FAQ - Medical Insurance

1. I have just become eligible to enroll in State Health Benefits. How can I decide which medical plan is the best one?
   
   There is no single best plan. Plan selection is a personal decision based on your needs. You should review information provided by the NJ Division of Pensions and Benefits and the individual carriers to familiarize yourself with the various plans and their provisions. Some of the main factors new enrollees usually consider are:
   
   
   • Cost
   • Ease of claims processing
   • Freedom of doctor/hospital selection
   • Whether or not your doctor participates in one or more State Health Benefit Plans
     
     
2. What is the difference between the HMOs the State offers?
   
   Both the Aetna and CIGNA HMO plans have a unique nationwide network of physicians and facilities. Other than this difference, the HMOs are very similar. Each has “General Operating Procedures” and “Conditions of Participation” which are minimum coverage requirements instituted by the state. These standards help to safeguard all participants and make it easier to compare and choose between the HMO plans. Additionally, each HMO may offer perks such as maternity programs, educational programs, newsletters, wellness programs including discounts on health club memberships, vision care discounts, and vitamin discounts.
   
   
3. What is the role of a Primary Care Physician (PCP) in the Aetna and CIGNA HMOs?
   
   Your PCP provides basic medical services and coordinates your overall medical care. If specialized treatment is required, your PCP is responsible for referring you to a specialist, lab, hospital or any other network physician or specialist.  A PCP is typically a general practitioner, internist, or pediatrician. HMO participants may change their PCPs as often as they like.
   
   
4. My 19 year old son works part-time and attends school part-time. Can he remain covered under my health insurance?
   
   Your son may continue to be covered as long as he remains your eligible dependent child through the end of the year in which he turns 23. The child must be unmarried and depend on you for support. His student status has no effect on eligibility.
   
   
5. How can my daughter continue coverage if she loses her status as an eligible dependent?
   
   She can elect COBRA coverage. COBRA is a federal law that allows for the continuation of health benefits for specific time periods for the employee and/or dependents when coverage terminates due to certain qualifying events. Dependent children of employees in the State Health Benefits Program may continue coverage under COBRA if coverage ends because of the loss of the dependent child’s eligibility through:
   
   
   • End of the year in which child turns 23
   • Independence
   • Marriage
                            
     
6. I currently have husband/wife coverage and my wife is pregnant. When should I add the baby?
   
   You can add your child within 30 days of the child’s birth. Complete a NJ State Health Benefits Program Application and provide a copy of the birth certificate and give them to the person in your department who handles Payroll processing. When you receive the child’s social security number a few months later, please indicate that information on a NJ State Health Benefits Program Application.
   
   
7. I am a Rutgers employee who waived State Health Benefits coverage because I wanted to continue coverage as a dependent on my husband’s plan. My husband recently lost his job and will soon no longer have health insurance coverage. Can my husband and I enroll in State Health Benefits through Rutgers?
   
   Yes, if your spouse’s employment status changes resulting in a loss of health coverage, you can enroll in State Health Benefits within 30 days of the event. Complete a NJ State Health Benefits Program Application and give it to the person in your department who handles Payroll processing. You must also provide documentation (a letter or certificate) of your spouse’s employer to show loss of coverage.
   
   
8. As a member of NJ DIRECT 15 I understand that I am required to pay deductibles and coinsurance for services from “non-preferred” providers. How can I locate preferred providers to reduce my costs?
   
   To locate preferred providers, visit the Horizon Blue Cross Blue Shield website and click on “provider directory.”

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Last Updated: 02/14/2008