State Health Benefits Program

Eligibility for Retired Group SHBP coverage is available to qualified retirees from the State including State colleges and universities, and Participating Local Government Employers, as determined by the State Health Benefits Program (SHBP).

Health Benefits Coverage – Enrolling as a Retiree

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Effective January 1, 2019, the SHBP will no longer offer Medicare Advantage (MA) plans through Horizon’s NJ DIRECT10 (PPO) or NJ DIRECT15 (PPO) plans.  Retirees previously enrolled in these plans will be automatically transferred to a corresponding Aetna Medicare Advantage PPO ESA plan.  No application is necessary and no other action is required by retirees. Affected members will receive correspondence directly from the plans.

Spouse or Partner with Different Medicare Eligibility than the Member

Retirees enrolled in one of the NJ DIRECT MA plans who have a spouse or partner who is not Medicare-eligible will move to the Aetna MA plan while the spouse/partner and/or any covered children remain in the NJ DIRECT10 or 15 plan.

Similarly, retirees who are not eligible for Medicare but have a spouse or partner who is Medicare-eligible will remain in their NJ DIRECT10 or 15 plan (along with any covered children) while the spouse/partner is transferred to the Aetna MA plan.

These rules will also be in effect for members, spouses, or partners whose Medicare effective date is 1/1/19 or after.  Non-Medicare-eligible retirees enrolled in NJ DIRECT 10 or 15 will be transferred automatically to an Aetna MA plan once enrolled in Medicare Parts A and B.

Aetna Medicare Advantage Plans

Medicare Advantage plans, sometimes referred to as “Part C” or “MA plans,” provide Medicare Part A (inpatient hospital insurance) and Medicare Part B (outpatient medical insurance) coverage.

The Aetna MA plans offer access to providers nationwide, with the same benefits in or out of network, and no referrals required.

SHBP Medicare-eligible retirees can enroll in the following Aetna Medicare Advantage plans: Aetna Medicare Advantage PPO ESA 10;* Aetna Medicare Advantage PPO ESA 15; Aetna Medicare Advantage HMO and Aetna Medicare Advantage HMO 1525.

*Not all State retirees will be eligible for Aetna Medicare Advantage PPO ESA 10

Retiree Medical Rates

  • Rates for State Retirees with Premium Sharing — If you worked for the State and earned 25 years prior to July 1, 2007 (or retired on a Disability Retirement on or before August 1, 2007), you share the cost of Aetna Freedom10 or NJ DIRECT10 coverage with the State.

Retiree Dental Rates

Retiree prescription drug coverage is included with retired group medical plan enrollment. OptumRx is the pharmacy benefits administrator for all Retired Group members of the SHBP.

Medical Plan Rates for retirees enrolled in Private Medicare Part D Plans are available by request to the NJDPB's Office of Client Services

If you retired from the State and earned 25 years of service after June 30, 2007, but before June 28, 2011, or retired on a Disability Retirement on or after August 1, 2007, but before June 28, 2011, you are eligible to enroll in the Retiree Wellness Program (RWP). If you do not enroll and meet the yearly requirements, you have to pay 1.5 percent of your gross retirement check.*

  • If you are a new eligible retiree, you will receive a RWP Welcome Letter and Retiree Wellness Program Pledge form as part of your SHBP enrollment materials.
  • To enroll, you are required to submit the Retiree Wellness Program Pledge form each year to show acceptance of the terms and conditions of RWP participation.
  • You are also required, each year, to complete a Health Assessment Test (HAT); have an annual medical check-up and submit the Annual Physician Certification; obtain age and gender appropriate tests and screenings; and participate in disease management programs.
  • You have the opportunity to enroll in the RWP each year between January 1 and October 31 during the RWP Open Enrollment. If you enroll and meet the requirements, the 1.5 percent health contribution will stop as of January 1 of the following year.

*ABP retirees pay a health contribution equal to 1.5 percent of 50 percent of the highest salary the retiree had in the 5 years prior to retirement.

Wellness Program Forms

NJ DIRECT Forms – Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ):

For Aetna Wellness information and forms visit: aetnastatenj.com/state/wellness.php


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Last Updated: Wednesday, 01/09/19