Health Plan Information


Board of Education Regular Public Meeting on Wednesday, January 20, 2021  at 7:00pm 
For Board Agenda: click this link

WELLNESS CHECK FORM: All TPS Staff & Visitors (including Vendors/Contractors) who plan to enter ANY district school or building, must complete the following Wellness Symptom Check Form BEFORE entering the building.

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Health Plan Information

Benefits Information

School Employees’ Health Benefits Program (SEHBP)

October 2020
Plan Year 2021 School Employees’ Health Benefits Program 

Open Enrollment

 
The School Employees’ Health Benefits Program (SEHBP) Open Enrollment period for Local Education employees begins on October 1, 2020, and ends on October 31, 2020.

Open Enrollment allows employees to make general changes (adding or deleting dependents, changing coverage levels, etc.) or enroll in a different medical or dental plan. All changes to coverage made during this Open Enrollment period will be effective on January 1, 2021.
 
ALL APPLICATIONS MUST BE FILED WITH THE BUSINESS OFFICE NO LATER THAN THE END OF THE BUSINESS DAY TUESDAY, NOVEMBER 3RD, 2020
 

NEW FOR PLAN YEAR 2021

 
New Jersey Educators Health Plan
 
P.L. 2020, c. 44 (Chapter 44) created the New Jersey Educators Health Plan (NJEHP) for all members of the SEHBP. The NJEHP is a Preferred Provider Organization (PPO) plan currently administered by Horizon Blue Cross and Blue Shield of New Jersey (Horizon). NJ DIRECT10, and NJ DIRECT 15 will remain available for certain members of the SEHBP. Other plans offered by the SEHBP (NJ DIRECT ZERO, NJ DIRECT1525, NJ DIRECT 2030, Horizon HMO, Horizon HMO1525, Horizon HMO2030, Horizon HMO2035, and NJ DIRECT HD1500) will no longer be available in Plan Year 2021. Horizon will be notifying current SEHBP enrollees of plan changes effective January 1, 2021.
 

Automatic Enrollment in the NJEHP

 
All SEHBP members will be automatically enrolled in the NJEHP effective January 1, 2021. Members hired prior to July 1, 2020, who are currently enrolled in NJ DIRECT10 or NJ DIRECT15, who will not be changing their level of coverage, and who do not wish to be enrolled in the NJEHP, must notify their employer of their intent by submitting a Health Benefits Enrollment and/or Change Form to payroll., along with proper documentation.
Prompt submission will ensure members’ elections to either enroll in the NJEHP or remain enrolled in the NJ DIRECT10 or NJ DIRECT15 plans.


Members hired on or after July 1, 2020, must enroll in the NJEHP. Applications are not needed for these members unless they wish to waive their coverage. See the “Waiving SEHBP Coverage” section for further details.

Any member who wishes to add or delete dependents during the Open Enrollment period should complete a Health Benefits Enrollment and/or Change Form regardless of their plan selection.

More  information  about  the  NJEHP  plan  can  be  found  on  the  NJDPB  website  at: School Employees' Health Benefit Program

TYPE AND LEVEL OF COVERAGE

 
If you currently have an SEHBP plan (NJ Dir10 or NJ Dir15) you will no longer be able to select different levels of Medical and Prescription Plan Coverage. For example, a member may not elect to have Single Medical coverage and Member/Spouse Prescription coverage. The level of coverage must be the same for both plans.
Members also must elect to enroll in both Medical and Prescription. If a member wishes to waive coverage, both Medical and Prescription coverage must be waived. 

MEDICAL PLAN RATES FOR 2021

 
Medical plan and prescription drug plan rates for 2021 are approved by the School Employees’ Health Benefits Commission. Rate charts are being finalized and will be posted to the NJDPB website for the Open Enrollment at: www.nj.gov/treasury/pensions/hb-active-sehbp.shtml 

FIND A HEALTH CARE PROVIDER WITH AMINO

 
Active employees enrolled in the SEHBP now have access to Amino, a fast, free, and easy to use online service to help you find and book healthcare. Because Amino is provided through the SEHBP, it will check your insurance coverage to help you find in-network providers and help you avoid billing surprises. Once you set up you Amino account, you can access Amino 24/7 through your phone, tablet, or computer.  Find out more or sign up at: amino.com/nj 

MEMBERSHIP TO DIRECT PRIMARY CARE MEDICAL HOME INCLUDED IN SHBP/SEHBP AT NO ADDITIONAL COST

 
The SEHBP offers employees and their covered dependents the opportunity to join a Direct Primary Care doctor's office at no additional cost. This is available as part of the Horizon plans and does not require any changes to members’ health plan election.

