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Certifying Officer Letters 2000

Subject

Date

Health Insurance Portability and Accountability Act (HIPAA) Update
December 2000

Military Service After Enrollment

November 3, 2000

HMO Expansion of Service Area

October 2000

PFRS Involuntary Disability — and sample Involuntary Retirement Letter

October 19, 2000

SHBP Fall Open Enrollment for 2001

August 18, 2000

TaxSave 2001

August 10, 2000

Introduction of Field Audit Unit

May 19, 2000

Special Open Enrollment Extension (SHBP)
May 5, 2000
PFRS Enrollment Eligibility and Age Limits
May 2, 2000
Increase in Prescription Drug Supply Limit at Retail Pharmacies and Change of ID Card Ordering Procedures (SHBP - State Prescription Drug Plan)
April 24, 2000
Back Payroll Deductions--Chapter 415, P. L. 1999 (PERS)
February 14, 2000
SHBP Open Enrollment 2000 (State bi-weekly and monthly employees)
January 31, 2000 
Special Open Enrollment for NJ PLUS and Horizon HMO
January 31, 2000
SHBP Open Enrollment 2000 (local government and school board employees)
January 21, 2000
Changes to PERS Employee Pension Contribution Rate
January 21, 2000

2007 Certifying Officer Letters
2006 Certifying Officer Letters
2005 Certifying Officer Letters
2004 Certifying Officer Letters
2003 Certifying Officer Letters
2002 Certifying Officer Letters
2001 Certifying Officer Letters
1999 Certifying Officer Letters
1998 Certifying Officer Letters
1997 Certifying Officer Letters


December 2000

To:         State Health Benefits Program Participating Employers

From:    Janice F. Nelson, Assistant Director, State Health Benefits Program

Subject: Health Insurance Portability and Accountability Act (HIPAA) Update

The federal Health Insurance Portability and Accountability Act (HIPAA) of 1996 contained a number of provisions that affected the State Health Benefits Program (SHBP) and its participating employers. The SHBP implemented several actions to comply with the requirements of HIPAA. These actions included:

  • establishing procedures to provide departing employees with certificates of coverage for use with their next health carrier;

  • amending SHBP rules to comply with HIPAA coverage requirements;

  • filing exemptions for 1998, 1999, and 2000 to the provisions of mental health parity in accordance with HIPAA procedures for the Traditional Plan and NJ PLUS; and

  • providing employers with a required notice of compliance with HIPAA to be distributed to all employees and their family members upon enrollment.

Since the mental health limitations currently in effect are detailed in the law governing the SHBP, a change in plan design would require legislative action. Therefore, the SHBP must file a mental health parity exemption each plan year as long as a group plan is not HIPAA compliant. The Commission has voted to file an exemption for 2001. Therefore, mental health benefits will remain unchanged through 2001 unless the statute governing the SHBP is amended. Since HIPAA has a continuing notification requirement, a revised compliance notice reflecting this exemption from federal mental health parity requirements is attached for your use with newly enrolling employees and family members. You should send it at the same time you send the initial notice of COBRA rights.

A brief refresher on HIPAA is also attached for your information. If you have questions, contact Client Services at (609) 292-7524 or call the Employer's SHBP Hotline at (609) 777-1082 and leave a message. A staff member will return your call on the next business day.

FEDERAL HEALTH INSURANCE ACTS OF 1996

Three pieces of federal legislation were enacted in 1996 that established several requirements to group health plans and insured health products. These were the Health Insurance Portability and Accountability Act (HIPAA), the Mental Health Parity Act, and the Newborns' and Mothers' Health Protection Act. HIPAA included the reporting requirements covering all three pieces of legislation and is therefore used to refer to all three acts. The requirements of the legislation and SHBP status on each requirement are show below:

FEDERAL REQUIREMENT

SHBP STATUS

Issue Certificates of Coverage to all employees and or dependents who lose coverage.

Participating employers were provided (August 1997) a sample certificate to use to meet this requirement.

Limit restrictions of coverage for pre-existing conditions.

All SHBP plans exceed this requirement since they have no preexisting condition restrictions.

Offer a special enrollment period to individuals who meet certain conditions, i.e., an employee or employee's dependent, who declined coverage because of other medical coverage, must have an opportunity for special enrollment should the other coverage end.

All SHBP plans comply with this HIPAA requirement for employees and family members.

Eliminate discrimination against participants and beneficiaries based on health status.

All SHBP plans comply with this requirement. (Note: the SHBP "actively at work" requirement is waived only for employees not at work due to illness).

Provide a minimum level of hospital coverage for newborns and mothers

All SHBP plans meet this requirement.

Provide parity in mental health benefits

All SHBP HMO plans meet this requirement. The SHBP has exempted the Traditional Plan and NJ PLUS for 2001 from mental health parity - different limits continue to exist for these plans.

Provide annual notice to covered members of any plan provisions not in compliance with HIPAA requirements.

A sample certificate to use to meet this requirement is enclosed.

Notice to State Health Benefits Program Participants about
Compliance with Federal Health Insurance Requirements

This notice is being provided to inform you about State Health Benefits Program (SHBP) conformance with federal health insurance regulations.

