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COBRA Continuation Coverage—Rates

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To find the correct COBRA rate chart effective January 1, 2007 - December 31, 2007, select the description that best fits your employee:

• State Monthly Active Group
• Chapter 172 Part-Time State Monthly Active COBRA Group
• Local Monthly Active Group - Education Employers - with RX coverage
• Local Monthly Active Group - Education Employers - without RX coverage
• Local Monthly Active Group - Local Government Employers- with RX coverage
• Local Monthly Active Group - Local Government Employers - without RX coverage
• Chapter 172 Part-Time Local Monthly Active COBRA Group
• COBRA Dental Rates, State
• COBRA Dental Rates, Local Government and Education
• Vision Care Program

 

To view applicable program updates, select the description that best fits your employees:

• State Employee
• Local Educational Employee with Separate Prescription Drug Coverage
• Local Educational Employee without Separate Prescription Drug Coverage
• Local Government Employee with Separate Prescription Drug Coverage
• Local Government Employee without Separate Prescription Drug Coverage

COBRA PLAN CHANGES
(LOCAL EDUCATION EMPLOYER WITH A SEPARATE PRESCRIPTION DRUG PLAN)
EFFECTIVE August 2003

If your employer does not offer a separate prescription drug program, click here.

MEDICAL PLAN CHANGES

• Effective April 14, 2003, the State Health Benefits Program (SHBP) is required by the federal Health Insurance Portability and Accountability Act (HIPAA) and State laws to maintain the privacy of any information that is created or maintained by the SHBP that relates to a member's past, present, or future physical or mental health. This Protected Health Information (PHI) includes information communicated or maintained in any form. Examples of PHI are a member's name, address, Social Security number, birth date, telephone number, fax number, dates of health care service, diagnosis codes, and procedure codes. PHI is collected by the SHBP through various sources, such as enrollment forms, employers, health care providers, federal and State agencies, or third-party vendors.
• Effective January 1, 2002, the State Health Benefits Commission (SHBC) adopted a change in policy with regard to reimbursement of chiropractic services for members enrolled in the Traditional Plan or New Jersey Plus, allowing for a maximum of 30 visits per calendar year. In addition, members no longer need to submit updated medical records and/or treatment plans for review.
• Chapter 227, P.L. 2001, requires all State Health Benefits Program (SHBP) medical plans to provide coverage for Pap smears, effective August 27, 2001.
• Effective December 27, 2001, Chapter 284, P.L. 2001, requires that any SHBP member enrolled in an HMO or NJ PLUS be provided with 90-days notice if the member's primary care physician is terminated from the provider network. If 90-days notice cannot be provided, NJ PLUS or the HMO must notify the SHBP member immediately. Once notified, the member may change coverage to another SHBP plan without waiting for the annual open enrollment period. The member must attach a copy of the plan notification to the SHBP application, requesting a change in coverage.
• As of May 1, 2002, Aetna/US Healthcare changed its name to Aetna Health.
• Effective August 1, 2002, University Health Plans (UHP) terminated its participation in the State Health Benefits Program.

If your educational employer offers a separate prescription drug program, click here.

MEDICAL PLAN CHANGES

• Effective April 14, 2003, the State Health Benefits Program (SHBP) is required by the federal Health Insurance Portability and Accountability Act (HIPAA) and State laws to maintain the privacy of any information that is created or maintained by the SHBP that relates to a member's past, present, or future physical or mental health. This Protected Health Information (PHI) includes information communicated or maintained in any form. Examples of PHI are a member's name, address, Social Security number, birth date, telephone number, fax number, dates of health care service, diagnosis codes, and procedure codes. PHI is collected by the SHBP through various sources, such as enrollment forms, employers, health care providers, federal and State agencies, or third-party vendors.
• Effective January 1, 2002, the State Health Benefits Commission (SHBC) adopted a change in policy with regard to reimbursement of chiropractic services for members enrolled in the Traditional Plan or New Jersey Plus, allowing for a maximum of 30 visits per calendar year. In addition, members no longer need to submit updated medical records and/or treatment plans for review.
• Chapter 227, P.L. 2001, requires all State Health Benefits Program (SHBP) medical plans to provide coverage for Pap smears, effective August 27, 2001.
• Effective December 27, 2001, Chapter 284, P.L. 2001, requires that any SHBP member enrolled in an HMO or NJ PLUS be provided with 90-days notice if the member's primary care physician is terminated from the provider network. If 90-days notice cannot be provided, NJ PLUS or the HMO must notify the SHBP member immediately. Once notified, the member may change coverage to another SHBP plan without waiting for the annual open enrollment period. The member must attach a copy of the plan notification to the SHBP application, requesting a change in coverage.
• As of May 1, 2002, Aetna/US Healthcare changed its name to Aetna Health.
• Effective August 1, 2002, University Health Plans (UHP) terminated its participation in the State Health Benefits Program.

