Medical and Prescription Drug Plans
Kean University employees participate in the State Health Benefits Program (SHBP) through the Division of Pensions and Benefits of the State of New Jersey.
Full-time employees, spouses, civil-union partners, certain same-sex domestic partners and dependent children are eligible for health insurance coverage.
Generally, employees and their eligible dependents may be covered after 60 days of continuous employment. Full-time faculty members whose appointments start on September 1 may be covered as of the beginning of the academic year. Faculty members that begin employment on other dates are eligible for health benefits following a 60 day waiting period.
For more details, please review the following documents that contain medical plan descriptions, costs and comparison charts.
SELECTING THE RIGHT PLAN FOR YOU
Below you will find helpful resources and information to help you make an informed decision regarding your health benefits.
Medical Plans - Web Addresses & Phone Numbers
State Health Benefits Member Guidebook 2024
Plans available to Managers, and Members of IFPTE, AFT (Faculty and Professional Staff), NJLESA, NJSOLEA
NJ DIRECT HDLow / NJ DIRECT HDHigh
Plans available to CWA
CWA Unity DIRECT / CWA Unity DIRECT 2019
NJ DIRECT HDLow / NJ DIRECT HDHigh
ENROLL/MAKE CHANGES TO YOUR HEALTH BENEFITS
New Hires health elections must be submitted online through mynjbenefitshub which can be accessed via the myNewJersey account portal. The Company Key is SHBP/SEHBP (all capital letters). Please note that rates may also be viewed in the portal.
Enrollments in medical, prescription drug and dental plans must be submitted online using the state system, Benefitsolver.
Guide for Health Plan Enrollment
Contact Medical, RX, and Dental Plan Contacts for specific plan questions.
INCENTIVE PROGRAM FOR OMNIA - TIERED NETWORK PLAN
The Incentive Program for Horizon OMNIA is extended for 2024. The program offers a financial incentive of $1,000 to first-time enrollees who remain enrolled for one year for all coverage levels (i.e., Single, Member and Spouse, Parent and Child, or Family coverage). 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.
For more information regarding this incentive, members may visit Incentive - Tiered Network.
Your Employee Contribution
The cost of the plans is determined based on variables that may include the plan that you select, your job category, your base salary and level of coverage. The following calculator will provide you with an estimate of your annual employee contributions for health benefits.
Horizon Cost Calculator - 2024
- Select Employee type:
- State Union Negotiated (For Managers, and Members of IFPTE, AFT (Faculty and Professional Staff), NJLESA, NJSOLEA)
- State CWA (For CWA Members)
- State All Other (For Members of NJSPBA)
- Select coverage type: family, single, etc.
- Select prescription plan: SHBP employee prescription drug plan
This will generate annual cost estimates for plans available to you.
- 10 month faculty member may divide the sum by 22 to obtain an estimate of the biweekly employee deduction.
- 12 month employees may divide by 26.
Checking In-Network Providers
Click on the Horizon Doctor & Hospital Finder. Then, enter the appropriate zip code and plan prefix code. See below for details.
- The card prefix is NJX for all of the PPO plans [All NJ DIRECT plans; CWA Unity DIRECT plans], including the NJ DIRECT High Deductible Health plans].
- The card prefix is SNJ for all of the Horizon HMO plans.
- The card prefix is NJO for OMNIA.
How do I check if my doctor is in network with Aetna?
Aetna Medical Plans – Find a provider link
Aetna DEP/DMO – Find a provider link
MEMBERSHIP TO DIRECT PRIMARY CARE MEDICAL HOME DOCTOR’S OFFICE INCLUDED IN SHBP
The SHBP offers employees and their covered dependents the opportunity to join a Direct Primary Care doctor's office. This is available as part of the Horizon plans and does not require any changes to members’ health plan elections. For more information, visit Direct Primary Care Medical Homes.
NJWELL PROGRAM
NJWELL provides inclusive and holistic experiences to meet members’ needs through activities and education programming to support healthy lifestyles. NJWELL is open to employees who are enrolled in the SHBP. Spouses and eligible partners also can participate, as long as they are covered by the SHBP plan. Participants have access to specialized programming and benefits, including live wellness events, fitness challenges, and online wellness platforms tailored to their unique needs. Participants can also earn up to a possible $350 in rewards based on points earned from participation in NJWELL. The current NJWELL 2023 Plan Year will be coming to a close on October 31, 2023. Watch your email for upcoming information about NJWELL in 2024. For information about the program, visit the NJWELL website.
PRESCRIPTION DRUG PLAN
The Employee Prescription Drug Plan is a separate drug plan for active employees. OptumRx is the current pharmacy benefits administrator. For further information regarding the Prescription Drug Plan, please click here.
OptumRx - Medication Home Delivery
You will not be able to select different levels of Medical and Prescription Plan Coverage. For example, a member may not elect to have Single Medical coverage and Member/Spouse Prescription coverage. The level of coverage must be the same for both plans.
Members also must elect to enroll in both Medical and Prescription. If a member wishes to waive coverage, both Medical and Prescription coverage must be waived.
Rx Chart - State Union Negotiated - Managers, and Members of IFPTE, AFT (Faculty and Professional Staff (Faculty and Professional Staff), NJLESA, NJSOLEA
Optum Rx Pricing Tool Available
Optum provides a prescription pricing tool and a comprehensive drug list on their website. Members can access this through a link on the Division website, which will direct members straight to the Optum site
Additional Resources
For additional information regarding the SHBP, please refer to the Division of Pensions and Benefits.
If you have questions regarding your benefits, please contact benefits@kean.edu.