Eligibility to Enroll in the State Health Benefits Program

Eligibility for Dependents

  • Legal spouse
  • Same-sex domestic partner or civil union partner
  • Eligible children under age 26 (including stepchildren, foster children, adopted children or children an employee is legally required to support)

When Coverage Begins

  • Academic year 10-month employees with September 1 hire date = September 1 effective date
  • All other employees, effective after 2 months of continuous employment; i.e., August 15 hire date = October 15 effective date

Program Overview

  • Administered by OptumRx
  • Access to thousands of retail locations
  • Most pharmacies in New Jersey participate
  • Prescription copayments determined by the health plan selected

NJ Direct 15, Aetna HMO, Horizon HMO

Retail Prescription Copayments

  • $3.00 Generic Copayment
  • $10.00 Brand Name Copayment (No generic available)
  • Member pays difference between Brand Name and Generic when Generic is available.

Mail Order Prescription Copayments

  • $5.00 Generic Copayment
  • $15.00 Brand Name Copayment (No generic available)
  • Member pays difference between Brand Name and Generic when Generic is available.

NJ Direct 1525, Aetna Freedom 1525, Horizon OMNIA, Aetna Liberty

Retail Prescription Copayments

  • $7.00 Generic Copayment
  • $16.00 Brand Name Copayment (No generic available)
  • Member pays difference between Brand Name and Generic when Generic is available.

Mail Order Prescription Copayments

  • $18.00 Generic Copayment
  • $40.00 Brand Name Copayment (No generic available)
  • Member pays difference between Brand Name and Generic when Generic is available.

NJ Direct 2030, Aetna Freedom 2030

Retail Prescription Copayments

  • $3.00 Generic Copayment
  • $18.00 Brand Name Copayment (No generic available)
  • Member pays difference between Brand Name and Generic when Generic is available.

Mail Order Prescription Copayments

  • $5.00 Generic Copayment
  • $36.00 Brand Name Copayment (No generic available)
  • Member pays difference between Brand Name and Generic when Generic is available.

NJ Direct 2035, Aetna Freedom 2035

Retail Prescription Copayments

  • $7.00 Generic Copayment
  • $21.00 Brand Name Copayment (No generic available)
  • Member pays difference between Brand Name and Generic when Generic is available.

Mail Order Prescription Copayments

  • $18.00 Generic Copayment
  • $52.00 Brand Name Copayment (No generic available)
  • Member pays difference between Brand Name and Generic when Generic is available.

NJ Direct HD 4000, Aetna Value HD 4000

  • Prescription is integrated with the medical plan and subject to deductible and coinsurance

NJ Direct HD 1500, Aetna HD 1500

  • Prescription is integrated with the medical plan and subject to deductible and coinsurance