MEDICARE AND NON-MEDICARE TRADITIONAL PLAN RATES
SHARED COSTS FOR STATE RETIREES
ENROLLED IN THE STATE HEALTH BENEFITS PROGRAM

HOW TO USE THESE CHARTS

To determine the monthly shared cost of your Retired Group SHBP Traditional Plan coverage, find the sharing group to which you belong.

• State retirees who attain 25 years of service credit between July 1, 2000 – June 30, 2007 or retire on a Disability Retirement between August 1, 2000 — July 31, 2007.
  
  
• State retirees who attained 25 years of service credit between July 1, 1997 – June 30, 2000 or retired on a Disability Retirement between August 1, 1997 — July 31, 2000.

Next, on the appropriate chart (below), find your coverage level in the left-hand column. To the right you will find the applicable SHBP shared rates.

• Most retirees who share the cost of their SHBP Traditional Plan coverage pay the "Full Shared Cost" amount shown. This amount will be deducted from your monthly retirement payment (or you will be billed directly if the retirement payment is not large enough to cover the Full Cost amount).
  
  
• If you or a covered dependent are enrolled in a Medicare Part D drug plan, you are not eligible to receive prescription drug coverage through the SHBP and you will be charged the "Shared Cost for Medical Only" amount.

Because the SHBP's prescription drug benefits are equal to or better than the Medicare Part D prescription drug benefit plans, most SHBP retirees and/or their dependents need not enroll in any Medicare Part D plan. If you and/or your covered dependents do enroll in Medicare Part D, your SHBP-provided retired group prescription drug benefits will be terminated for you and all of your dependents. For additional information about the SHBP and Medicare Part D, see the Medicare Part D Frequently Asked Questions page.

RATES FOR STATE RETIREES WHO ATTAIN 25 YEARS OF SERVICE CREDIT
BETWEEN JULY 1, 2000 – JUNE 30, 2007
Or retire on a Disability Retirement between August 1, 2000 — July 31, 2007

For these members, the premium for the Traditional Plan is 25% of the Traditional Plan cost.
There is no charge for NJ PLUS or an HMO plan.

PLAN AND COVERAGE LEVEL

 MONTHLY SHARED COST

Rx Differential

TRADITIONAL PLAN (002)

SINGLE - No Medicare

SINGLE - With Medicare

MEMBER & SPOUSE/PARTNER - No Medicare

MEMBER & SPOUSE/PARTNER - One on Medicare

MEMBER & SPOUSE/PARTNER - Both on Medicare

FAMILY - No Medicare

FAMILY - One on Medicare

FAMILY - Member & Spouse/Partner on Medicare

PARENT & CHILD - No Medicare

PARENT & CHILD - Retiree on Medicare

RATES FOR STATE RETIREES WHO ATTAINED 25 YEARS OF SERVICE CREDIT
BETWEEN JULY 1, 1997 – JUNE 30, 2000
Or retired on a Disability Retirement between August 1, 1997 — July 31, 2000

If enrolled in the Traditional Plan, these members pay either 1% of their salary on Jan 1 of their retirement year
or, if the salary was greater than $40,000.00, the Maximum Share (shown below).
There is no charge for NJ PLUS or an HMO plan.

PLAN AND COVERAGE LEVEL

 MONTHLY SHARED COST

Rx Differential

TRADITIONAL PLAN (002)

SINGLE - No Medicare

SINGLE - With Medicare

MEMBER & SPOUSE/PARTNER - No Medicare

MEMBER & SPOUSE/PARTNER - One on Medicare

MEMBER & SPOUSE/PARTNER - Both on Medicare

FAMILY - No Medicare

FAMILY - One on Medicare

FAMILY - Member & Spouse/Partner on Medicare

PARENT & CHILD - No Medicare

PARENT & CHILD - Retiree on Medicare