PRESCRIPTION DRUG PROGRAM CHANGES

• On January 1, 2002, Advance PCS began administering prescription drug benefits of the SHBP Employee Prescription Drug Plan. They also administer the drug benefits in the Traditional Plan and NJ PLUS, for employers who do not provide a separate prescription drug plan.
• The State Health Benefits Commission has revised its existing retail pharmacy 30-day supply limit. Effective May 1, 2000, State Health Benefits Program (SHBP) members enrolled under the State Prescription Drug Plan can have prescriptions filled at a retail pharmacy for up to and including a 90-day supply. The disbursement of a 90-day supply is contingent upon the receipt of co-payments from eligible participants as shown in the chart below and a physician's prescription for the 90-day supply.

COBRA Members Enrolled in the State Prescription Drug Plan
Supply Available at Retail Pharmacy	Employee Co-pay for Generic Drugs	Employee Co-pay for Brand Name Drugs
1-30 days	$1	$5
31-60 days	$2	$10
61-90 days	$3	$15

 

COBRA PLAN CHANGES
(LOCAL GOVERNMENT EMPLOYER WITH A
SEPARATE PRESCRIPTION DRUG PLAN)
EFFECTIVE AUGUST 2003

MEDICAL PLAN CHANGES

• Effective April 14, 2003, the State Health Benefits Program (SHBP) is required by the federal Health Insurance Portability and Accountability Act (HIPAA) and State laws to maintain the privacy of any information that is created or maintained by the SHBP that relates to a member's past, present, or future physical or mental health. This Protected Health Information (PHI) includes information communicated or maintained in any form. Examples of PHI are a member's name, address, Social Security number, birth date, telephone number, fax number, dates of health care service, diagnosis codes, and procedure codes. PHI is collected by the SHBP through various sources, such as enrollment forms, employers, health care providers, federal and State agencies, or third-party vendors.
• Effective January 1, 2002, the State Health Benefits Commission (SHBC) adopted a change in policy with regard to reimbursement of chiropractic services for members enrolled in the Traditional Plan or New Jersey Plus, allowing for a maximum of 30 visits per calendar year. In addition, members no longer need to submit updated medical records and/or treatment plans for review.
• Chapter 227, P.L. 2001, requires all State Health Benefits Program (SHBP) medical plans to provide coverage for Pap smears, effective August 27, 2001.
• Effective December 27, 2001, Chapter 284, P.L. 2001, requires that any SHBP member enrolled in an HMO or NJ PLUS be provided with 90-days notice if the member's primary care physician is terminated from the provider network. If 90-days notice cannot be provided, NJ PLUS or the HMO must notify the SHBP member immediately. Once notified, the member may change coverage to another SHBP plan without waiting for the annual open enrollment period. The member must attach a copy of the plan notification to the SHBP application, requesting a change in coverage.
• As of May 1, 2002, Aetna/US Healthcare changed its name to Aetna Health.
• Effective August 1, 2002, University Health Plans (UHP) terminated its participation in the State Health Benefits Program.

