Health Benefits

Rutgers is proud of our best-in-class benefits packages offered to employees. Eligible employees may enroll in one or more State Health Benefit Plans providing medical, prescription drug, dental, and vision coverage.

Horizon Blue Cross Blue Shield continues to be the sole provider of medical insurance plans for the SHBP. In addition to PPOs, HMO, Tiered Network, and High Deductible health coverage plans, Horizon offers resources for virtual medical and behavioral health care (telemedicine) as well as a host of other services and tools. More information regarding Horizon can be found below, as well as on their website. All medical plans will include a prescription plan automatically. Employees will no longer be able to select only a medical plan with no prescription plan and vice versa.

The Prescription Drug Plan for Rutgers University is Administered by OptumRx. Prescription Drug Plans allow participants to obtain prescriptions at participating retail pharmacies for modest co-payments. A mail order service is also available for participants who require maintenance medications. Prescription copayments will be determined by the health plan selected.

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Medical & Prescription Benefits
Full-Time Employee Eligibility:
  • Regularly appointed full-time (100%) faculty and staff with an Appointment of 12 months or greater for Calendar Year (CY) employees or an appointment of 10 months for Academic Year (AY) employees.
  • Legal Spouse, Registered Civil Union, or Same-Sex Domestic Partner Eligible children under age 26 (including stepchildren, foster children, adopted children or children an employee is legally required to support).
Part-Time Employee Eligibility:
  • Members of a NJ state administered pension program.
  • Must pay the full monthly premium.
  • May also be eligible for the same medical and prescription coverage as full-time employees via the Affordable Care Act (ACA). More information is available at Affordable Care Act (ACA) Legal Spouse, Registered Civil Union, or Same-Sex Domestic Partner.
  • Eligible children under age 26 (including stepchildren, foster children, adopted children or children an employee is legally required to support.
Multiple Enrollments for Full-Time Employees:
  • Individuals may belong to a SHBP medical plan as an employee or a dependent but not both.
  • Two state employees married to each other cannot both cover the same children or each other under two SHBP medical plans.
  • No individual is eligible for coverage in more than one state dental plan.
When Coverage Begins:
  • Academic year 10-month employees with September 1 hire date = September 1 effective date.
  • All other employees, including part-time employees, effective after 2 months of continuous employment, i.e., August 15 hire date = October 15 effective date.
When Coverage Ends:
  • Employees with 10-month academic year appointments that end June 30 will continue health insurance coverage through July and August.
  • Effective January 2, 2020: Medical, dental and prescription drug coverage will terminate at the end of the month the termination of employment occurs. Example: employment termination date is January 29th, insurance coverage will end on January 31st.
  • Coverage for full-time employees can be continued through COBRA for up to 18 months.
  • Coverage for eligible children ends the last day of the calendar year in which the child reaches age 26.
  • Coverage for part-time employees continues as long as the monthly premiums are paid.
How to Enroll:
Available Medical Coverage Plans

The following plans are available to part-time and full-time employees unless otherwise noted:

For a detailed explanation of each plan and associated costs, access the Medical Plan Design Chart (2023) and the Premium Contribution Calculator.

