TABLE OF CONTENTS
SPECIAL PLAN PROVISIONS UNDER THE SHBP
Womens Health and Cancer Rights Act
Work-Related Injury or Disease
Health Insurance Portability and Accountability Act
Mental Health Parity Act Requirements
Notice of Provider Termination
Purchase of Individual Insurance Coverage
Medical Plan Extension of Benefits
STATE HEALTH PROGRAM ELIGIBILITY
Medicare Coverage While Employed
Eligible Dependents of Retirees
Enrolling in the Retired Group of the SHBP
How to File a Claim if You are Medicare Eligible
Retirees with Medicare Who Move outside the United States
Continuing Coverage When It Would Normally End
Employer Responsibilities Under COBRA
Employee Responsibilities Under COBRA
Failure to Elect COBRA Coverage
GENERAL CONDITIONS OF THE PLAN
Medical Need and Appropriate Level of Care
Reasonable and Customary Allowances
Experimental or Investigational Treatments
Educational or Developmental Services or Supplies, or Educational Testing
Custodial, Maintenance, and Supportive Care
Employee Prescription Drug Plan
Prescription Drug Benefits Provided Through SHBP Health Plans
Employee Prescription Drug Reimbursement Plan for NJ PLUS Members
Retiree Prescription Drug Coverage
Selecting a Primary Care Physician (PCP)
How to Access Information That Will Help You Choose a PCP
Summary of Covered Services and Supplies
Alcoholism and Substance Abuse
Diabetic Self-Management Education
Durable Medical Equipment and Supplies
Hospital-Based Weight Loss Programs
Lyme Disease Intravenous Antibiotic Therapy
Maternity/Obstetrical Care for Child Dependents
Mental or Nervous Conditions and Substance Abuse
Patient Controlled Analgesia (PCA)
Skilled Nursing Facility Charges
Temporomandibular Joint Disorder (TMJ) and Mouth Conditions
Charges Not Covered by the Plan
Filing Deadline - Proof of Loss
APPENDIX I Summary Schedule of Services and Supplies
For Non-Biologically-Based Mental Illnesses
Eligible Services and Supplies
APPENDIX II Utilization Review Appeal Procedure
APPENDIX III Claim Appeal Procedures
APPENDIX IV SHBP Medical Treatment Policies
Lyme Disease Intravenous Antibiotic Therapy
Early Disseminated Lyme Disease
Late/Chronic Disease Lyme Arthritis and Late/Chronic Disease Neuroborreliosis
APPENDIX VI SHBP Notice of Privacy Practices