FAQs - State Health Benefits Program Medical Plan Changes

1. I recently received a new NJ PLUS ID card with "single" coverage listed.  What should I do with this card? When will I get new NJ DIRECT 15 ID cards?
   
   Horizon Blue Cross Blue Shield of New Jersey mailed ID cards for NJ PLUS listing "single" coverage in error; these cards can be destroyed and you can continue using your current NJ PLUS ID card.  Members transferring to NJ DIRECT 15 will receive new ID cards by March 26, 2008.  New ID cards for NJ DIRECT 15 are to be used beginning April 1, 2008.
   
   
2. Why do all of my family's NJ DIRECT 15 ID cards have my name on them?
   
   With NJ DIRECT 15, Horizon Blue Cross Blue Shield of New Jersey will only print the employee's name on the ID cards. Names of the individual covered dependents enrolled on the plan will not be printed on NJ DIRECT 15 ID cards.
   
   
3. What are the New Jersey State Health Benefits Program Plan changes?
   
   Effective April 1, 2008, the New Jersey State Health Benefits Program (SHBP) will offer two types of medical plans: a Preferred Provider Organization (PPO) and Health Maintenance Organizations (HMOs). Horizon Blue Cross Blue Shield of New Jersey has been awarded the PPO contract. Aetna and CIGNA have been awarded individual HMO contracts.
   
   The Traditional Plan and NJ PLUS will no longer be offered and will be replaced with the PPO plan, NJ DIRECT 15. The current Aetna and CIGNA HMO plans will continue to be offered. However, the AmeriHealth, Health Net, and Oxford HMO plans will be terminated as of March 31, 2008.
   
   
4. What do these medical plan changes mean for active employees?
   
   

   Employees currently enrolled in the Traditional Plan or NJ PLUS will automatically be enrolled in the new NJ DIRECT 15 plan, administered by Horizon Blue Cross Blue Shield of New Jersey.

   Employees currently enrolled in an HMO plan that is not being renewed (AmeriHealth, Health Net, or Oxford), will automatically be enrolled in NJ DIRECT 15.

   Employees currently enrolled in the Aetna HMO or CIGNA HMO will remain in their respective HMO plan.

   The Horizon NJ DIRECT 15 PPO and Aetna and CIGNA HMOs provide for wellness and preventive care as well as coverage for injury and illness. Each plan features an extensive national provider network.
   

5. Are active Rutgers University employees eligible for NJ DIRECT 10?
   
   No, only certain state retirees and local education and local government employees are eligible for NJ DIRECT 10. Active Rutgers University employees are eligible for NJ DIRECT 15, as well as the Aetna HMO and CIGNA HMO plans.
   
   
6. What are the differences between NJ PLUS and NJ DIRECT 15? 
   
   NJ DIRECT 15 is a PPO plan administered by Horizon Blue Cross Blue Shield of New Jersey. The plan is similar to the current NJ PLUS plan in that it covers treatment from both preferred and non-preferred providers. NJ DIRECT 15 offers a national network of providers, does not require members to choose a primary care physician, and does not require referrals. These features are not available under NJ PLUS.
   
   The copayment for NJ DIRECT 15 is $15 for services received from preferred providers. NJ DIRECT 15 allows for treatment of injury or illness by non-preferred providers with a $100 deductible and 70% coinsurance for most services. For more information, see A Guide to Choosing a SHBP Health Plan.
   
   
7. Will there be another Open Enrollment period?
   
   A special Open Enrollment period will be held January 28 through February 15, 2008. This is a “passive” Open Enrollment, meaning that employees will be automatically enrolled in the NJ DIRECT 15 PPO plan or will remain in the Aetna HMO or CIGNA HMO plan, depending on their current medical plan election. No action is required on your part unless you want to select a different medical plan or waive medical coverage.
   
   
8. How do I select a different plan?
   
   Employees who wish to elect a plan other than the one in which they will be automatically enrolled must complete a SHBP Enrollment Application during the special Open Enrollment period. This special Open Enrollment will be held January 28 through February 15, 2008. For example, if you are currently enrolled in NJ PLUS, you will automatically be enrolled in NJ DIRECT 15. However, if you wish to enroll in an HMO plan instead, you must complete a SHBP Enrollment Application during Open Enrollment.
   
   If you wish to waive your medical coverage, you must complete both a SHBP Enrollment Application and a SHBP Waiver/Reinstatement Form.

