For Plan Year 2018, the Division of Pensions & Benefits is offering an Incentive Program for the Tiered-Network plans: the Aetna Liberty Plan and the Horizon OMNIA Health Plan. This program encourages employees to subscribe to one of the Tiered-Network Plans by offering financial incentives.
The Incentive Program is available to first-time enrollees who must remain enrolled for two years, from January 1, 2018 through December 31, 2019. This program does not extend to over age children or COBRA members. The incentives vary depending on level of coverage: Single-coverage employees receive $1,000; Member/Spouse or Parent/Child-covered employees receive $1,250; and Family-covered employees receive $2,000. This incentive is paid by gift card within the first quarter of Plan Year 2018, and is deemed reportable income for tax purposes.
IMPORTANT – The incentive shall be forfeited and returned to the SHBP if you fail to remain enrolled in the Tiered Plan for at least two plan years, except if you become ineligible for healthcare due to: layoff, involuntary separation, reduction to part-time status, or classification into an ineligible position. If you voluntarily retire or change health plans due to catastrophic or emergency health needs as determined by the NJDPB after a full year, then the incentive shall be forfeited on a pro-rata basis.
State employees are automatically eligible to participate in the program. For local employees, the incentive program is voluntary and at the option of the employer; therefore, eligibility for the incentive is based on whether the employer participates. Local employers must complete a Resolution for the Incentive Program for the Tiered-Network plans.
Recently, the SHBP Plan Design Committee had passed a resolution offering the incentive to State employees who had previously enrolled in a Tiered Plan. This benefit now applies to State employees who enrolled in a Tiered Plan on or after August 29, 2016, and outside of the normal Open Enrollment period.
Newly eligible members must maintain their enrollment in the Tiered Plan for at least two years to remain eligible for the incentive.
Members who are now eligible for the incentive should receive their gift card shortly, if they have not already received their gift card. Any member who has recently enrolled in a Tiered Plan will receive their gift card the next quarter.
A brief overview of Aetna's Liberty Plan and Horizon’s OMNIA Health Plan
The Aetna Liberty Plan and Horizon’s OMNIA Health Plan give members the flexibility to visit practitioners in the carrier’s managed care network as well as significant premium share reductions, with no referrals required. The plans offer members lower cost sharing, with copays as low as $5.00 for an office visit, when utilizing Tier 1 providers. Tier 1 refers to specific doctors, hospitals and other health care professionals who offer cost-effective care. Liberty and OMNIA plan members also have the flexibility to see any Tier 2 provider included in the managed care network, but with slightly higher cost sharing. There is no out-of-network coverage with either plan.
Please note: SHBP retired members and School Employees’ Health Benefits Program (SEHBP) active and retired members are not eligible to join the Liberty or OMNIA plans.
For more information about the tiered-network plans, visit the following websites:
Aetna Liberty Plan -- Members can use DocFind™ to search for participating Tier 1 and Tier 2 providers at: http://www.aetnastatenj.com/
Horizon’s OMNIA Health Plan -- Members can identify Tier 1 and Tier 2 providers on the Horizon online Doctor & Hospital finder at: http://shbp.horizonblue.com/
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