Employers' Pensions and Benefits Administration Manual (EPBAM)
   

 

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State Health Benefits Program
Employer Responsibilities
Reporting and Financial


   
   

Reporting Forms

 
   
   

Local Group

 
    Sample Employer Bill  
   

State Monthly

 
   

State Biweekly

 
   

Individual Retirees

 
   

COBRA Members

 
   

Overpayments and Shortages

 
   

Local Employer Late Payments

 
   

Premium Delay

 
   

Review and Reconcile Reports

 
   

Part B Medicare Premium Reimbursements

 
   

Part A Medicare Premium Reimbursements

 
   

Local Employer Payment of Retiree Coverage under Chapter 48

 
   

How Plan Rates Are Set

 
   

Surcharge for Nonparticipating School Districts

 
 

Reporting SHBP Changes

Each month the Health Benefits Bureau sends to all local employers and the monthly subgroups of the State a report listing the following: 

  • The changes that the employer had submitted in advance (by the fifth of the month);
  • The total number of employees covered under each coverage code, together with the total billing amounts, and;
  • The payment transmittal amounts, listing the total premiums due for the employer and dependent portions. The monthly report is sent to the employer on or about the 20th of each month.

    To view a sample monthly report, click here. Payment transmittal must be made through the Transmittal Electronic Payment System, or TEPS, by the 15th of the following month in order to guarantee continuation of coverage for all employees.

Please recall that in order for your payment to be timely, you must complete your call to the TEPS program by 5:30 p.m. EST/EDT, one business day prior to the day you wish to transfer the funds.

For further information about the Transmittal Electronic Payment System, or TEPS, visit any of the TEPS links listed below:

Each month the Health Benefits Bureau will mail a completed alphabetical listing ("Alpha List") to participating employers showing all of the location's covered employees (and retirees, if the local employer is paying for retiree coverage).

To ensure accuracy of coverage for employees and retirees, the lists generated by the SHBP should be audited by the employer, and any discrepancies reported immediately to the Health Benefits Bureau. Employers are periodically requested to confirm enrollments of all eligible employees to the Division.

All State biweekly employees covered by the State Health Benefits Program are reported for coverage through the State Health Benefits Bureau. All applications for changes in coverage and new enrollment applications must be received in the Health Benefits Bureau on the first Friday of the week following the date that the member actually receives biweekly pay. This is in accordance with the biweekly payroll date schedule produced by Centralized Payroll.

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Forms

The following forms are to be used for the submission of changes by the fifth of each month:
  • Transmittal of Deletions
    This form is to be used for deletions due to death, termination, and retirement. Instructions for its completion are printed on the reverse side of the form.
  • Monthly Change Summary
    This form must be completed by employers each month and should include the total number of applications for new enrollments, coverage changes, and rejections of coverage being submitted, as well as the total number of deletions reported for the month.

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Collect and Remit Premium Payments

Local Group

The SHBP will bill Local Group employers each month for the complete cost of health benefits coverage and, if the employer elected to join the State program, for prescription drug coverage for its employees and their eligible family members. The SHBP will also bill for health benefits coverage of eligible retirees, if the employer has opted to pay for them.

The employer is responsible for collecting any required employee contributions, such as the cost of dependent coverage or payments for coverage during a leave of absence. The employer is also responsible for maintaining any separate accounting for employee payments that it deems necessary.

Separate bills for active employees and eligible retirees are mailed each month. Payment, made through the Transmittal Electronic Payment System, or TEPS, is due on the 15th of the month of coverage unless the employer has enrolled in the Premium Delay program.

The bill includes information such as the employer identification number, employer name, billing date, payment due date, current coverage period, premium delay information, and amounts due - past, current and total. To view a sample bill, please click here.

If a past due amount has been paid, but was not received by the SHBP before the bill was printed, the employer may make adjustments and remit the corrected amount due through TEPS.