 

STATE HEALTH BENEFITS PROGRAM
COBRA PLAN CHANGES
(LOCAL GOVERNMENT EMPLOYER WITHOUT A SEPARATE PRESCRIPTION DRUG PLAN)
EFFECTIVE AUGUST 2003

MEDICAL PLAN CHANGES

• Effective April 14, 2003, the State Health Benefits Program (SHBP) is required by the federal Health Insurance Portability and Accountability Act (HIPAA) and State laws to maintain the privacy of any information that is created or maintained by the SHBP that relates to a member's past, present, or future physical or mental health. This Protected Health Information (PHI) includes information communicated or maintained in any form. Examples of PHI are a member's name, address, Social Security number, birth date, telephone number, fax number, dates of health care service, diagnosis codes, and procedure codes. PHI is collected by the SHBP through various sources, such as enrollment forms, employers, health care providers, federal and State agencies, or third-party vendors.
• Effective January 1, 2002, the State Health Benefits Commission (SHBC) adopted a change in policy with regard to reimbursement of chiropractic services for members enrolled in the Traditional Plan or New Jersey Plus, allowing for a maximum of 30 visits per calendar year. In addition, members no longer need to submit updated medical records and/or treatment plans for review.
• Chapter 227, P.L. 2001, requires all State Health Benefits Program (SHBP) medical plans to provide coverage for Pap smears, effective August 27, 2001.
• Effective December 27, 2001, Chapter 284, P.L. 2001, requires that any SHBP member enrolled in an HMO or NJ PLUS be provided with 90-days notice if the member's primary care physician is terminated from the provider network. If 90-days notice cannot be provided, NJ PLUS or the HMO must notify the SHBP member immediately. Once notified, the member may change coverage to another SHBP plan without waiting for the annual open enrollment period. The member must attach a copy of the plan notification to the SHBP application, requesting a change in coverage.
• As of May 1, 2002, Aetna/US Healthcare changed its name to Aetna Health.
• Effective August 1, 2002, University Health Plans (UHP) terminated its participation in the State Health Benefits Program.

PRESCRIPTION DRUG PROGRAM CHANGES

• On January 1, 2002, Advance PCS began administering prescription drug benefits of the SHBP Employee Prescription Drug Plan. They also administer the drug benefits in the Traditional Plan and NJ PLUS, for employers who do not provide a separate prescription drug plan.
• The State Health Benefits Commission has revised its existing retail pharmacy 30-day supply limit. Effective May 1, 2000, State Health Benefits Program (SHBP) members enrolled under the State Prescription Drug Plan can have prescriptions filled at a retail pharmacy for up to and including a 90-day supply. The disbursement of a 90-day supply is contingent upon the receipt of CO-payments from eligible participants as shown in the chart below and a physician's prescription for the 90-day supply.

COBRA Members Enrolled in the State Prescription Drug Plan
Supply Available at Retail Pharmacy	Employee CO-pay for generic drugs	Employee CO-pay for brand name drugs
1-30 days	$3	$10
31-60 days	$6	$20
61-90 days	$9	$30

 

MEDICAL PLAN CHANGES

• Depending upon the collective bargaining unit covering an employee's position, a new employee hired on or after July 1 may not be eligible for coverage under the Traditional Plan. This ineligibility for Traditional Plan coverage carries over to any future COBRA coverage for the member or the member's dependent.
• Effective April 14, 2003, the State Health Benefits Program (SHBP) is required by the federal Health Insurance Portability and Accountability Act (HIPAA) and State laws to maintain the privacy of any information that is created or maintained by the SHBP that relates to a member's past, present, or future physical or mental health. This Protected Health Information (PHI) includes information communicated or maintained in any form. Examples of PHI are a member's name, address, Social Security number, birth date, telephone number, fax number, dates of health care service, diagnosis codes, and procedure codes. PHI is collected by the SHBP through various sources, such as enrollment forms, employers, health care providers, federal and State agencies, or third-party vendors.
• Effective January 1, 2002, the State Health Benefits Commission (SHBC) adopted a change in policy with regard to reimbursement of chiropractic services for members enrolled in the Traditional Plan or New Jersey Plus, allowing for a maximum of 30 visits per calendar year. In addition, members no longer need to submit updated medical records and/or treatment plans for review.
• Chapter 227, P.L. 2001, requires all State Health Benefits Program (SHBP) medical plans to provide coverage for Pap smears, effective August 27, 2001.
• Effective December 27, 2001, Chapter 284, P.L. 2001, requires that any SHBP member enrolled in an HMO or NJ PLUS be provided with 90-days notice if the member's primary care physician is terminated from the provider network. If 90-days notice cannot be provided, NJ PLUS or the HMO must notify the SHBP member immediately. Once notified, the member may change coverage to another SHBP plan without waiting for the annual open enrollment period. The member must attach a copy of the plan notification to the SHBP application, requesting a change in coverage.
• As of May 1, 2002, Aetna/US Healthcare changed its name to Aetna Health.
• Effective August 1, 2002, University Health Plans (UHP) terminated its participation in the State Health Benefits Program.

