State COBRA Subsidy Rates Adobe PDF (95 kb)
Local Government COBRA Subsidy Rates Adobe PDF (260 kb)
Local Education COBRA Subsidy Rates Adobe PDF (260 kb)
State Legacy Plans - Traditional. NJ PLUS - Adobe PDF (50 kb)

ABOUT THE SHBP and SEHBP

The State Health Benefits Program (SHBP) was established in 1961 under N.J.S.A. 52:14-17.25 et seq. to provide health benefits to State employees, retirees, and their dependents. The SHBP was extended to employees, retirees, and dependents of participating local public employers in 1964. Local employers must adopt a resolution to participate in the SHBP. Rules governing the operation and administration of the program are found in Title 17, Chapter 9 of the New Jersey Administrative Code.

The State Health Benefits Commission is the executive body established by statute to be responsible for operation of the SHBP. The Commission meetings are open to the public and are conducted at the Division of Pensions and Benefits in Trenton. Plan members are entitled to appeal to the Commission for resolution of any complaints after they have completed the formal grievance procedure of their plan administrator.

The School Employees' Health Benefits Program (SEHBP) was established by Chapter 103, P.L. 2007. It offers medical and prescription drug coverage to qualified school employees and retirees, and their eligible dependents. Local employers must adopt a resolution to participate in the SEHBP. The School Employees’ Health Benefits Program Act is found in the N.J.S.A. 52:14-17.46 et seq. Rules governing the operation and administration of the program are found in Title 17, Chapter 9 of the New Jersey Administrative Code.

The School Employees' Health Benefits Commission is the executive body established by statute to be responsible for operation of the SEHBP. The Commission meetings are open to the public and are conducted at the Division of Pensions and Benefits in Trenton. Plan members are entitled to appeal to the Commission for resolution of any complaints after they have completed the formal grievance procedure of their plan administrator.

The Division of Pensions and Benefits, specifically the Health Benefits Bureau and the Bureau of Policy and Planning, are responsible for the daily administrative activities of the SHBP and the SEHBP. The Division provides news and updates to participating employees and retirees through its newsletters and publications.