Please recall that for your payment to be timely, you must complete your call to the TEPS program by 5:30 p.m. EST/EDT, one business day prior to the day you wish to transfer the funds.

For further information about the Transmittal Electronic Payment System, or TEPS, visit any of the TEPS links listed below:

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State Monthly Group

All State Monthly Group employers (all State colleges and universities, Palisades Interstate Park Commission, NJ State Library, NY-NJ Harbor Commission, NJ Commerce and Economic Growth Commission) will be sent a billing statement each month from the SHBP for the complete cost of their active employees' health benefits, dental coverage, and prescription drug coverage. The total cost listed in the billing statement for each program is only for informational purposes, as funds for the State share of the premiums are provided to the SHBP by the State Office of Management and Budget. The employer is responsible for collecting any required employees' contributions, such as the health benefits Traditional and HMO premium shares, the 50% dental premium employee share, and leave of absence payments.

The billing statements include information such as the employer identification number, employer name, billing date, current coverage period, and total cost. Employers must remit a separate payment for each of the three programs (health, dental, and prescription drugs) through TEPS, with each payment amount representing total monthly collections from employees for that program. Payments should include premium shares, prepaid premiums, and leave of absence premiums.

Please recall that in order for your payment to be timely, you must complete your call to the TEPS program by 5:30 p.m. EST/EDT, one business day prior to the day you wish to transfer the funds.

For further information about the Transmittal Electronic Payment System, or TEPS, please visit any of the TEPS links listed below:

State Biweekly Group

Each biweekly pay period, the SHBP will provide the State Centralized Payroll with the complete cost of health benefits and dental and prescription drug coverage. The State Centralized Payroll is responsible for collecting, through payroll deductions, any required employee contributions, such as the health benefits Traditional Plan and HMO medical plan premium share and the 50% dental employee share. Centralized Payroll will collect premiums due from payroll benefits administrators or clerks for all employees required to pay premiums when employees are on leaves of absence and off the State payroll.

Centralized Payroll will initiate the transfer of funds from the State of New Jersey General Fund account to the corresponding bank accounts for each of the benefits programs. A breakdown of all fund transfers is to be provided to the SHBP.

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Individual Retirees

The Division will deduct from monthly pension allowances the cost of health benefits coverage for any State or local retiree who is enrolled in the State Health Benefits Program but is not eligible for local employer-paid or State-paid health coverage. If the retirees do not receive a pension allowance from the Division or the allowance is insufficient to cover the premium, the SHBP will send them a monthly bill. The bill includes the retiree's name, Social Security number, payment due date, billing date, current coverage period, and amounts due—past, current and total. The lower portion of the bill is a payment stub, which includes the return address, that should be returned with the retiree's payment to a SHBP lockbox account maintained by our bank, in the window envelope provided. Payment is due on the 15th of the month of coverage and is payable to the New Jersey State Health Benefits Program (NJSHBP).

State Part-time Employees and Part-time Faculty Members Employed at NJ Public Institutions of Higher Education (NJ State Colleges, State Universities, and County Community Colleges)

The Division will mail the eligible employee a monthly bill for the cost of the coverage selected by the employee. The bill includes information such as the member's name, Social Security number, billing date, payment due date, current coverage period, past and current amounts due for each of the programs in which the member is enrolled, and the total amount due. The lower portion of the bill is a payment stub, with return address, which should be mailed with the member's payment in the window envelope provided, to a SHBP lockbox account maintained by the Division's bank (State of New Jersey Health Benefits Program, PO Box 19519, Newark, NJ 07195-0519). Payment is due on the 15th of the month of coverage and is payable to the New Jersey State Health Benefits Program (NJSHBP).

Upon retirement, part-time State employees and part-time faculty members who are enrolled in the SHBP under the provisions of Chapter 172, P.L. 2003, are permitted to enroll in retired group NJ PLUS coverage, provided that they continue to pay the full cost of their retiree coverage. Prescription drug coverage for these retirees is provided through NJ PLUS — they are not eligible for the Employee Prescription Drug Plan.