Health Maintenance Organization (HMO):
  • Health Maintenance Organization plans administered by Horizon
  • Separate HMO plans administered by Horizon
  • HMOs cover a wide range of services for preventative and diagnostic care
  • Both HMO plans have a unique nationwide directory of participating providers
  • Select a Primary Care Physician (PCP) to coordinate your health care
  • The PCP will issue a referral if you need to see a network specialist as part of your treatment
  • No deductibles or claim forms
  • Standard copayments required for services
  • For part-time employees, certain preventative care such as annual exams, well-baby care, and certain screenings will be covered with no cost sharing
Preferred Provider Organization (PPO)
  • Preferred provider organization plans administered by Horizon.
  • Benefits fall into two categories: services from preferred providers and those provided by non-preferred providers.
  • Preferred provider benefits are paid after required copay.
  • Non-preferred provider benefits require members to meet an annual deductible. After deductibles are met, covered claims are paid of the “reasonable and customary” allowance for most services.
  • Members are not required to choose a primary care physician and do not need to obtain referrals.
  • Certain preventative care such as annual exams, well-baby care, and certain screenings will be covered with no cost sharing.
  • A nationwide network of providers is available.
Tiered Network (TN) (available to full-time employees only):
  • Tiered network plans administered by Horizon.
  • Unique network of physicians and facilities.
  • Managed care network; no Out-of-network coverage.
  • Lower cost sharing when using Tier 1 In-network providers when compared to Tier 2 In-network providers.
  • Other copayment required, deductible only required for Tier 2 provider services.
High Deductible Health Plans (HDHP) (available to full-time employees only):
  • Preferred provider organization plans administered by Horizon.
  • Must pay all costs up to the deductible amount before plan pays for covered services; preventative care covered at no cost (In-network only).
  • In-network Coinsurance after deductible for preferred providers.
  • Out-of-network Coinsurance after deductible for non-preferred providers.
  • Prescription is integrated with the plan and subject to deductible and coinsurance.
  • Access to contribute to optional Health Savings Account (HSA).
Preventive Services, Immunizations and Certain Screenings:

Under the Patient Protection and Affordable Care Act (PPACA) and the Health Care and Education Reconciliation (HCR) Acts, certain preventive care, such as immunizations (age and population restrictions may apply), certain screenings (blood pressure, cholesterol, depression, newborn, etc.), FDA-approved contraceptive methods, and well-baby care, will be covered by all of the SHBP medical plans without member cost sharing.

As a result, primary care well visits (annual exams) will no longer require a copayment or coinsurance by the member for certain wellness services provided by an in-network provider. However, if the preventive service is not the primary reason for the office visit, the member may still be responsible for a copayment or coinsurance. Contact your medical provider or plan for more information.

If you need assistance with making your selections, please have your hiring department sign you up for a Rutgers New Employee Orientation (NEO) session. NEO is designed to provide full-time faculty and staff members and academic- or calendar-year TA/GAs with the opportunity to learn more about available benefits and assistance with navigating through making the selections that are most appropriate for you and your family.

Dental Benefits
Eligibility
  • Regularly appointed full-time (100%) faculty and staff with an Appointment of 12 months or greater for Calendar Year (CY) employees or an appointment of 10 months for Academic Year (AY) employees
  • Legal Spouse, Registered Civil Union, or Same-Sex Domestic 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
Dental Coverage Plans
Rutgers offers two types of dental insurance plans including a Dental Expense Plan (PPO) and Dental Plan Organizations (DPO):

Information regarding employee and employer contributions can be found on the 2023 Dental Rates Information Sheet. Details regarding deductibles and copayments can be found on the Dental Comparison Fact Sheet. Please be sure to review the plan rules including exclusions and limitations before selecting a plan. You must remain in the dental plan you select for at least 12 months before you can transfer to another dental plan or cancel coverage.

The Dental Expense Plan (PPO)
  • Dental Expense Plan- Aetna
Dental Plan Organizations (DPOs)
Vision Care Plans

You may receive up to $45 reimbursement for single vision corrective lenses and receive up to $50 reimbursement for bifocal or trifocal corrective lenses. For all contact lenses, 1 box per eye will be reimbursed, up to $45 for single-vision contacts and up to $50 for bifocal / multifocal contacts.

Employees and eligible dependents are entitled to receive one reimbursement for lenses purchased in a designated two-year contract period.

How to Complete Reimbursement:
  • Obtain an original itemized receipt for the purchase of corrective lenses
  • Complete a Vision Care Plan Claim Form
  • Submit completed Vision Care Plan Claim Form and the original itemized receipt to OneSource Rutgers Faculty and Staff Service Center
  • A case will be created and an agent will communicate information via the case.
Once Approved:

Employees will receive their reimbursement through either direct deposit, if enrolled, or in their biweekly paycheck. This reimbursement will have a payroll code of "VisionReim" on the pay stub and will not be subject to taxes or pension calculations.

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