SHBP RATES FOR RETIREES WHO SHARE
THE COST OF NJ DIRECT10 PLAN PREMIUMS

RATES EFFECTIVE APRIL 1, 2008

MEDICARE AND NON-MEDICARE NJ DIRECT10 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 NJ Direct10 plan coverage, find the sharing group to which you belong.

• 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.
  
  
• 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 attain 25 years of service credit on or after July 1, 2007 or retire on a Disability Retirement after August 1, 2007, cannot enroll in NJ DIRECT10, but may be enrolled in NJ DIRECT15, Aetna HMO, or CIGNA HealthCare HMO. These retirees may also be subject to a health contribution of 1.5% of the retirement allowance unless participating in the "Retiree Wellness Plan".

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 NJ DIRECT10 coverage pay the "Full Shared Cost" amount as 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 will be charged a "Shared Cost for Medical Coverage Only." Contact the Division of Pensions and Benefits' Office of Client Services for more information about these costs.

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 NJ DIRECT10 Plan is 25% of the NJ DIRECT10 cost.
There is no charge for NJ DIRECT15 or an HMO plan.

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 NJ DIRECT10 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 DIRECT15 or an HMO plan.

PLAN AND COVERAGE LEVEL	MONTHLY SHARED COST
	Maximum Shared Cost (includes Rx coverage)
NJ DIRECT10 (050)
SINGLE - No Medicare	$63.18
SINGLE - With Medicare	$5.18
MEMBER & SPOUSE/PARTNER - No Medicare	$127.96
MEMBER & SPOUSE/PARTNER - One on Medicare	$67.20
MEMBER & SPOUSE/PARTNER - Both on Medicare	$13.73
FAMILY - No Medicare	$158.45
FAMILY - One on Medicare	$82.31
FAMILY - Member & Spouse/Partner on Medicare	$26.75
PARENT & CHILD - No Medicare	$97.63
PARENT & CHILD - Retiree on Medicare	$27.38
Partner means a Civil Union Partner or eligible same-sex Domestic Partner as recognized under New Jersey State Law.