2018 Plan year information

All plan year 2018 health benefits information for active employees can be found here.

What's New

Pharmacy benefits to be managed by OptumRx

We are pleased to announce that, beginning January 1, 2018,* the State Health Benefits Program and School Employees’ Health Benefits Program prescription drug benefit will be managed by OptumRx. Following a competitive bidding process, OptumRx was awarded the contract for pharmacy benefits management for the State Health Benefits Program and School Employees’ Health Benefits Program.

Members will receive more information directly from OptumRx during the implementation process, including a welcome letter and OptumRx ID cards to be mailed to member home addresses. The NJDPB will work in conjunction with OptumRx to ensure a smooth transition.

*December 23, 2017 for members paid through the State’s Centralized Payroll Unit

Continuation of incentive for joining Tiered Network Plans

  • State employees may participate
  • Local government employees may participate IF their employer has adopted a resolution to take part in the Incentive Program
  • Available to first-time enrollees in a tiered network medical plan and continuing for two complete plan years
  • Choice of either the Aetna Liberty Plan or the Horizon OMNIA Health Plan
  • Employee financial incentive:
    • $1,000 for single
    • $1,250 for member/spouse/partner
    • $1,250 for parent/child(ren)
    • $2,000 for family
  • Incentive amount shall be paid by a gift card within the first quarter of plan year 2018 and is reportable as taxable income
  • Incentive will be forfeited and returned to the SHBP if subscriber fails to remain enrolled for at least two plan years (1/1/18 through 12/31/19)

To enroll in one of the tiered network plans, submit your certified application during our Open Enrollment period. Find more information about the tiered network plans and the financial incentive program

New Direct Primary Care Initiative for SHBP/SEHBP Members!

The SHBP/SEHBP has recently introduced the Direct Primary Care Medical Home (DPCMH) initiative to their members and covered dependents. This exciting new program focuses on improving the doctor-patient partnership and reducing health care costs by providing unlimited access to a personal doctor. This initiative is a no copay, no deductible, add-on benefit option that works with your current health insurance carrier, Horizon Blue Cross Blue Shield of New Jersey or Aetna, and does not change anything with your current health plan. DPCMH services are provided by R-Health and Paladina Health.

The concept of a Direct Primary Care (DPC) doctor is to provide a broader scope of primary care services (such as preventive, urgent, and sick care, health and wellness coaching, chronic disease management, and care coordination) that differ from a typical primary care practice. The benefits of joining a DPCMH doctor’s office include unlimited access to your own personal doctor, same-day or next-day appointments, evening and weekend hours, reduced waiting-room time, and unhurried consultations with your doctor. DPC doctors offer onsite lab draws, dispense medications for acute conditions, and administer immunizations onsite, creating a one-stop-shop for comprehensive primary care. Additionally, not all interactions with the doctor need to happen at the doctor’s office; members have access to their doctor via in-person appointments as well as phone consultations, digital messaging, and video visits – making it more convenient to access superior care. This is all provided to members and their families, regardless of age, with no copayment, no deductible, or any other out-of-pocket costs.

The DPCMH design ensures that doctors are more accessible to members and gives them increased time with each patient, affording them the opportunity to build strong relationships. Currently, R-Health can accept enrollees in the Horizon NJ Direct and OMNIA plans, or in the Aetna Freedom and Liberty plans. Paladina Health, at this time, is limited to enrollees from only the Horizon NJ Direct and OMNIA plans. Neither DPCMH provider can accept enrollees in an HMO plan or members who are eligible for Medicare.

Horizon and Aetna members can visit R-Health at www.r-health.md/nj/ or call 1-800-797-1289 for more information or to sign up. Horizon members can visit Paladina Health at www.paladinahealth.com/form/membership-info-SONJ-members or call 1-866-808-6005. Select your doctor and schedule your first appointment today!