The Health Insurance Portability and Accountability Act (HIPAA), the Mental Health Parity Act, and the Newborns' and Mothers' Health Protection Act, federal laws enacted in 1996, contain a number of provisions that have affected the SHBP since January, 1998. HIPAA required all group health plans to implement the following provisions that are contained in the three federal laws:

#1 - Limit the use of pre-existing condition restrictions to a maximum of twelve months;

#2 - Offer a special enrollment period to employees and dependents who do not enroll in the plan when initially eligible because they have other coverage, and who subsequently lose that coverage;

#3 - Eliminate discrimination against participants and beneficiaries based on health status;

#4 - Provide a minimum level of hospital coverage for newborns and mothers, generally 48 hours for a vaginal delivery and 96 hours for a cesarean delivery; and

#5 - Provide parity in mental health benefits, that is, any dollar limitations applied to mental health treatment cannot be lower than those on medical and surgical benefits.

Since January 1, 1998, all SHBP plans have met or exceeded HIPAA requirements #1 through #4 above. SHBP HMOs also have complied with requirement #5 above. The State Health Benefits Commission filed exemptions from HIPAA compliance on mental health parity (requirement #5) for 1998, 1999, and 2000 for the Traditional Plan and NJ PLUS, as self-insured, non-federal governmental plans are permitted to do. The Commission has voted to continue that exemption through 2001. As a result, the mental health limits for the Traditional Plan and NJ PLUS that are described in the New Jersey State Health Benefits Program Medical Plans Information Handbook will remain in effect throughout 2000.


MEMORANDUM

October 2000

TO: SHBP Participating Local Government Employers
SHBP Participating Local Education Employers
State Biweekly Benefits Administrators
State Monthly Human Resource Directors/Benefits Administrators

FROM: NJ State Health Benefits Program

SUBJECT: Health Maintenance Organization (HMO) Expansion of Service Area

The NJ State Health Benefits Program (SHBP) will be expanding service areas for two of our HMOs: Aetna US Healthcare and CIGNA Healthcare effective January 1, 2001. The SHBP will begin offering these two HMOs in several states outside of the New Jersey region. Aetna US Healthcare is expanded to parts of Arizona, California, Florida, Georgia, Illinois, Indiana, Maryland, North Carolina, Texas and Virginia. CIGNA Healthcare is expanded to parts of California, Florida, Georgia, North Carolina, Pennsylvania, Virginia, and West Virginia. CIGNA will also include the entire state of South Carolina, Arizona, Maryland except the City of Ocean City and all zip codes in Washington D.C. The areas of expansion are shown on the attached charts. This expansion is only open to the retirees enrolled in the SHBP.

Aetna US Healthcare and CIGNA will be sending out information packets to those retirees living within the expansion areas during the months of October and November. The cost of coverage for these HMOs will not change as a result of the service area expansion. Rates will remain as currently approved. The next rate change will become effective January 1, 2002.

Members/dependents enrolled in the federal Medicare program must continue their enrollment in both Parts A and B. Medicare will pay for all medical services as primary, with the HMO coverage as a supplement.

This expansion will give retirees a managed care option to the Traditional Plan. Any questions regarding this matter should be directed to our Client Services Unit at (609) 292-7524.


November 3, 2000

To: All Pension Funds Certifying Officers

From: William H. Kale
Assistant Director, Client Services

Subject: Military Service After Enrollment Amended Rule: N.J.A.C. 17:1-4.36

The Division of Pensions and Benefits adopted an amendment to the New Jersey Administrative Code regarding military service credit (copy of rule attached). This was done to comply with federal requirements under the Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA) 38 USC 4301 et seq. The rule applies to all the defined benefit and defined contribution retirement systems administered by the Division of Pensions and Benefits. This memorandum explains the new requirements of this rule and what employers must do to implement its provisions and comply with the federal law.

Military service used for benefits qualification

USERRA provides benefit protection to an employee who leaves public employment after October 13, 1994, to serve in the uniformed services and then returns to public employment within time frames specified in the law, normally within ninety days of the end of the uniformed service. That employee is entitled to the restoration of certain pension and similar benefits that would have accrued but for the employee's absence due to the qualified USERRA service. USERRA requires an employer to treat an employee's period of service in the uniformed services as if the employee had never left public employment for the purposes of vesting and/or determining eligibility for retirement and health benefits.

For example, an employee with 24 years of pension credit and one year of USERRA-eligible service in the uniformed services would have 25 years of service for the purpose of determining eligibility for retirement. That employee, if a PERS or TPAF member, would be eligible to collect a retirement benefit before age 60 under the Early Retirement provisions. The employee would also be eligible for employer-paid health benefits coverage based on 25 years of service (if the employer normally provided this benefit). An example for vesting purposes would be that an employee with eight years of pension credit and two years of USERRA-eligible service would be vested.

Special Note: The employee need not return to employment with the same public employer (s) he left to enter the military service. The employee can return to employment with a different public employer, as long as that employer participates in the same retirement system the member was in prior to the USERRA-eligible service. For example, a PERS member from "Township A" terminated employment to serve in the uniformed services for two years. Upon completion of the military service, the employee returns to public employment at "Township B" within the timeframe specified by law. The employee is eligible for USERRA service credit.

