STATE HEALTH BENEFITS
SCHOOL EMPLOYEES' HEALTH BENEFITS
COBRA BILLING NOTICE
The image below shows the
COBRA billing statement which indicates recent activity to
your account. Scroll down or click on a field in the image
to see more information about that area of the bill.
PAYMENT DUE STATEMENT
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.
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
DATES OF COBRA COVERAGE
This area indicates the starting and end dates of your COBRA
MESSAGE BOX This area is
used for information about credits, adjustments, and for special
messages from the State Health Benefits Program.
For your convenience each bill includes a telephone number
(609) 292-7524 for billing questions.