STATE HEALTH BENEFITS PROGRAM — COBRA BILLING NOTICE

The State Health Benefits Program (SHBP) has redesigned the billing statement to show recent activity in your account. The image below shows the new bill design. Scroll down or click on a field in the image to see more information about that area of the bill.

PAYMENT DUE STATEMENT — Identifies the covered COBRA enrollee, the payment amount, due date, and the mailing address for the payment. Return the Payment Due Statement portion of the bill with your payment. Please submit all health benefit payments to the address noted on the Payment Due Statement and include your 12-digit ID number on the check or money order. If you use an online banking service or the Payment Due Statement cannot be sent with your payment, please make certain that your 12-digit ID number is included with your payment.

Any other correspondence should be sent to: Division of Pensions and Benefits, P.O. Box 299, Trenton, NJ 08625-0299.

NAME AND ID NUMBER — This information identifies the covered COBRA enrollee.

OPENING BALANCE — Total unpaid balance as of the last billing statement date.

PAYMENTS AND ADJUSTMENTS — Payments received and applied between billing statements.

CURRENT MONTHLY CHARGE — A list of the total amounts charged to your account this billing cycle and any payments or adjustments credited to them.

CLOSING BALANCE — Total amount due up to the current coverage period.

TOTAL PAYMENT DUE — The amount due with the current billing statement. Please pay this amount by the due date to keep your account current. Be sure to include your 12-digit ID number on the check or money order. Please do not include any other paperwork with your payment and Payment Due Statement.

DATES OF COBRA COVERAGE — This area indicates the starting and end dates of your COBRA coverage period.

MESSAGE BOX — This area is used for information about credits, adjustments, and for special messages from the State Health Benefits Program.

BILLING QUESTIONS — For your convenience each bill includes a telephone number — (609) 292-7524 — for billing questions.