Military service used for benefit calculation

While the USERRA-eligible service will be used to determine eligibility for benefits, the actual calculation of retirement benefits will not use the USERRA-eligible service unless the employee pays required pension contributions for the period of military service. The employee may, however, receive this pension credit for the period of uniformed service by making the pension contributions that would have been required had the employee not left employment to serve in the uniformed services. Once notified of the USERRA-eligible service, the Division will contact affected employees and ask if they wish to make the necessary contributions for the period of military service so that it will be used in the calculation of their retirement allowances. The contributions will be based upon the pensionable salary the employee would have received had the employee not gone for military service. If the determination of that pensionable salary is not reasonably certain by the employer, contributions will be made on the basis of the employee's average pensionable compensation during the ten- or twelve-month period immediately preceding the military service. Any payment to the plan described in this paragraph must be made during the period that begins on the date of reemployment and continues for the lesser of either five years or three times the period of the uniformed service. For example, if an employee returns to employment after three months of USERRA-eligible service, back deductions for that service must be paid during the first nine months after the return to work. Note: an exception to this timeframe because of the delay in implementation of the federal law is described later in this letter.

Additional supplemental plan elective contributions

USERRA also provides that employees are permitted to make additional elective deferrals for any programs, e.g., deferred compensation, SACT, or ACTS programs, in which they were enrolled immediately prior to their military service. These deferrals may not exceed the maximum amount employees would have been permitted to contribute during the period of military service had the employees been continuously employed by the public employer during those periods.

The USERRA Process

The following actions should occur when an employee returns to covered employment within the time frames specified under USERRA.

  • The employer should notify the Division not later than 30 days after the employee's return from service in the uniformed services by submitting a Request for Userra-Eligible Service. A copy of the Request for Userra-Eligible Service is attached. This notification is also required for employees on a leave of absence for military service, without pay, for which no deductions were made and no service credited to their pension accounts. If the employee received pay from the employer, had pension deductions taken, and, therefore, received pension credit for the period of military service, no action is required of the employer with respect to USERRA for pension purposes.

  • Once notified, the Division will annotate the employee's pension account to reflect the USERRA credit for benefits eligibility only. We will notify the employee of the crediting of this USERRA-eligible service at the home address and send a quotation for the cost to have the pension service credit count for benefits calculation. Along with the quotation will be an authorization form the employee must sign and return to the Division if (s) he wishes the pension service credit to count for benefits calculation.

  • If the employee authorizes deductions to obtain retirement credit for the USERRA-eligible service, the employer should take and remit those deductions in accordance with the instructions on the certification of payroll deductions, which the Division of Pensions and Benefits will send to the employer.

Notifying employees and catching up

Employers should notify employees of the benefit protection provided by USERRA and this special opportunity to obtain service credit for any periods of uniformed service since October 13, 1994. This can be done by posting the attached notice to employee bulletin boards, distributing a synopsis of the benefit in a human resource newsletter, and/or directly contacting employees the employer can identify as having USERRA-eligible service.

Employees eligible for USERRA credit who returned to public employment between October 13, 1994 and the present date may apply for this service until December 31, 2000. The employer should submit a Request for Userra-Eligible Service to the Division for employees who may have qualified for service credit under USERRA since its enactment in October 1994. We need that information to give the employees service credit for benefit eligibility purposes.

After December 31, 2000, any request for credit for USERRA-eligible service should be made within 30 days of return to employment. If the member wants the USERRA-eligible service to be used to calculate benefits, the request will have to be made so contributions can be collected within the lesser of either five years or three times the period of the uniformed service from the date of reemployment.

Special situations

USERRA provides that those contributions or lump sum payments made by employees for USERRA-eligible service periods shall be deferred from federal taxation. Therefore, they must be taken through payroll deductions. Employers should be prepared to process lump sum requests made by employees.

Employee requests to make additional elective contributions to supplemental programs for the USERRA-eligible service periods should be made directly to each employer. You should contact your supplemental plan administrator for instructions on how to process and report these voluntary contributions. Instructions for the State administered supplemental plans, i.e., Deferred Compensation, SACT, and ACTS, will be issued in separate communications.

Alternate Benefit Program Employers

If an employee who participates in the Alternate Benefit Program (ABP) is re-employed under the provisions of USERRA by an employer who participates in the ABP, the employer is liable to the employee's pension plan for funding any obligation of the plan to provide benefits. That is, the employer must allocate the amount of any employer contribution for that employee in the same manner and extent that the allocation occurred for other employees during the same period of service. However, the employee is entitled to these employer contributions only if (s) he makes the employee contributions to the plan for the period of uniformed service.

The procedures shown in the USERRA Process on page two will also be used for the ABP. The vehicle for reporting the employee contributions and securing reimbursement from the State of New Jersey for the employer's contribution will be the Alternate Benefit Program Employer Contribution Report. Under the Mandatory Back Deduction section of the report, the employer should report the employee's name, Alternate Benefit Program number, and the salary amount on which the employee contributions to the plan for the period of uniformed service are made. A notation indicating that this salary is relative to military service after employment should also be provided.

The employer is not required nor expected to make up the earnings that contributions made for USERRA-eligible service would have made had the employee been employed continuously.

Summary

A public employer who hires a member of a New Jersey public retirement system administered by the Division of Pensions and Benefits under the provisions of USERRA should submit a Request for Userra-Eligible Service to the Division within 30 days of that employee's return from service in the uniformed services.