COBRA Members

A member or dependent of a member eligible to enroll under the provisions of COBRA for the medical benefits and/or the dental, prescription drug, and vision care programs, will receive a monthly bill. The bill includes information such as the member's name, Social Security number, billing date, payment due date, current coverage period, past and current amounts due for each of the programs in which the member is enrolled, and the total amount due. The lower portion of the bill is a payment stub, with return address, which should be mailed, with the member's payment, to a SHBP lockbox account maintained by the Division's bank in the window envelope provided (State of New Jersey Health Benefits Program, PO Box 19519, Newark, NJ 07195-0519). Payment is due on the 15th of the month of coverage and is payable to the New Jersey State Health Benefits Program (NJSHBP).

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Overpayments and Shortages

When an employer, retiree, or COBRA member remits an amount that is more than the required payment, the overpayment will be credited to the account and will be used to reduce the following month's total payment due. If a direct refund is desired instead of the payment application to the following month's bill, a request in writing should be forwarded to the SHBP.

When there is a payment shortage of an employer bill for active employees that is not paid during the 15 day grace period for that bill, a past due amount plus an interest penalty for the payment shortage will be included in the following month's bill. Interest is calculated at the rate of 1% above the average rate of return on State Cash Management Fund investments for the most recent fiscal year.

There is no interest charged for payment shortages on an employer's retiree bill, an individual retiree bill, or a COBRA member bill.

Failure to Pay by Retirees

If a retiree fails to pay the required premiums for two consecutive months, coverage can and will be terminated. A letter notifying the retiree of pending termination is sent to the retiree when payment is late, and a second notice is given if no response is received.

Coverage can be reinstated if the retiree pays the premium in full within a reasonable time (two to three months). If the retiree contacts the Division of Pensions and Benefits, SHBP Retired Group, and pays all premiums owed to date, coverage will be reinstated. Each case is handled separately, and the date of reinstatement depends upon the circumstances that caused nonpayment (i.e., illness, incapacitation, etc.).

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Local Employer Late Payments

An interest penalty is added to the employer bill for employees when payment is not received within 15 days of the due date. Interest is calculated at the rate of 1% above the average rate of return on State Cash Management Fund investments for the most recent fiscal year.

Premium Delay

The State Health Benefits Commission allows participating local employers the option to elect a 30- or 60-day delay in remitting payments for their active employee bills. The local employer is required to complete a premium delay resolution form provided by the SHBP. 

The premium delay will be effective on the first bill 60 days after the resolution is received by the SHBP. If an employer with a premium delay terminates from the program, all premiums become due and payable before the termination effective date.


Review and Reconcile Reports

Local and State monthly employers are provided with a monthly member report, listed alphabetically. The report includes information such as member name, spouse name, member Social Security number, date of birth, insurance carrier code, coverage level, effective date, and the corresponding monthly premium for each of the programs. The employer should review the list and inform the SHBP of any information that may need to be changed.

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Part B Medicare Premium Reimbursements

Reimbursements are made to certain retired members who have met the following criteria:

  1. State employees who attained 25 years of service credit or retired under a disability retirement prior to July 1, 1997;

  2. Employees of State universities and colleges and others who have 25 or more years of credited service;



  3. Members of TPAF with 25 or more years of service credit; or

  4. School board or County college employees enrolled in the PERS or ABP who retire with 25 or more years of service credit, or who retire under a disability retirement.

Part B reimbursement is added directly to the retirement allowance of those retirees who are members of a State-administered pension fund. 

When a member receives a retirement allowance from a non-State-administered pension fund, a check from the SHBP is automatically mailed to the retiree between the 1st and 15th of the month. Non-State-administered pension funds include the Alternate Benefits Program, Rutgers retirees covered under the Federal Employees retirement system, NJIT retirees receiving Prudential annuities, UMDNJ retirees of the Employees' Retirement Fund of the City of Newark, and the Board of Education Employees' Pension Fund of Essex County.

