The Employee Health and Dental Plans are available to all full-time NJIT staff and faculty employees and their eligible dependents. It is important that you review the services provided by each plan, and determine which Carrier meets the needs of you and your dependents. NJWELL is an employee wellness program designed to help actively employed members of the State Health Benefits Program (SHBP) live a healthy lifestyle and get rewarded for completing activities designed to promote healthy behaviors.
HIPAA Notice of Privacy Practices and HIPAA Forms
There are four types of medical plans for NJIT employees. A Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), High Deductible Health Plan (HDHP), Tiered-Network Plans
The SHBP offers two HMO plans: Aetna HMO plan and Horizon HMO plan. With HMO plans, you select a Primary Care Physician (PCP) within the carrier’s HMO network; you must get referrals to see specialists and there is no out-of-network coverage except for emergencies. You pay set copayments for PCP and specialist visits, so there is no guesswork involved with coinsurance. HMO plans are best for members who prefer predictable, manageable costs for their health care.
The SHBP offers several PPO plans: Aetna Freedom15, Aetna Freedom1525, Aetna Freedom2030, and Aetna Freedom2035; and Horizon’s NJ DIRECT15, NJ DIRECT1525, NJ DIRECT2030, and NJ DIRECT2035. With PPO plans, you are not required to choose a PCP and referrals are not required for specialists. You have copayments for PCP and specialist visits, but some services do require that you pay coinsurance; out-of-network charges cost more out of your pocket. PPO plans are best for members who prefer a wider range/variety of doctors over cost.
The SHBP offers four HDHP: Aetna Value HD1500 and Aetna Value HD4000 plans, and Horizon’s NJ DIRECT HD1500 and NJ DIRECT HD4000 plans. With HDHP plans, you pay for services out-of-pocket until you reach your deductible; preventive care and certain screenings are paid by the plan without reaching the deductible. Once the deductible is met, you pay only coinsurance until you reach an out-of-pocket maximum, at which point eligible services are covered in full by the plan. You may be able to open a Health Savings Account (HSA) when you enroll in an HDHP. An HSA is an interest-bearing account that helps you save for future health care expenses. HDHP plans also offer lower monthly premiums. HDHP plans are best for members who want greater control over how they manage health care spending.
There are two tiered-network plans: Aetna Liberty Plan, and Horizon’s OMNIA Health Plan. With tiered-network plans, you have the flexibility to visit high quality practitioners in the carrier’s managed care network, with no referrals required, based on two “tiers”: Tier 1 refers to specific doctors, hospitals, and other healthcare professionals who offer high-quality, cost-effective care; Tier 2 refers to providers included in the managed care network, but with slightly higher cost sharing. There is no out-of-network coverage with the tiered-network plans.
Health Benefits Program Application
Prescription Drug Plan
Prescription drug coverage begins and ends when health benefits start and terminate. The plan is administered by Express Scripts, and the amount you pay for prescription drugs is determined by the medical plan you select.
- Retail Pharmacy Normally, retail pharmacy co-payment amounts are for a 30-day supply. However, you may obtain up to a 90-day supply of your prescription drug. To do so, you must pay two copayments for a 31 to 60-day supply or three co-payments for a 61 to 90 day supply.
Mail Order Service Mail order benefits are available where participants can receive up to a 90-day supply of prescription drugs for one co-payment.
Click here for detailed Prescription Drug Plan Information
Waiver of Coverage (Health)
If an employee wishes to waive health and prescription drug, the Waiver/Reinstatement Declaration Form and the Health Benefits Program Application must be completed along with proof of other group health insurance coverage. Coverage may be resumed within 60 days after the other group health insurance coverage ends.
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There are two types of dental plans for NJIT employees: Dental Plan Organization (DPO) and Dental Expense Plan (DEP)
Dental Plan Organizations (DPO)
There are several DPOs participating in the Employee Dental Plans from which you may choose. You must use providers who participate with the DPO you select to receive coverage. Be sure you confirm that the dentist or dental facility you select is taking new patients and participates with the SHBP/SEHBP Employee Dental Plans, since DPOs also service other organizations. When you use a DPO dentist, diagnostic and preventive services are covered in full. Most other eligible expenses require a copayment. In addition, orthodontic treatment is covered for both children and adults, subject to a copayment.
If your dentist drops out of the DPO, you must select another dentist from the DPO. If there are none available within 30 miles of your home, or if you move and your DPO cannot provide a dentist within 30 miles of your home, you may change plans immediately.
Please review the plan rules including exclusions and limitations before selecting a plan. You must remain in the dental plan you select for at least 12 months before you can transfer/change to another dental plan. Enrollment in a dental plan is optional. If you do not enroll when first eligible, you will have the option to enroll each year during the annual SHBP Open Enrollment Period.
Dental Expense Plan (DEP)
The Dental Expense Plan is administered by Aetna Dental. The plan allows you to choose any licensed dentist for your dental care; however, you will pay less if you use an in-network provider. There is a deductible to satisfy for some services and some services are eligible only up to a limited amount.
NJ Employee Dental Plans Application
Waiver of Coverage (Dental)
If an employee wishes to waive dental coverage, the Waiver/Reinstatement Declaration Form and the NJ Employee Dental Plans Application must be completed. Coverage may be resumed within 60 days after the other group health insurance coverage ends.
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The Vision Care benefit provides a reimbursement for employees and their eligible dependents of $35.00 for an eye exam, and a reimbursement of $35.00 for single vision lenses or contacts, or $40.00 for bifocal or progressive lenses. Frames are not covered. Faculty and staff and their eligible dependents are entitled to receive one reimbursement in a designated two year period (July 1, 2014 – June 30, 2016). To receive the reimbursement:
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- Obtain an original itemized receipt for the purchase of corrective lenses.
- Vision Care Reimbursement Form
- Forward the form along with the itemized receipt(s) to Human Resources.
The federal Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 requires that most employers sponsoring group health plans offer employees and their eligible dependents the opportunity to temporarily extend their group health coverage in certain instances where coverage under the plan would otherwise end. For SHBP participants, COBRA is not a separate health program; it is a continuation of SHBP coverage under the provisions of the federal law.
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Summary of Benefits and Coverage
Health Benefits Comparison chart
Dependent enrollment documentation requirements
Health Benefits Premium Calculator
Horizon BCBSNJ Plans
Express Scripts National Preferred Formulary
Employee Dental Plans Information
Participating Employee Dental Plans
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