There is a catch-up period until December 31, 2000 to submit a Request for Userra-Eligible Service for eligible service since October 1994, when the federal law was effective.

Any requests for this USERRA-eligible service received after December 31, 2000, must be received within the time frames specified under USERRA.

If you have any questions, contact Client Services at (609) 292-7524 or E-mail us at pensions.nj@treas.state.nj.us

Enclosures: N.JA.C. 17:1-4.36, Peacetime Military Service; Service Credit
Request for Userra-Eligible Service Form
USERRA Notice for Employees


ATTENTION: EMPLOYEES WITH MILITARY SERVICE

If you meet the criteria shown below, you may qualify for additional pension benefits under the federal Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA). If you

  • Were a member of a New Jersey administered pension system prior to serving in the uniformed services of the United States; and

  • Left public service in New Jersey after October 13, 1994, to serve on active duty in the uniformed services of the United States; and

  • Returned to public service in New Jersey, within time frames specified in the USERRA law, to a position covered in the same pension system from which you left to enter the uniformed service.

USERRA provides benefit protection to an employee who leaves public employment after October 13, 1994, to serve in the uniformed services and then returns to public employment within time frames specified in the law. (Note: The law says that an employee must normally return to public employment within 90 days of the end of the uniformed service to qualify for USERRA benefits). That employee is entitled to the restoration of certain pension and similar benefits that would have accrued but for the employee's absence due to the qualified USERRA service. USERRA requires an employer to treat an employee's period of service in the uniformed services as if the employee had never left public employment for the purposes of vesting and/or determining eligibility for retirement and health benefits. The service time will not be included in the service time used to calculate your retirement allowance, only to qualify for the retirement benefit. You will, however, be able to have your USERRA time included for benefit calculation by making the pension contributions that would have been made had you not left employment for military service.

If you think you may meet the criteria shown above, ask your Personnel/Human Resources Office for a Request for USERRA-Eligible Service form so the Division of Pensions and Benefits can determine your eligibility for pension service credit under the provisions of USERRA.


October 19, 2000

TO: Certifying Officers, Police and Firemen's Retirement System

FROM: Thomas P. Bryan, Director

SUBJECT: PFRS Retirement Options for Members with 20 to 25 Years of Service

The enactment of Chapter 428, PL 1999, in January of this year has raised some questions concerning the retirement benefits available to members of the Police and Firemen's Retirement System (PFRS) with more than 20 but less than 25 years of credited service. The purpose of this memorandum is to provide information on the benefits available to these members and hopefully answer the questions.

There are several retirement possibilities for PFRS members with more than 20 but less than 25 years of credited service.

Service Retirement

Members enrolled in the PFRS when Chapter 428 was enacted are eligible to receive a service retirement allowance equal to 50% of final compensation. If they are forced to retire because of the mandatory retirement age (65) with less than 25 years of service, they will receive an additional 3% of final compensation per year of service for their 21st through 25th years.

Accidental Disability Retirement

Members who are totally and permanently disabled as a direct result of a traumatic event arising out of the performance of their regular or assigned duties may file for an accidental disability retirement allowance. This provides a benefit equal to 2/3rds of the member's salary at the time of the accident or at the time of retirement, whichever is higher.

Ordinary Disability Retirement

Members with at least four years of service who are totally and permanently disabled, not as a direct result of a traumatic event arising out of the performance of their regular or assigned duties, may file for an ordinary disability retirement allowance. This provides a benefit equal to 40% of the member's final salary.

Ordinary Disability Retirement Filed by the Employer

Employers may request retirement for members who are totally and permanently disabled by filing an ordinary disability retirement application for them. Members with more than 20 years of service, if approved by the PFRS Board of Trustees for ordinary disability retirement filed by the employer, will receive a retirement allowance equal to 50% of final compensation plus 3% for each year of creditable service over 20 years up to 25 years of credited service.

Ordinary disability retirement filed by the employer is not a new benefit, but the increase in the amount of the benefit for members with more than 20 but less than 25 years is new as provided in Chapter 428. The clear intent of Chapter 428 is that if a member with 20 or more years of service is permanently and totally incapacitated for the performance of regular or assigned duties, the member should be retired on an ordinary disability retirement benefit and should receive the higher retirement allowance. The employer's responsibility in situations like this has not changed as a result of Chapter 428. If the employer believes that the member is permanently and totally incapacitated for the performance of regular or assigned duties [and has at least four years of service credit*], the employer should initiate the retirement application to qualify the member for the higher benefit under the law. If a member with over 20 years of service has already filed for an ordinary disability, the Division will process the retirement for the higher benefit upon receipt of a letter, signed by the certifying officer, indicating that the employer believes the member is permanently and totally incapacitated for the performance of regular or assigned duties. A sample letter is attached.

If you have questions about this letter, please write to the address above, E-mail the Division at pensions.nj@treas.state.nj.us or call Client Services at (609) 292-7524.

The Employer Education Unit of the Division of Pensions and Benefits is available to all public employers for assistance and training on pension enrollment issues, completing the Quarterly Report of Contributions, and general pensions processing. To contact the Employer Education Unit, write, E-mail, or call (609) 777-2112 or (609) 777-2111.

Attachment

* annotation in brackets [] not in original letter.