PRESCRIPTION DRUG PROGRAM CHANGES

• On January 1, 2002, Advance PCS began administering prescription drug benefits of the SHBP Employee Prescription Drug Plan. They also administer the drug benefits in the Traditional Plan and NJ PLUS, for employers who do not provide a separate prescription drug plan.

• The State Health Benefits Commission has revised its existing retail pharmacy 30-day supply limit. Effective May 1, 2000, State Health Benefits Program (SHBP) members enrolled under the State Prescription Drug Plan can have prescriptions filled at a retail pharmacy for up to and including a 90-day supply. The disbursement of a 90-day supply is contingent upon the receipt of CO-payments from eligible participants as shown in the chart below and a physician's prescription for the 90-day supply.

DENTAL PROGRAM CHANGES

The State Employee Group Dental Program is implementing new Current Dental Terminology (CDT) codes, issued by the American Dental Association in order to identify and standardize dental procedures. As of October 16, 2003, in compliance with the Health Insurance Portablility and Accountability Act of 1996 (HIPAA), participating dental plans must process all claims using only CDT codes. Because of the implementation of the CDT codes, some services may be combined or split, resulting in the alteration of DPO copayments for some of the services provided.

The new codes will be listed in the revised State Employee Group Dental Program Handbook for the new plan year.

Members enrolled in the Dental Expense Plan were previously required to obtain precertification for crown, inlays, periodontics, prosthodontics, and orthodontics. Effective January 1, 2003, precertification is no longer required for the procedures listed above, but it is still recommended, especially if the cost will be greater than $300, ensuring that you are informed about the charges covered by your plan, and those that you will have to pay for yourself.

The State Health Benefits Commission has elected to freeze new participant enrollment in Unity Dental, so for the Open Enrollment period from October 1 to October 31, 2003, for the 2004 plan year, no new enrollments will be alllowed in this DPO. Current members may, however, remain in the plan.

Protective DentalCare of New Jersey, Inc., joined Fortis Benefits Insurance Company on December 31, 2001, becoming Fortis Benefits DentalCare of New Jersey, Inc.;

Aetna US Healthcare, administrator of the Dental Expense Plan, changed the name to Aetna Dental, effective May 1, 2002.

Dental Group of New Jersey, Inc., has rejoined the State Employee Group Dental Plan for Plan Year 2003, and is available for selection during Open Enrollment and beyond.

Based on a review of plan information, several dental plans have been noted as providing services superior to the high standards required of all participating DPO's For the first time in many years, three DPO's - CIGNA (#305), Community Dental Associates (#302), and Atlantic Southern [BeneCare] (#301) - will have higher premium levels than the other DPOs. Since State employees pay 50 percent of the dental premium, these plans will cost slightly more than the others. You should remember, however, that the additional cost indicates that these three plans provide you with a superior quality of service.

STATEWIDE DPO, INC. (#315) - Statewide DPO will no longer be participating in the State Employee Group Dental Program after July 1, 2000. Employees enrolled in this plan must select another dental plan during this Open Enrollment if they wish to retain dental coverage after July 1, 2000.

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