New Jersey Division of Pensions and Benefits

STATE HEALTH BENEFITS PROGRAM
CHAPTER 330 RETIREES
EFFECTIVE BEGINNING APRIL 1, 2008

Local Retired Group - Local Government Employers

Local Retired Group - Local Education Employers

DEPARTMENT OF THE TREASURY - DIVISION OF PENSIONS & BENEFITS NEW JERSEY STATE HEALTH BENEFITS PROGRAM CHAPTER 330 RETIREES LOCAL RETIRED GROUP- LOCAL GOVERNMENT EMPLOYERS MEDICARE & NON-MEDICARE RATES EFFECTIVE BEGINNING APRIL 1, 2008
PLAN COVERAGE/DESCRIPTION	RETIREE SHARE
NJ DIRECT15 #150
Single - No Medicare	$251.26
Single - With Medicare	$94.04
Member & Spouse/Partner - No Medicare	$547.77
Member & Spouse/Partner - One with Medicare	$345.30
Member & Spouse/Partner - Both with Medicare	$188.07
Family - No Medicare	$623.14
Family - One with Medicare	$420.68
Family - Both with Medicare	$263.45
Parent & Child - No Medicare	$351.77
Parent & Child - Retiree with Medicare	$181.98
NJ DIRECT10 #050
Single - No Medicare	$282.63
Single - With Medicare	$112.86
Member & Spouse/Partner - No Medicare	$616.16
Member & Spouse/Partner - One with Medicare	$395.49
Member & Spouse/Partner - Both with Medicare	$225.72
Family - No Medicare	$700.94
Family - One with Medicare	$480.29
Family - Both with Medicare	$310.51
Parent & Child - No Medicare	$395.69
Parent & Child - Retiree with Medicare	$211.78
AETNA, INC. #019
Single - No Medicare	$94.54
Single - With Medicare	$70.91
Member & Spouse/Partner - No Medicare	$206.11
Member & Spouse/Partner - One with Medicare	$165.45
Member & Spouse/Partner - Both with Medicare	$141.82
Family - No Medicare	$234.47
Family - One with Medicare	$193.82
Family - Both with Medicare	$170.18
Parent & Child - No Medicare	$132.36
Parent & Child - Retiree with Medicare	$104.00
CIGNA HEALTHCARE #020
Single - No Medicare	$99.27
Single - With Medicare	$74.46
Member & Spouse/Partner - No Medicare	$216.42
Member & Spouse/Partner - One with Medicare	$173.73
Member & Spouse/Partner - Both with Medicare	$148.91
Family - No Medicare	$246.19
Family - One with Medicare	$203.51
Family - Both with Medicare	$178.69
Parent & Child - No Medicare	$138.98
Parent & Child - Retiree with Medicare	$109.20
Partner means a Civil Union Partner or eligible same-sex Domestic Partner as recognized under New Jersey State Law.

DEPARTMENT OF THE TREASURY - DIVISION OF PENSIONS & BENEFITS NEW JERSEY STATE HEALTH BENEFITS PROGRAM CHAPTER 330 RETIREES LOCAL RETIRED GROUP- EDUCATION EMPLOYERS MEDICARE & NON-MEDICARE RATES RATES EFFECTIVE EFFECTIVE BEGINNING APRIL 1, 2008
PLAN COVERAGE/DESCRIPTION	RETIREE SHARE
NJ DIRECT15 #150
Single - No Medicare	$242.62
Single - With Medicare	$96.46
Member & Spouse/Partner - No Medicare	$528.92
Member & Spouse/Partner - One with Medicare	$339.09
Member & Spouse/Partner - Both with Medicare	$192.94
Family - No Medicare	$601.70
Family - One with Medicare	$411.87
Family - Both with Medicare	$265.72
Parent & Child - No Medicare	$339.67
Parent & Child - Retiree with Medicare	$181.39
NJ DIRECT10 #050.
Single - No Medicare	$271.03
Single - With Medicare	$113.51
Member & Spouse/Partner - No Medicare	$590.85
Member & Spouse/Partner - One with Medicare	$384.54
Member & Spouse/Partner - Both with Medicare	$227.03
Family - No Medicare	$672.15
Family - One with Medicare	$465.85
Family - Both with Medicare	$308.33
Parent & Child - No Medicare	$379.44
Parent & Child - Retiree with Medicare	$208.38
AETNA, INC. #019
Single - No Medicare	$81.84
Single - With Medicare	$61.38
Member & Spouse/Partner - No Medicare	$178.42
Member & Spouse/Partner - One with Medicare	$143.23
Member & Spouse/Partner - Both with Medicare	$122.77
Family - No Medicare	$202.97
Family - One with Medicare	$167.78
Family - Both with Medicare	$147.32
Parent & Child - No Medicare	$114.58
Parent & Child - Retiree with Medicare	$90.03
CIGNA HEALTHCARE #020
Single - No Medicare	$85.93
Single - With Medicare	$64.45
Member & Spouse/Partner - No Medicare	$187.35
Member & Spouse/Partner - One with Medicare	$150.39
Member & Spouse/Partner - Both with Medicare	$128.91
Family - No Medicare	$213.12
Family - One with Medicare	$176.16
Family - Both with Medicare	$154.69
Parent & Child - No Medicare	$120.31
Parent & Child - Retiree with Medicare	$94.54
Partner means a Civil Union Partner or eligible same-sex Domestic Partner as recognized under New Jersey State Law.

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Division of Pensions and Benefits
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Trenton, NJ 08625-0295

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Last Updated: January 22, 2008