Transcript Retirement Health Benefits

NJPSA Presentation
Retirement Health Benefits Webinar
 Eligibility
 Enrollment
 Coverage
 Medicare
 Payment of Coverage Costs
State Health Benefits Coverage at RetirementCategories of Eligibility
 Members already covered by SHBP through employer. Premium
cost to member if not eligible for State or employer paid
coverage.
 Members with 25 years service credit in TPAF or on
disability retirement (includes deferred with 25 years).
State pays for health benefit cost.
 Medicare eligible members retired from BOE, Voc.Tech., Spec.
Serv. Comm., not participating in SHBP and not eligible above,
must be in employer’s plan and enrolled Medicare A and B. You
pay full cost.
ENROLLMENT
 Offering Letter (about 3 months before retirement)
 Eligibility of coverage

Coverage for you, your spouse/partner, and dependents
 Children to age 26 and 31 (Chapter 375)
 Disabled dependents (documentation required)
 Cost to you



State paid
Partial Pay (Chapter 78) – % based on amount of pension
You pay in full
ENROLLMENT
 Complete the application (print out from the Division of
pension Website)
 Retiree information.
 Medicare (check off and submit documentation)
 Plan Selection
 Coverage Waiver
 Dental – at additional cost
 Dependents and documentation to be attached to the
application
Health Plans
Medical Plan options (plan summaries on
Division Web page)
Prescription plans (included with
all plans)
Dental – Available at additional cost.
SHBP Medical Plans
(Effective January 1, 2016)
 Preferred Provider Organizations (PPO)
(H)NJ Direct 10 (H)NJ Direct 1525 *Freedom 10
(H)NJ Direct 15 (H)NJ Direct 2030 *Freedom 15
*Freedom 1525
*Freedom 2030
(H) Administered by Horizon Blue Cross Blue Shield of New Jersey
* Administered by Aetna
 Health Maintenance Organizations (HMO)
Aetna HMO
Aetna 1525
Horizon HMO Horizon HMO 1525
Aetna 2030
Horizon HMO 2030
 HD- High Deductible Health Plan (New in 2014)
 AETNA VALUE HD4000
 NJ DIRECT HD4000
**Medicare Eligible Retirees Cannot enroll in plans listed in RED
Horizon NJ Direct
Aetna Freedom
(Effective January 1, 2016)
Nationwide service areas
 Primary care physician NOT required - No referrals
 Certain services require pre-certification
 In-network routine physical exams
 Immunizations
 Annual routine vision exam
Horizon NJ Direct 10/15
Aetna Freedom 10/15
(Effective January 1, 2016)
Direct 10
Direct 15
In-Network Copayments
$10
$15
Maximum Out-of Pocket In-Network
$400 Individual
$5,317 Individual
$1,000 Family
$10,634 Family
20% R/C after
30% R/C after
deductible
deductible
($100/$250)
($100/$250)
$2,000 Individual
$2,000 Individual
$5,000 Family
$5,000 Family
Out-of-Network Coinsurance
Maximum Out-of-Pocket Out-of-Network
Maximum Covered Expenses Annual/Lifetime
In-Network/Out-of-Network UNLIMITED
Refer to Approved Medical Plan Design Chart for Other Local Education Retired Group Plans
Aetna HMO / Horizon HMO
 Nationwide service areas
 Primary care physician (PCP) required
 Referrals required
 Routine physical exams
 Immunizations
 Annual routine vision exam
 All services, except emergencies, coordinated through PCP
 Refer to Approved Medical Plan Design Chart for Other Local
Education Retired Group Plans
Aetna HMO / Horizon HMO
 No deductibles or claim forms to file
 Copayments required for visits to PCP or a referred
specialist
 In network OOP Max


