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To locate preferred providers, visit the Horizon Blue Cross Blue Shield website and click on “provider directory.”
She has the option to elect COBRA or Chapter 375 coverage. To compare the two plans and their eligibility criteria, visit the following webpage.
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 return the completed form to your Human Resources department. You must also provide documentation (a letter or certificate) of your spouse’s employer to show loss of coverage.
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 return the completed forms to your Human Resources department. 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.
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:
Your son may continue to be covered through the end of the year in which he turns 26. A “child” is defined as an enrollee’s child until age 26, and is eligible to be enrolled in the SHBP regardless of the child’s marital, student, or financial dependency status even if the young adult no longer lives with his or her parents and is eligible for other employer-based coverage.
The service areas for Horizon HMO plans are limited to New Jersey, Delaware, and bordering counties of Pennsylvania and New York. The Aetna 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” that 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, and wellness programs including discounts on health club memberships, vision care discounts, and vitamin discounts.
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.