(SAMPLE LETTER)

Employer Letterhead

(Date)

Division Director
Division of Pensions and Benefits
PO Box 295
Trenton, NJ 08625-0295

Dear (Name of Division Director):

(Name of employee) is employed by (name of location) in the position of (title) and is an active member of the Police and Firemen’s Retirement System (PFRS) with at least four years of credited service.

We believe that (name of the employee) is totally and permanently disabled and can no longer perform his/her assigned duties. Since we are unable to provide an alternative PFRS covered position with duties capable of being performed by the employee, (name of the employee) should be approved for a disability retirement benefit from the PFRS.

Sincerely,
(Signature)
(Name of PFRS Certifying Officer)
(Title)


State Health Benefits Program
Fall 2000 Open Enrollment Announcement Letters for Employers

State (Centralized Payroll)

State (monthly payroll)

Rutgers and NJIT

Local Government and School Boards

August 18, 2000

TO:              State Health Benefits Program Participating Local Employers

FROM:        Janice F. Nelson, Assistant Director for Health Benefits

SUBJECT: Fall 2000 SHBP Open Enrollment

The State Health Benefits Program (SHBP) Open Enrollment period for local employees will begin on September 18, and end on October 31, 2000. Completed employer certified applications must arrive at the Health Benefits Bureau no later than November 6, 2000. All changes to coverage made during the fall open enrollment will be effective on January 1, 2001.

This is the second open enrollment in 2000, and marks the SHBP's change from a plan year based on the fiscal year (July 1 - June 30) to one based on the calendar year (January 1- December 31). Because of the plan year change, future SHBP Open Enrollment periods will be held each fall for changes effective the following January. This means that there will be no open enrollment in the spring of 2001 and this open enrollment is your employees' only chance to change their benefit status until the fall of 2001.

While the SHBP's plan year is changing, there have been no other changes to the health plans or to the benefits they offer.

Enclosed you will find approved rates and other plan information. We have included rate charts for employees with and without prescription drug coverage. All rates for SHBP health and prescription drug plans were set as of July 1, 2000, for an 18-month period (through December 31, 2001), so premiums will not change with this open enrollment period.

Also enclosed are:

  • A milestone chart that lists key Open Enrollment events, their dates, and the projected delivery dates for all Open Enrollment publications.

  • A chart for employees showing the available SHBP medical plans with contact information.

  • A flier to publicize the SHBP's Unified Provider Directory. The Unified Provider Directory is an online service that provides a comprehensive listing of health care providers and facilities who deliver their services through one or more of the SHBP's health care plans. Updated monthly, you can access the Unified Provider Directory through the SHBP homepage at: www.state.nj.us/treasury/pensions/shbp.htm

Because of the recent spring Open Enrollment, the SHBP will not be coordinating health fairs for the fall.

Publications scheduled for distribution include an Open Enrollment issue of the Health Capsule newsletter. You will receive sufficient copies of the Health Capsule for distribution to all of your employees.

Also scheduled for distribution is a publication of particular note - the SHBP Summary Program Description (SPD). This is a new publication for your employees that provides an overview of the SHBP, a description of each plan offered, and comparisons of selected benefits. You will receive sufficient copies of the SPD for distribution to all of your employees.

If you have any questions about the Open Enrollment, please contact our Office of Client Services at (609) 292-7524. Thank you for your cooperation.

Enclosures:

2000 SHBP Open Enrollment Milestone Chart

SHBP Medical Plans and Contact Information

Health Benefit Rate Charts


(LOC - MILESTONE)

FALL 2000 SHBP OPEN ENROLLMENT MILESTONE CHART
for Participating Local Employers

Note: If the event is underlined, you should be accomplishing the event.

PROJECTED

DATE

EVENT

August 18

Initial Open Enrollment Letter mailed to employers.

Fiscal Year 2000 rate charts sent to employers.

September 1-15

Disseminate rate information to employees as necessary.

September 10-15

SHBP Summary Program Description and the Health Capsule newsletter shipped to employers. Distribute to employees.

September 18

Open Enrollment Begins.

October 31

Open Enrollment Ends.

November 6

Employer certified applications due at the Health Benefits Bureau.

January 1, 2001

Open Enrollment changes effective.

 


August 18, 2000

TO:                State Monthly Human Resource Directors/Benefits Administrators

FROM:         Janice F. Nelson, Assistant Director for Health Benefits

SUBJECT: Fall 2000 State Health Benefits Program (SHBP) Open Enrollment

The State Health Benefits Program (SHBP) Open Enrollment period for State monthly employees will begin on September 18, and end on October 31, 2000. Completed employer certified health benefit and/or dental applications must arrive at the Health Benefits Bureau no later than November 6, 2000. All changes to coverage made during the fall open enrollment will be effective on January 1, 2001.

This is the second open enrollment in 2000, and marks the SHBP's change from a plan year based on the fiscal year (July 1 - June 30) to one based on the calendar year (January 1- December 31). Because of the plan year change, future SHBP Open Enrollment periods will be held each fall for changes effective the following January. This means that there will be no open enrollment in the spring of 2001 and this open enrollment is your employees' only chance to change their benefit status until the fall of 2001.

While the SHBP's plan year is changing, there have been no other changes to the health plans or to the benefits they offer.

