Plan Administrator Change
Effective January 1, 2020, all active employee SHBP plan designs will be solely administered by Horizon Blue Cross Blue Shield of New Jersey (Horizon). This change was the result of a public competitive procurement process that resulted in an award to Horizon only. Any employees who are currently enrolled in an Aetna medical plan will be automatically enrolled into the corresponding Horizon medical plan. For example, employees enrolled in the Aetna Freedom 15 plan will be automatically moved to the Horizon NJ DIRECT15 plan. Aetna will continue to administer the Aetna Dental Expense Plan (DEP), Aetna DMO, and Medicare Advantage Plans for retirees. Horizon will be implementing Horizon Health Guides, a member navigation and advocacy initiative with enhanced customer service programs tied to the improvement of member health outcomes. For more information, please see the Plan Administrator Change Q&A .
New PPO Plans
IFPTE-, AFSCME-, and CWA-represented members — State employees represented by the International Federation of Professional and Technical Engineers (IFPTE), the American Federation of State, County, and Municipal Employees (AFSCME), and the Communication Workers of America (CWA) will now have access to a new plan option pursuant to recent labor agreements. Along with the Health Maintenance Organization (HMO), Tiered Network Plan, and High Deductible Health Plans (HDHP), new Preferred Provider Organization (PPO) plans are offered. IFPTE/AFSCME-represented members may select NJ DIRECT/NJ DIRECT 2019,* and CWA-represented members may select CWA Unity DIRECT/CWA Unity DIRECT 2019.* These PPO plans replace the PPOs that were formerly offered.
Members represented by IFPTE, AFSCME, and CWA should use Health Benefit Enrollment and/or Change Forms specific to their union.
All Other SHBP Members — In addition to those groups listed above, the SHBP Plan Design Committee created NJ DIRECT/NJ DIRECT 2019* PPO plans for all other State employees in addition to the other PPOs, HMO, Tiered Network Plan, and High Deductible Health Plans (HDHP) currently offered.
*Members hired prior to July 1, 2019, will be enrolled in NJ DIRECT or CWA Unity DIRECT. Members hired after July 1, 2019, will be enrolled in NJ DIRECT 2019 or CWA Unity DIRECT 2019.
Incentive Program for Tiered-Network Plan
The Incentive Program for Horizon OMNIA has been modified and extended to December 31, 2020, for State employees and Local Government employees. All State employees may participate. Local Government employee participation is at the voluntary option of the employer and is administered by the local employer.* The program offers a financial incentive of $1,000 to first-time enrollees at all coverage levels (i.e., Single, Member and Spouse, Parent and Child, or Family coverage) who remain enrolled for one year. The incentive is paid by gift card no later than the end of the current tax year and is deemed reportable income for tax purposes. The incentive shall be forfeited and returned to the SHBP if the subscriber fails to remain enrolled in the Tiered-Network Plan for at least one plan year. This program does not extend to children over the age of 26 or COBRA members.
*Local Government employees should verify with their human resources representative or benefits administrator if the employer has filed a resolution to join in the modified Incentive Program.
Generic Mail Order Incentive
To encourage member utilization of mail order services for generic drugs, the SHBP Plan Design Committee (PDC) approved a resolution to reduce the copayment for generic prescriptions. Beginning November 1, 2019, active State and local employees will pay $0 for a 90-day supply of Generic prescriptions filled through the mail service program. This incentive will continue for at least one plan year, subject to renewal by the SHBP PDC.
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