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The State Health Benefits Program Committee has approved new plan designs for 2017 that will be available during the current open enrollment period. The annual open enrollment for the State Health Benefits Program (SHBP) has begun and continues to October 31, 2016.  Certified applications are due to the Division of Pensions and Benefits no later than November 11, 2016.  Changes made during open enrollment will take effect on January 1, 2017.

Financial Incentive For Joining Tiered Network Plan

A noteworthy change in 2017 is a pilot program to provide an incentive for joining the Tiered Network Plan.  This pilot program is optional for local employers.

First time enrollees in a tiered network medical plan beginning Plan Year 2017 and continuing for two years until December 31, 2018 will receive a financial incentive paid in the first quarter of Plan Year 2017.  The financial incentive, which is reportable income, is $1,000 for single coverage; $1,250 for member/spouse or parent/child coverage; and $2,000 for family coverage.

At the local level, the incentive can be either a gift card or cash at the discretion of the local employer.  It is important to note that the incentive must be forfeited and returned, if the employee fails to remain enrolled in the Tiered Network Plan until December 31, 2018.

If the municipality choses to participate in the Pilot Program they will need to adopt the following resolution http://www.nj.gov/treasury/pensions/epbam/exhibits/pdf/ha0992.pdf.

An employee can still enroll in the Tiered Network plan if a municipality does not offer the financial incentive.

Prescription Drug Changes

There are several changes in the prescription drug plans, with various effective dates as follows:

  • Generic Drug Substitution: When a generic drug is available for a brand name drug, an employee who wishes to have the brand name drug will be required to pay the difference in cost  plus the generic copayment.  This change takes effect December 1, 2016.
  • Formulary: Certain drugs will be excluded from coverage. If an employee is currently taking medication that will no longer be eligible for coverage, they should ask their doctor if a preferred alternative is appropriate.  The employee’s doctor may initiate an appeal by calling Express Scripts.  This change will take effect December 1, 2016.
  • Preferred Drug Step Therapy (PDST): An employee is required  to try and fail a lower cost prescription drug before approval of a high cost prescription drug in the following classes of drugs: Proton Pump Inhibitors (ulcer/reflux drugs), SSRI/SSNRI antidepressants, osteoporosis drugs, nasal steroids, and hypnotics.

Out of Network Cost of Physical Therapy

The maximum payments for Out-of-Network Physical Therapy visits will be $55 under Aetna plans and $52 for Horizon Blue Cross Blue Shield plans. If the physical therapist charges more than the maximum payment, the employee will have to pay the difference.  This change takes effect November 1, 2016.

Increase in Emergency Room Visits

Emergency room co-pays will increase by $25, where the co-pay is currently less than $100.

The following resources are available:

A plan design comparison chart for active municipal employees is available at http://www.state.nj.us/treasury/pensions/hb_open_enrollment_2016/ha0896-2016.pdf

The Division of Pensions and Benefits has also posted a Percentage of Premium Worksheet to assist employees in calculating their approximate payroll deduction for health benefits.  The worksheet is available at http://www.state.nj.us/treasury/pensions/hb-percentage-home.shtml

Rates for local employers for Plan Year 2017 are available at http://www.state.nj.us/treasury/pensions/hb_open_enrollment_2016/local-gov-with-without.pdf

We will continue to keep you posted as new information is released from the Division of Pensions.

Contact: Lori Buckelew at lbuckelew@njslom.org or 609-695-3481, ext. 112.