There are a lot of changes happening to the State Health Benefits Program starting in November 2016 and continuing into 2017. These changes affect current and future retirees, active members in State, Judiciary, and Local Government who are in the SHBP.
It is important that all members are educated about these changes so you have time to understand the impact on you, your family, your doctors, and your prescription needs.
Below, CWA Local 1036 has created guidance documents and gathered a list of links from various sources so you have access to all the information you need to make informed decisions.
Ultimately, your health care choices are yours to make - we can guide you. If you have any questions, please contact the Local or your staff representative.
MUST READ! Detailed booklet on SHBP changes
CWA 1036 Tips and Guidance (updated 10/5)
MUST READ! Specific advice for preparing for the changes to prescription drug program in November and December 2016, and the medical plan changes in 2017. Follow these steps!
MUST READ! Includes discussion of Medicare Advantage for Retirees, background of how these changes were created, premium increases for each plan and other information.
(prints on legal size paper)
A chart showing all plan designs and benefit levels so you can compare the plan benefits side-by-side.
Also includes all premiums for the plans and your chapter 78 percentage contribution.
What Doctors are in Horizon or Aetna?
Will My Prescription Drug Still be Covered in the new Formulary?
Express Scripts is the pharmacy benefits administrator for the SHBP
Want to do Mail Order of a Prescription NOW to Prepare?
- Express Scripts Mail-Order Form
CHANGES TO THE SHBP FOR PLAN YEAR 2017 – Plan Design Committee
The Plan Design Committee (PDC), created under Chapter 78 as a joint union-management committee with the authority to make changes to the SHBP for State and Local Government units, passed a resolution making several significant changes to the SHBP for Plan Year 2017. The PDC is made up of an equal number of union (6) and management (6) representatives. The Unions represent state, county, and municipal employees, firefighters, state troopers, and police. The PDC negotiates SHBP changes separate from any bargaining table where we negotiate our own individual contracts. In past years, the PDC has reduced copays for retirees, added more plans to the menu of available options, and made other changes to contain premium costs.
The State Health Benefits Commission (SHBC) approved the premium rates for plans in the SHBP and adopted the changes for Plan Year 2017 from the PDC. The SHBC is made up of 5 representatives: 3 from management (Treasury, Banking and Insurance, and CSC) and 2 from the union (AFL-CIO representative for Local Government and State Government).
See the Local’s handouts above detailing the changes to the State Health Benefits Plan for Plan Year 2017.
These changes include:
Prescription Drug Program Changes
- Mandatory Generics
- Step Therapy
- Eliminating coverage for certain Prescription drugs on a Formulary list
Medical Plan Changes
- Medicare Advantage for Current and Future Retirees
- Emergency Room copay increases of $25
- Tiered Network Plans – incentives to join
- Limiting Out of Network Physical Therapy
PREMIUM COST INCREASES FOR 2016
Effective January 1, 2017, AON recommended overall increases of 3.4% for active employees to the total premium costs of the medial and prescription drug plans, and that overall increase reflects a 1.9% increase in single and employee + spouse rates, a 4.4% increase in family rates and a 5.9% increase in employee + child(ren) rates. The recommended renewal increases for Plan Year 2017 were calculated separately for the PPO, HMO and Prescription Drug Plans.
AON’s complete report can be found at: http://www.state.nj.us/treasury/pensions/pdf/hb/rate-renewal-state-2017.pdf
Premium rates increase every January with the State plans, so this is not something new that was created through Chapter 78. However, the impact of premium increases is more significant now under Chapter 78, because your contribution is tied to the premium. This is the second consecutive year since Chapter 78 was passed that the premium increase wasn’t so significant. If you recall, we saw an overall increase for active employees of 7.5% in 2013, 8.1% in 2014, 8% in 2015 and 4.5% in 2016.
NJ WELLNESS PLAN
By enrolling in NJWELL and participating in health assessments, screenings, flu shots, online coaching and activities and telephonic wellness/disease management coaching, participants can earn points and receive gift cards as incentives to participate in the program. CWA recommends that every member consider enrolling. Incentives for Plan Year 2017 are still being developed and we will share them with the membership in the new year.
Information on NJWELL can be found at: http://www.state.nj.us/treasury/pensions/njwell/
WAIVING SHBP COVERAGE
State employees can waive SHBP medical and prescription coverage, and not be required to make the Chapter 78 contribution, provided they have other medical coverage and can show proof of coverage. To waive coverage a SHBP State Waiver form and a Health Benefit Application must be completed during Open Enrollment.
If you are getting ready to retire soon, and you are eligible for post-retirement health benefits, CWA recommends that you schedule an appointment with Pensions before you make any changes to your health benefits plan because the changes you make could impact your choice of health plans when you retire. We particularly caution any near-retiree from dropping coverage because a spouse already has coverage without having this discussion first with Pensions. Contact information for the Division of Pension and Benefits is:
50 West State Street, Trenton | Counseling Hours: Monday – Friday from 7:40 a.m. – 3:30 p.m.