   All completed forms must be received by Payroll Services, 65 Davidson Road, ASB Room 317, Busch Campus by noon on February 15, 2008.
   

9. What changes can be made during the special Open Enrollment period?
   
   Only medical plan selections may be changed during this special Open Enrollment. You cannot add dependents, change coverage levels, or make changes to dental or prescription drug coverage.
   
   
10. How can I obtain additional information about the Horizon NJ DIRECT 15 PPO plan and the Aetna and CIGNA HMO plans?
    
    Representatives from the medical plan providers and University Human Resources will be available to answer questions and offer additional plan information from 10 a.m. to 3 p.m. on the following dates:

    January 30 – Camden Campus Center, Multipurpose Room
    January 31 – Cook Campus, Administrative Services Building II, Community Room
    February 4 – Busch Campus Center, Multipurpose Room
    February 5 – Rutgers Student Center, Multipurpose Room
    February 6 – Newark Campus, Blumenthal Hall, Room 201

    The SHBP has released a comprehensive guide to the plan choices, a plan comparison chart, provider directories, and an updated online Unified Provider Directory. This information will also be available at the sessions that will be held on each campus.
    

11. If I elect the Aetna HMO or CIGNA HMO option, can I continue to use my current provider if he or she is out-of-network?

    If you are currently in an active course of treatment by a provider who is not in the HMO network, you may be able to continue to receive treatment by that provider. To be considered, the treatment must have started prior to the April 1, 2008 enrollment date in the HMO plan. The provider must also agree to the terms of the transition coverage.

    In order to apply for "transition of care" coverage, you must contact Aetna or CIGNA for eligibility requirements and to request the Transition of Care application.
    

12. Are there any changes to the prescription drug plan?
    
    No, there are no changes to the prescription drug plan at this time.
    
    
13. Will there be a change in employee contribution for the new plans?
    
    Employees who currently contribute 1.5% of their salary for insurance coverage will continue to do so, regardless of plan selection (PPO or HMO) and level of coverage (e.g., single or family). The SHBP will announce premium rates in late January for those employees who do not currently pay the 1.5% contribution.
    
    
14. Will the part-time health insurance change?

    Yes. Part-time employees enrolled in part-time health benefits through the SHBP will be switched from NJ PLUS to NJ DIRECT 15 effective April 1, 2008. The SHBP will contact employees who are currently enrolled prior to April 1 concerning the change, including notification of new monthly contribution rates.
    

15. What do these medical plan changes mean for retirees?
    

    Changes to the medical plans for retirees will be effective April 1, 2008.
    
    NJ DIRECT 10 will be available to state retirees who:

    • pay the full cost of retired SHBP coverage.
    • attained 25 years of pension-credited service on or before June 30, 2007.
    • retired on a disability retirement on or before July 1, 2007.

    NJ DIRECT 15 will be available to state retirees who:

    • attain 25 years of pension-credited service on or after July 1, 2007.
    • retire on a disability retirement on or after August 1, 2007.

    In addition, all state retirees will be eligible to enroll in the Aetna HMO and CIGNA HMO plans. 
    
    Certain state retirees who attain 25 years of pension-credited service after June 30, 2007, or retire on a disability retirement on or after August 1, 2007, will pay a health contribution of 1.5% of the retirement benefits. The contribution will be waived if the retiree is enrolled in the Retiree Wellness Plan, which is currently under development by the State Health Benefits Program.
    

16. How will coverage for currently retired employees change as of April 1, 2008?
    
    The following retirees will be automatically transferred to NJ DIRECT 10:
    
    • Current retirees in the Traditional Plan
    • Retirees with 25+ years of pension-credited service on or before June 30, 1997
    • Retirees paying the full cost of retiree health

    The following retirees will be automatically transferred to NJ DIRECT 15:

    • Current retirees in the NJ PLUS plan
    • Current retirees in the AmeriHealth, Health Net, and Oxford HMO plans
    • Retirees with 25+ years of pension-credited service on or after July 1, 1997
    • Retirees on a disability retirement on or before July 1, 2007

    Retirees currently enrolled in the Aetna HMO or CIGNA HMO will remain in their respective HMO plan.

    All current state retirees will be contacted directly by the Division of Pensions and Benefits regarding enrollment in the new retiree health plans.
    

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Last Updated: 03/26/2008