More information regarding Direct Primary Care Medical Homes, Paladina Health and R-Health, can be found on our website: www.nj.gov/treasury/pensions/dpcmh.shtml  

PLAN COMPARISON CHARTS

 
The SEHBP Plan Comparison Charts provide a  side-by-side  view  of  the  basic  benefits, copayments, and other out-of-pocket costs for the SEHBP medical and prescription drug plans. The comparison charts can be found on the NJDPB website: 2021 Plan Comparison Charts 

SUMMARIES OF BENEFITS AND COVERAGE
 
Detailed information about the SEHBP’s medical plans is available through the Summaries of Benefits and Coverage. A link to the 2021 summaries can be found on the NJDPB website at: Summary of Benefits and Coverage. A direct mailing will be sent to all SEHBP members to announce the availability of the summaries. 

NJWELL PROGRAM

 
NJWELL provides inclusive and holistic experiences to meet members’ needs through activities and education programming to support healthy lifestyles. NJWELL is open to employees who are enrolled in the SEHBP. Spouses and eligible partners also can participate, as long as they are covered by the SEHBP plan. Participants have access to specialized programming and benefits, including live wellness events, fitness challenges, and online wellness platforms tailored to their unique needs. Participants can also earn a possible $250 in rewards based on points earned from participation in NJWELL. The current NJWELL 2020 Plan Year will be coming to a close on October 31, 2020. Watch your email for upcoming information about NJWELL in 2021, including enhanced programming and online tools available to members. For information about the program visit the NJWELL website at: NJ WELL 

EMPLOYEE CONTRIBUTIONS FOR SEHBP COVERAGE

 
Employees covered by the NJEHP will pay a percentage of their base salary pursuant to Chapter 44. Employees that opt out of coverage under the NJEHP and who are eligible and opt to be covered by NJ DIRECT10 or NJ DIRECT15 must pay a percentage of the cost of the medical and prescription plans pursuant to P.L. 2011, c. 78 (Chapter 78). Percentage of salary and percentage of premium contribution worksheets for 2021 are available on the NJDPB website at: www.nj.gov/treasury/pensions/hb-active-sehbp.shtml
 

WAIVING SEHBP COVERAGE

 
Local education employees are permitted to waive SEHBP medical and prescription coverage if they have other employer-provided or retiree coverage, or other coverage as a dependent. Employers are permitted to offer an incentive to employees who waive SEHBP coverage. Under P.L. 2010, c. 2 (Chapter 2), the incentive amount for waivers is limited to 25 percent of the amount saved by the employer or $5,000, whichever is less. In addition, because multiple coverage under the SHBP/SEHBP is prohibited, waiver incentives are only payable if the other coverage is through a non-SHBP/SEHBP plan. To waive coverage, an Employee Coverage Waiver/Reinstatement Form must be completed and submitted during Open Enrollment. To waive coverage effective January 1, 2021, employees should indicate “Open Enrollment” on the waiver form; otherwise, the waiver will be effective before January 1st.

Note(s): 
*It will be necessary for members who have previously waived coverage to complete an Employee Coverage Waiver/Reinstatement Form this year.
 
**Please keep in mind that NJ Dir 10 & 15 does not fall under  chapter 44 guidelines; it remains under chapter 78 guidelines . 
 
***As of January 1st, 2020 Direct Zero will no longer be an available option for health benefits
 

NJ Paid Leave Insurance

For General Information visit the NJ Department of Labor and Workforce Development, Family Leave Insurance web page.
 

Long Term Disability Insurance

For Information contact Jason Anders, Account Manager, The Standard Insurance Company, 430 Mountain Avenue, Suite 304, Murray Hill, NJ 07974, Telephone (732) 815-2115, Fax (732) 815-2118, Cell (973) 362-5983, or by email [email protected].

Retirement and Pension

For information for Active Employees including Enrollment, Purchase of Service Credits, Pension Loans and Retirement, visit the State of NJ Department of the Treasury Division of Pensions and Benefits “Information for Active Employees” web page.

Workers Compensation

For information on District Workers Compensation procedures see Memorandum from the Interim Business Administrator to All Staff and Nurses.
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