Open Enrollment for SHBP

The Office of Human Resources at Kean University would like to inform you of new information regarding the Open Enrollment Period for the State Health Benefit Program (SHBP), which began October 17, 2011 and will continue until November 11, 2011.

During the Open Enrollment Period, employees can make general changes (adding or deleting dependents, changing coverage levels, etc.) or enroll in a different medical or dental plan. All changes to coverage made during this Open Enrollment Period will be effective as of January 1, 2012.



NEW PLAN DESIGNS

On October 5, 2011, the State Health Benefits Plan Design Committee approved new medical and prescription drug plans to be offered through the SHBP.

 

The current NJ DIRECT15, Aetna HMO, and CIGNA HealthCare HMO plans will still be available through the SHBP in plan year 2012. However, additional plan options are now also available. The total number of available plans for 2012 is 15.

  • Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ), Aetna, and CIGNA will each offer two additional plan design options, which provide lower premiums in exchange for slightly higher copayments, deductibles, and out-of-pocket amounts on services that are received.
  • Horizon BCBSNJ, Aetna, and CIGNA will each also offer two High Deductible Health Plans for employees and certain retirees.
  • Under the active Employee Prescription Drug Plan the copayments will remain the same for the current plans; however, the new plan designs have different copayments. In addition, employees who choose a high deductible health plan cannot be enrolled in the active Employee Prescription Drug Plan. Instead, prescription drugs are covered under the plan and are subject to a deductible.

 

 

EMPLOYEE CONTRIBUTIONS FOR SHBP COVERAGE

Pursuant to Chapter 78, P.L. 2011, the Pension and Health Benefit Reform Law, new employee health benefit contribution amounts became effective in October 2011. Employees must pay either a percentage of the medical and prescription plan premium or 1.5% of annual salary, whichever is greater. There will NOT be another Open Enrollment period before July 1, 2012. For employees that are subject to the 4-year phase-in of Chapter 78 contribution rates, Year One contribution rates (with the 2012 plan costs) will apply for the period of January 1, 2012 through June 30, 2012 and Year Two contribution rates (with the 2012 plan costs) will apply for the period of July 1, 2012 through December 31, 2012.

 

Premium Rate Charts, Plan Descriptions and Enrollment Applications are now available for the all plans by clicking here.

 

 

WAIVING SHBP COVERAGE

State employees are permitted to waive SHBP medical and prescription coverage provided they have other health care coverage. To waive coverage a SHBP State Waiver form and a Health Benefit Application must be completed and submitted by November 11, 2011. To waive coverage effective January 1st, employees should indicate “Open Enrollment” on the waiver form; otherwise, the waiver will be processed on a timely basis.

 

 

DENTAL PLANS AND EMPLOYEE COSTS

Dental coverage is offered to all eligible State employees through the Employee Dental Plans. Seven different dental plans are offered based on one of two different plan designs — Dental Plan Organizations (DPO) and a Dental Expense Plan.

 

Six DPOs are available: Aetna DMO; BeneCare; CIGNA DHMO; Community Dental Associates; Healthplex; and Horizon Dental Choice. DPOs contract with a network of providers for dental services. When an employee or dependent uses a DPO dentist, diagnostic and preventive services are covered in full. Most other eligible expenses require a small copayment. Providers must participate with the DPO selected to receive coverage. Be sure to confirm that the dentist or dental facility selected is taking new patients and participates with the SHBP Employee Dental Plans, since DPOs also service other organizations.


The Dental Expense Plan is changed from an indemnity type plan to a PPO plan that continues to allow members to obtain services from any dentist. After satisfying an annual deductible (no deductible for preventive services), members are reimbursed a percentage of the reasonable and customary charges for most services.

 

The Dental Expense Plan is changed from a passive PPO to a true PPO plan effective January 1, 2012. Under the new design, employees will see no change in benefits provided they use an in-network provider. As outlined below, using an out-of-network provider will increase an employee’s costs and reduces the annual maximum benefit. The new PPO plan does not change the current $50 in-network deductible or $3000 benefit maximum.

 

 

In-Network

Out-of-Network

Deductible/Calendar Year

$50 / Individual
$100 / Family
Waived for Preventive

$75 / Individual
$150 / Family
Waived for Preventive
Deductible applies to in-network services as well

Coinsurance (as % of
R&C)

100% Preventive
80% Basic Restorative
65% Major Restorative
50% Periodontics & Prosthodontics

90% Preventive
70% Basic Restorative
55% Major Restorative
40% Periodontics &
Prosthodontics

Maximum Annual
Benefit/ Individual

$3,000

$2,000 (Maximum of $3,000
combined in and out-of-network)

Orthodontia under age 19

50% to $1,000 lifetime maximum (not subject to
deductible)
(Maximum not combined with Annual Maximum)

40% to $750 lifetime
(maximum of $1,000
combined in and out-of-network)

(not subject to deductible)
(Maximum not combined with Annual Maximum)

 

 

The employee cost for coverage under a dental plan is 50 percent of the actual dental plan premium. Therefore, the employee cost varies depending on which dental plan an employee chooses; however, the rate for coverage under a DPO remains considerably less expensive than the Dental Expense Plan.

 

Dental Plan Rates for 2012 are now available and can be found by clicking here.

 

Employees must remain enrolled in a dental plan for a minimum of 12 months before they will be allowed to change plans. This means that if an employee was not enrolled in a dental plan as of January 1, 2011, they will not be permitted to change dental plans during this Open Enrollment.

 

 

TAX$AVE AND THE SHBP

The State Employees’ Tax Savings Program (Tax$ave) Open Enrollment Period began October 1, 2011 and has been extended until November 11, 2011 (to coincide with the end of the SHBP Open Enrollment Period). Tax$ave is a benefit program available to full-time State employees who are eligible for the SHBP. Tax$ave can save employees tax money by paying health and dental benefit premiums and eligible unreimbursed medical and/or dependent care expenses with before-tax dollars.

 

Please also note the items detailed below that relate to both Tax$ave and SHBP medical and dental plan enrollment.

 

  • Limitations on Plan Changes if Enrolled in POP — Internal Revenue Service (IRS) rules require that for an employee covered by the Premium Option Plan, payroll deductions for health and dental plan benefits remain the same for the entire plan year. Therefore, no coverage level changes can be made which result in a change in the amount of an employee’s health and/or dental plan deduction unless a Qualifying Event has occurred. Employees should consider the Year 2, “phase two” increases effective July 1, 2012 in their 2012 plan selection and Tax$ave decisions.

  • Tax$ave, Civil Unions, and Domestic Partners — SHBP members need to be aware of the possible federal tax implications of adding a civil union partner or domestic partner to SHBP benefits. Since the federal tax code does not view civil union or domestic partners in the same manner as spouses, an employer may have to treat the civil union or domestic partner SHBP benefit as taxable to the employee and withhold federal income, Social Security, and Medicare taxes on its value. Similarly, since the partner's coverage is a federally taxable benefit, an employee who participates in the Tax$ave Premium Option Plan cannot make pre-tax payments for the cost of a civil union or domestic partner's coverage. Pre-tax dollars may still be used to pay for the employee's portion of the cost of his or her own and dependent children's coverage. If an employee wants to claim a federal tax dependency exemption for a civil union or domestic partner, he or she should contact the Internal Revenue Service or see IRS Publication #503, Dependents.


ADDITIONAL INFORMATION

For further information, please feel free to contact us at benefits@kean.edu.

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