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Pensions and Benefits
Tiered-Network Incentive Program

Tiered-Network Incentive Program - New!


For plan year 2017, the Division of Pensions and Benefits is implementing a “Pilot 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 Plans by offering financial incentives.

The Pilot Incentive Program is available to first-time enrollees who must remain enrolled for 2 years, from January 1, 2017 through December 31, 2018. 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 2017, 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 2 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 Division 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 Pilot Incentive Program for the Tiered-Network plans.

 

What is a Tiered-Network Plan?

A brief overview of the Aetna Liberty Plan and Horizon’s OMNIA Health Plan.

During the State Health Benefits Program (SHBP) Open Enrollment period for active members of the State and Local Government employees (October 3 - October 31, 2016), Aetna and Horizon Blue Cross Blue Shield of New Jersey will each offer a new tiered-network plan. The Aetna Liberty Plan and Horizon’s OMNIA plan are being offered in addition to the plans that are currently available.

The following describes the tiered-network plan design:

The Aetna Liberty Plan and Horizon’s OMNIA Health Plan will give members the flexibility to visit practitioners in the carrier’s managed care network, significant premium share reductions and no referrals are required. There will be lower member 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:

  • This tiered-network plan design does not impact any of the existing PPO, HMO, HDHP plans currently administered by Aetna or Horizon.
  • SHBP retired members and School Employees’ Health Benefits Program (SEHBP) active and retired members are not eligible to join the Aetna Liberty Plan or Horizon’s OMNIA Health Plan.

For more information about the tiered-network 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/  For the current listing of Aetna Liberty Plan Tier 1 hospitals:
New Jersey
Pennsylvania
New York

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/ For the current listing of OMNIA Health Plan Tier 1 hospitals - click here. OMNIA members can receive Obstetric services at hospitals in Burlington County at a Tier 1 level of benefits.

 

 
 
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