$5,317 Individual
$10,634 Family
 No out-of-network benefits
 Copayment $10 per visit
 Emergency Room Copayment $35
 Unlimited Maximum Plan Covered Expenses
Annual/Lifetime
Retiree Dental Plans
Eligibility:
Retiree and survivors enrolled in SHBP medical plan.
Waiver eligible due to other coverage as dependent of
spouse or domestic partner, or own employment
 Dependent eligibility same as medical plan eligibility
Retiree Dental Plans
Enrollment:
One opportunity to enroll 30-60 days of retirement
 Waiver eligible must request coverage within 60 days
of loss of coverage
 COBRA coverage does not apply
Two Options – Dental Expense Plan (DEP)
or Dental Plan Organization (DPO)
Retiree Dental Expense Plan
Plan Summary
 Traditional indemnity fee for service plan
 $50 per person annual deductible/maximum $150 family
 Deductible waived for preventive services
 Benefit Tiers 1,2,3 for enrollees who have gone without
group dental coverage
 Reimburses for covered services at % of reasonable and
customary charges
Retiree Dental Expense Plan
Covered Services (In Network)

Preventive Care Tier 3 = 100%

Basic Restorative Care Tier 3 =70%

Major Restorative Care Tier 3 =50%

No orthodontic services

Maximum Annual Benefit $1500 per person

Aetna Dental
Retiree Dental Plan Organization (DPO)






5 Companies – each with a network of providers
Must use a network dentist in the DPO you select
Diagnostic and preventive services are covered in full
Eligible expenses require a co-payment (see handout)
Orthodontic services are NOT covered
May Change plans immediately if:
 Your dentist drops out of Network and none available
within 30 miles of your home
 You move and your DPO cannot provide a dentist within
30 miles of your home
2016 Prescription Drug Coverage for Retirees Administered by Medco-Express Scrips
Drug
Pharmacy-30 day
Generic
Preferred
Other
Mail Order-90 day
Generic
Preferred
Other
Aetna/Horizon HMO
Direct 10/15
$5
$13
$26
$8
$20
$42
$2
$19
$31
$3
$30
$52
Max Out-of-Pocket
Copayment $1,411 /person
Annually
Max Out-of-Pocket
Copayment $1,411 /person
Annually
Miscellaneous Items
Medicare Coverage – age 65
Multiple Coverage (in state plan
prohibited)
Changing Plans
Survivor Enrollment
HEALTH CARE CONTRIBUTION
Annual Earnings
Year 1
Year 2
Year 3
Year 4
Contribution Toward Cost of Single Coverage* (Percentage of Premium)
$95,000 and Over
8.75%
17.50%
26.25%
35.00%
Contribution Toward Cost of Member/Spouse* (Percentage of Premium)
$100,000 and Over
8.75%
17.50%
26.25%
35.00%
Contribution Toward Cost of Family Coverage* (Percentage of Premium)
$110,000 and Over
8.75%
17.50%
26.25%
35.00%
*No less than 1.5% of salary for health care coverage
SHBP Employers- Based on Medical and Prescription Cost
Non-SHBP Employers- Based on Medical, Prescription, Dental, Vision Cost
New Hire After Expiration of CNA- Contribution at Year 4 Level
Chapter 78, P.L. 2011
Cost Impact for Future Retirees Health Benefits
With Less Than 20 Years of Service on 6/30/2011
Sections 125 Plans- Creation of Cafeteria Plans
Employee Payments “Pre-tax”
Permits Dependent Care Flexible Spending Accounts
Employee Pension Contribution 6.5%
with additional one percent phased in over 7 years
Payment for Waiver of Health Benefits- Shall not exceed 25% or $5,000, whichever is less,
of the amount saved by the employer. Waiver maximum applies to all new employees and
to any existing employee who submits or renews a waiver on or after May 21, 2010.
(Chapter 2, P.L. 2010)
Retirement Resources
Retirement Living Information Center
www.retirementliving.com

Retirement Communities

Places to Retire

Taxes by State

Newsletter

Retirement News

Resources

Senior Bookstore

Senior Online Publications

Marketplace

Products and Services

State Aging Agencies
Division of Pensions
www.state.nj.us/treasury/pensions
Horizon
http://www.horizon-bcbsnj.com/shbp
Aetna
http://www.aetna.com/statenj/
Aetna Dental
http://www.aetna.com/statenj
Social Security
www.socialsecurity.gov
Medicare
www.medicare.gov
Medco
www.medco.com
IRS
www.irs.gov
Robert Murphy
Director Retirement Services
12 Centre Drive
Monroe, NJ 08831-1564
Phone:
Fax:
E-Mail:
609-860-1200
609-860-2999
[email protected]