All rates for SHBP health, dental, prescription drug, and vision plans were set as of July 1, 2000, for an 18-month period (through December 31, 2001), so premiums will not change with this open enrollment period.

Unions representing most State employees have new contracts in effect that provide for premium sharing arrangements with the State. The contracts are identical with respect to their premium sharing provisions. There is no premium cost to any employee who enrolls in NJ PLUS. Employees will pay 5 percent of the premium cost if enrolled in an HMO, or 25 percent of the premium cost if enrolled in the Traditional Plan. These percentages apply regardless of salary level or date of hire.

Enclosed you will find sample Open Enrollment announcement fliers that provide a list of medical and dental plans and the premium sharing costs for State employees not paid through Centralized Payroll. The fliers are provided for three different payroll schedules (Monthly, 24 Pay Periods, and 26 Pay Periods). Choose the flier that corresponds to your location's payroll schedule. These fliers are designed to assist your employees in making informed decisions concerning their health care coverage during this open enrollment. These are master copies and may be reproduced for distribution to your employees (State employees paid through the State's Centralized Payroll Unit will receive these publications with their September 15 paychecks). If you have specific questions about the fliers, contact Steven R. Stokley by telephone at (609) 633-1462 or by fax at (609) 292-9500.

Also included with this letter are:

  • A milestone chart that lists key Open Enrollment events, their dates, and the projected delivery dates for all Open Enrollment publications.

  • A flier to publicize the SHBP's Unified Provider Directory. The Unified Provider Directory is an online service that provides a comprehensive listing of health care providers and facilities who deliver their services through one or more of the SHBP's health care plans. Updated monthly, you can access the Unified Provider Directory through the SHBP homepage at: www.state.nj.us/treasury/pensions/shbp.htm

  • A registration flier for one of four 90-minute Tax$ave/SHBP Employer Workshops. These will be presented for benefits administrators on September 7 at the Division of Pensions and Benefits' Trenton offices. Topics of discussion will be the benefits of Tax$ave and the recent changes to the SHBP plan year.

With the change to a fall open enrollment, the SHBP Open Enrollment now runs concurrently with the State Employees Tax Savings Program (Tax$ave) Open Enrollment. Tax$ave is a benefit program, available to State employees who are eligible for the SHBP. Tax$ave can save you money by paying health benefit premiums and eligible unreimbursed medical and/or dependent care expenses from before-tax dollars. See the Health Capsule newsletter and the Tax$ave 2001 Open Enrollment materials for more information, or call to reserve a place at the workshops.

Because of the recent spring Open Enrollment, the SHBP will not be coordinating health fairs for the fall.

Another publication scheduled for distribution is the Open Enrollment issue of the Health Capsule newsletter. Sufficient copies will be provided for distribution to all of your employees.

Also scheduled for distribution is a publication of particular note - the SHBP Summary Program Description (SPD). This is a new publication for your employees that provides an overview of the SHBP, a description of each plan offered, and comparisons of selected benefits. You will receive sufficient copies of the SPD for distribution to all of your employees.

If you have any questions about the Open Enrollment, please contact our Office of Client Services at (609) 292-7524. Thank you for your cooperation.

Enclosures:

Health and Dental Plan Rate Charts/Fliers

2000 SHBP Open Enrollment Milestone Chart

Unified Provider Directory Flier

Tax$ave/SHBP Employer Workshop Flier


August 18, 2000

TO:              Campus Human Resource Directors

FROM:        Janice F. Nelson, Assistant Director for Health Benefits

SUBJECT: Fall 2000 State Health Benefits Program (SHBP) Open Enrollment

The State Health Benefits Program (SHBP) Open Enrollment period for State monthly employees will begin on September 18, and end on October 31, 2000. Completed employer certified health benefit and/or dental applications must arrive at the Health Benefits Bureau no later than November 6, 2000. All changes to coverage made during the fall open enrollment will be effective on January 1, 2001.

This is the second open enrollment in 2000, and marks the SHBP's change from a plan year based on the fiscal year (July 1 - June 30) to one based on the calendar year (January 1- December 31). Because of the plan year change, future SHBP Open Enrollment periods will be held each fall for changes effective the following January. This means that there will be no open enrollment in the spring of 2001 and this open enrollment is your employees' only chance to change their benefit status until the fall of 2001.

While the SHBP's plan year is changing, there have been no other changes to the health plans or to the benefits they offer.

All rates for SHBP health, dental, prescription drug, and vision plans were set as of July 1, 2000, for an 18-month period (through December 31, 2001), so premiums will not change with this open enrollment period.

Unions representing most State employees have new contracts in effect that provide for premium sharing arrangements with the State. The contracts are identical with respect to their premium sharing provisions. There is no premium cost to any employee who enrolls in NJ PLUS. Employees will pay 5 percent of the premium cost if enrolled in an HMO, or 25 percent of the premium cost if enrolled in the Traditional Plan. These percentages apply regardless of salary level or date of hire.

Employees who are represented by unions which have not settled a new contract with the State will continue to share in the premium cost of the Traditional Plan according to the provisions of their old contracts.