When retroactive Medicare enrollment coverage is processed, the reimbursement for prior months will be added to the retirement allowance or the monthly check paid to the member. Retroactive Medicare reimbursement is limited to a maximum of 12 months.

The amount of Part B reimbursement paid to State retirees may be subject to a current monthly maximum amount of $46.10 per member, or $92.20 for a member and spouse when both are on Medicare, based on union contracts or regulations in effect at the time the member qualified for the reimbursement in retirement. This level of reimbursement may change over time.

Local employers who have agreed to reimbursement of Part B Medicare premiums to their retirees are responsible for establishing their own procedures to do so.

Part A Medicare Premium Reimbursements

Chapter 447, Public Law 1987, provides that the State shall reimburse retirees of the State Police Retirement System and their spouses who pay the full monthly premium charges for Hospital Insurance (Part A) under the Federal Medicare Program. A claim form is provided by the SHBP to the retiree, who is required to complete and submit the claim form at the end of every quarter. Proof of payment made to the Federal Medicare Program for Part A coverage, such as copies of the canceled check or check stub, should be included when submitting the claim form to the SHBP. The reimbursement is paid three to four weeks after the completed claim form is received by the SHBP.

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Local Employer Payment of Retiree Coverage under Chapter 48

If the local employer opts to pay for retiree coverage under the provisions of Chapter 48, and establishes conditions that the SHBP can program for, the SHBP will bill the employer for the retiree benefits. If the Chapter 48 resolution adopted by the employer cannot be programmed by the SHBP, then the SHBP will deduct the full cost of coverage from the retiree's pension allowance, or bill the retiree for the cost of coverage. The employer must then establish procedures to reimburse the retiree for the coverage it has agreed to provide.

Chapter 88 and Chapter 436 Resolutions

Chapter 48 Resolution

How Plan Rates Are Set

The SHBP is required to contract with independent actuaries to provide consulting services to the program. Seven months prior to the effective date of the new plan rates, all participating claims administrators and insurance carriers are required to submit their rate proposals to our consultants. The consultants perform a review of the claims, administrative expenses, and other financial and statistical information for each plan, prepare cost projections for current and upcoming periods, determine the adequacy of funding levels, and submit their recommendation on the plan rates for adoption by the State Health Benefits Commission. The Commission hears testimony about the proposed rate actions and approves rates it deems appropriate for the SHBP.

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Surcharge for Nonparticipating School Districts

Chapter 8, Public Law 1993, provides for insurers of school districts that do not participate in the SHBP to pay an annual surcharge to the program. The surcharge is determined by the State Treasurer and is based on a percentage of the total claims paid for the coverage of employees of the nonparticipating school districts. The surcharge is to compensate the SHBP for the excess cost of the health coverage of the school district's eligible retirees (25 or more years of credited service in a State-administered pension fund, or retired on disability with fewer years of service), who are covered in the SHBP.

Every November 1, a survey is sent to each nonparticipating school district requesting the name and address of their health benefits insurance carrier. A response is required by the end of November. The SHBP sends a surcharge payment request form on December 1 to the insurance carrier. The insurance carrier will complete the surcharge form and forward the form and payment to the SHBP by December 31. The surcharge form includes information such as adjustments from prior year payment, total claims paid, the surcharge rate and the amount to be remitted.

The surcharge rates are shown in the chart below.

Chapter 8 Surcharge Rates for
Non SHBP- participating
Education Employers

FISCAL YEAR RATE
2007 2.40%
2006 2.40%
2005 2.20%
2004 2.20%
2003 2.20%

2002

2.20%

2001

2.20%

2000

3.61%

1999

5.64%

1998

5.64%

1997

5.64%

1996

4.84%

1995

4.04%

1994

3.25%

1993

3.25%

 

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Last Updated: March 1, 2011