Enclosed you will find a sample Open Enrollment announcement flier that provides a list of medical and dental plans and the premium sharing costs for your employees. This flier is designed to assist your employees in making informed decisions concerning their health care coverage during this open enrollment. This is a master copy tailored to your location which may be reproduced for distribution to your employees (State employees paid through the State's Centralized Payroll Unit will receive these publications with their September 15 paychecks). If you have specific questions about the flyer, contact Steven R. Stokley by telephone at (609) 633-1462 or by fax at (609) 292-9500.

Also included with this letter are:

  • A flier to publicize the SHBP's Unified Provider Directory. The Unified Provider Directory is an online service that provides a comprehensive listing of health care providers and facilities who deliver their services through one or more of the SHBP's health care plans. Updated monthly, you can access the Unified Provider Directory through the SHBP homepage at: www.state.nj.us/treasury/pensions/ shbp.htm

  • A milestone chart that lists key Open Enrollment events, their dates, and the projected delivery dates for all Open Enrollment publications.

  • A registration flier for one of four, free 90-minute Tax$ave/SHBP Employer Workshops. These will be presented for benefits administrators on September 7 at the Division of Pensions and Benefits' Trenton offices. Topics of discussion will be the benefits of Tax$ave and the recent changes to the SHBP plan year.

With the change to a fall open enrollment, the SHBP Open Enrollment now runs concurrently with the State Employees Tax Savings Program (Tax$ave) Open Enrollment. Tax$ave is a benefit program, available to State employees who are eligible for the SHBP. Tax$ave can save you money by paying health benefit premiums and eligible unreimbursed medical and/or dependent care expenses from before-tax dollars. See the Health Capsule newsletter and the Tax$ave 2001 Open Enrollment materials for more information, or call to reserve a place at the workshops.

Because of the recent spring Open Enrollment, the SHBP will not be coordinating health fairs for the fall.

Another publication scheduled for distribution is the Open Enrollment issue of the Health Capsule newsletter. You will receive sufficient copies for distribution to all of your employees.

Also scheduled for distribution is a publication of particular note - the SHBP Summary Program Description (SPD). This is a new publication for your employees that provides an overview of the SHBP, a description of each plan offered, and comparisons of selected benefits. You will receive sufficient copies of the SPD for distribution to all of your employees.

If you have any questions about the Open Enrollment, please contact our Office of Client Services at (609) 292-7524. Thank you for your cooperation.

Enclosures:

Health and Dental Plan Rate Charts/Flier

Unified Provider Directory Flier

2000 SHBP Open Enrollment Milestone Chart

Tax$ave/SHBP Employer Workshop Flier


(STMON - MILESTONE)

FALL 2000 SHBP OPEN ENROLLMENT MILESTONE CHART
For Monthly State Employers

Note: If the event is underlined, you should be accomplishing the event.

PROJECTED

DATE

EVENT

August 18

Initial Open Enrollment Letter mailed to employers.

Fiscal Year 2000 rate charts sent to employers.

September 1-15

Disseminate rate information to employees as necessary.

September 7

State Employer Benefit Administrator's Tax$ave/SHBP

Workshops conducted by Division of Pensions and Benefits in Trenton.

September 10-15

SHBP Summary Program Description and the Health Capsule newsletter shipped to employers. Distribute to employees.

September 18

Open Enrollment Begins.

October 31

Open Enrollment Ends.

November 6

Employer certified applications due at the Health Benefits Bureau.

January 1, 2001

Open Enrollment changes effective.


August 18, 2000

TO:             State Departmental Human Resource Directors
                    State Biweekly Benefits Administrators

FROM:       Janice F. Nelson, Assistant Director for Health Benefits

SUBJECT: Fall 2000 SHBP Open Enrollment

The State Health Benefits Program (SHBP) Open Enrollment period for State biweekly employees will begin on September 18, and end on October 31, 2000. Completed employer certified health benefit and/or dental applications must arrive at the Health Benefits Bureau no later than November 6, 2000. All changes to coverage made during the fall open enrollment will be effective on December 30, 2000, for employees paid through the State's Centralized Payroll Unit, and January 1, 2001, for all other employees.

This is the second open enrollment in 2000, and marks the SHBP's change from a plan year based on the fiscal year (July 1 - June 30) to one based on the calendar year (January 1- December 31). Because of the plan year change, future SHBP Open Enrollment periods will be held each fall for changes effective the following January. This means that there will be no open enrollment in the spring of 2001 and this open enrollment is your employees' only chance to change their benefit status until the fall of 2001.

While the SHBP's plan year is changing, there have been no other changes to the health plans or to the benefits they offer.

All rates for SHBP health, dental, prescription drug, and vision plans were set as of July 1, 2000, for an 18-month period (through December 31, 2001), so premiums will not change with this open enrollment period.

Unions representing most State employees have new contracts in effect that provide for premium sharing arrangements with the State. The contracts are identical with respect to their premium sharing provisions. There is no premium cost to any employee who enrolls in NJ PLUS. Employees will pay 5 percent of the premium cost if enrolled in an HMO, or 25 percent of the premium cost if enrolled in the Traditional Plan. These percentages apply regardless of salary level or date of hire.

Employees who are represented by unions which have not settled a new contract with the State will continue to share in the premium cost of the Traditional Plan according to the provisions of their old contracts.

Enclosed you will find sample Open Enrollment announcement fliers that provide a list of medical and dental plans and the premium sharing costs for State employees paid through Centralized Payroll. These fliers are designed to assist your employees in making informed decisions concerning their health care coverage during this open enrollment and will be distributed to your employees with their September 15 paychecks.

Also included with this letter are:

  • A milestone chart that lists key Open Enrollment events, their dates, and the projected delivery dates for all Open Enrollment publications.

  • A flier to publicize the SHBP's Unified Provider Directory. The Unified Provider Directory is an online service that provides a comprehensive listing of health care providers and facilities who deliver their services through one or more of the SHBP's health care plans. Updated monthly, you can access the Unified Provider Directory through the SHBP homepage at: www.state.nj.us/treasury/pensions/shbp.htm

With the change to a fall open enrollment, the SHBP Open Enrollment now runs concurrently with the State Employees Tax Savings Program (Tax$ave) Open Enrollment. Tax$ave is a benefit program, available to State employees who are eligible for the SHBP. Tax$ave can save employees money by paying health benefit premiums and eligible unreimbursed medical and/or dependent care expenses from before-tax dollars. Workshops will be presented for benefits administrators on September 7 at the Division of Pensions and Benefits' Trenton offices. Topics of discussion will be the benefits of Tax$ave and the recent changes to the SHBP plan year. See the Health Capsule newsletter and the Tax$ave 2001 Open Enrollment materials for more information, and call to reserve a place at the workshops.

Because of the recent spring Open Enrollment, the SHBP will not be coordinating health fairs for the fall.

Another publication scheduled for distribution is the Open Enrollment issue of the Health Capsule newsletter. This will also be distributed to all of your employees with their September 15 paychecks.

Also scheduled for distribution is a publication of particular note - the SHBP Summary Program Description (SPD). This is a new publication for your employees that provides an overview of the SHBP, a description of each plan offered, and comparisons of selected benefits. You will receive sufficient copies of the SPD for distribution to all of your employees.

If you have any questions about the Open Enrollment, please contact our Office of Client Services at (609) 292-7524. Thank you for your cooperation.

Enclosures:

Health and Dental Plan Rate Charts/Flier

2000 SHBP Open Enrollment Milestone Chart

Unified Provider Directory Flier

Tax$ave/SHBP Employer Workshop Flier


(STBW - MILESTONE)

FALL 2000 SHBP OPEN ENROLLMENT MILESTONE CHART
for Biweekly State Employers

Note: If the event is underlined, you should be accomplishing the event.

PROJECTED

DATE

EVENT

August 18

Initial Open Enrollment Letter with sample rate charts mailed to employers.

Initial Open Enrollment paycheck message to employees.

September 7

State Employer Benefit Administrator's Tax$ave/SHBP

Workshops conducted by Division of Pensions and Benefits in Trenton.

September 10-15

SHBP Summary Program Description shipped to employers. Distribute to employees.

September 15

Open Enrollment paycheck message to employees. Health and Dental Rate Charts and Health Capsule newsletter distributed with payroll.

September 18

Open Enrollment Begins.

September 29

Open Enrollment "reminder" paycheck message to employees.

October 13

Open Enrollment "reminder" paycheck message to employees.

October 27

Open Enrollment "last chance" paycheck message to employees.

October 31

Open Enrollment Ends.

November 6

Employer certified applications due at the Health Benefits Bureau.

December 30

Open Enrollment changes effective.


NEW JERSEY STATE HEALTH BENEFITS PROGRAM - MEDICAL PLANS

PLAN NAME

PLAN/

HMO #

PHONE

NUMBER

SERVICE AREAS

NJ PLUS

Administered by Horizon Blue Cross

Blue Shield of New Jersey

001

800-414-7427

In-Network: All of New Jersey and Delaware

Parts of New York and Pennsylvania

Out-of-Network: Unrestricted

Traditional Plan

Administered by Horizon Blue Cross

Blue Shield of New Jersey

002

800-414-7427

Unrestricted

HEALTH MAINTENANCE ORGANIZATIONS

Horizon HMO

010

800-355-2583

All of New Jersey and Bucks County, Pennsylvania

Aetna/US Healthcare

019

800-309-2386

All of New Jersey, Washington DC and Connecticut

Parts of New York, Pennsylvania, Maryland, Virginia, Illinois, Texas, Georgia, Delaware and California

CIGNA HealthCare

020

800-832-3211

All of New Jersey, Pennsylvania, New York, Connecticut and Delaware

Oxford Health Plan

028

800-444-6222

All of New Jersey

Parts of New York

AmeriHealth HMO Plan

033

800-454-7651

All of New Jersey and Delaware

Parts of Pennsylvania

Physicians Health Services

034

800-535-3647

All of New Jersey

Parts of New York and Connecticut

University Health Plans, Inc.

036

800-564-6847

All of New Jersey

If you have access to the Internet, you can look up SHBP plan participating doctors in our Unified Provider Directory on the SHBP home page:

http://www.state.nj.us/treasury/pensions/shbp.htm

August 10, 2000

TO: Benefits Administrators
State Biweekly Payroll Locations
State Universitiesy and Colleges Benefits Administrators
Palisades Interstate Parkway Commission Benefits Administrator
NJ Commerce and Economic Growth Commission Benefits Administrator
State Department Human Resource Directors

FROM: John D. Megariotis