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Pensions and Benefits

STATE HEALTH BENEFITS PROGRAM (SHBP) and
SCHOOL EMPLOYEES' HEALTH BENEFITS PROGRAM (SEHBP)

HEALTH BENEFITS FOR RETIRED MEMBERS

RETIRED GROUP ELIGIBILITY | PLAN INFORMATION | ENROLLMENT | APPLICATIONS AND FORMS
PRESCRIPTION DRUG PLANS | RETIREE DENTAL PLAN | PLAN RATE CHARTS | CHAPTER 330 ENROLEES

HEALTH BENEFITS HOME | DEPENDENTS | EMPLOYEES | COBRA | EMPLOYERS


RETIRED GROUP ELIGIBILITY

Eligibility for Retired Group SHBP/SEHBP coverage is available to qualified retirees from the State including State colleges and universities, and Participating Local Government Employers, or Local Education Employers, as determined by the State Health Benefits Program (SHBP) or School Employees’ Health Benefits Program (SEHBP).

If you have any questions concerning eligibility in the SHBP/SEHBP, contact the Division of Pensions and Benefits.


PLAN INFORMATION AND PROGRAM DESCRIPTIONS

HANDBOOKS AND PUBLICATIONS

PROVIDER INFORMATION — Find a participating doctor or hospital

PRIVACY PRACTICES

OTHER RESOURCES


ENROLLMENT

You are not covered as a retiree until you qualify for and enroll in Retired Group the SHBP or SEHBP.

If eligible, you must enroll within 60 days of being offered enrollment — normally as of the date of retirement, or if waived for other coverage upon loss of that other coverage.  See the SHBP/SEHBP Summary Program Description Adobe PDF (597K) for eligibility criteria.

APPLICATIONS AND FORMS

Be sure to provide all of the information requested on the Enrollment Application and any required supporting documentation.

Retired Coverage Enrollment ApplicationNew Retired Enrollees ONLY

SHBP/SEHBP Non-Medicare Retired Coverage Enrollment Application Adobe PDF (41K)

SHBP/SEHBP Medicare Eligible Retired Coverage Enrollment Application Adobe PDF (41K)

SHBP/SEHBP Retired Coverage Enrollment Application for High Deductible Health Plans Adobe PDF (35K)

— Medicare Enrollment is Required if eligibleMedicare Requirements and Notice Adobe PDF (17K)Medicare & You Adobe PDF (3MB)

Retired Change of Status ApplicationFor retirees making changes to existing coverage

SHBP/SEHBP Non-Medicare Retired Change of Status Application Adobe PDF (45K)

SHBP/SEHBP Medicare Eligible Retired Change of Status Application Adobe PDF (45K)

SHBP/SEHBP Retired Change of Status Application for High Deductible Health Plans Adobe PDF (45K)

Documentation requirements when enrolling dependents for coverage Adobe PDF (33K)

Other SHBP/SEHBP Commonly Requested Forms and Applications

Spouse, Civil Union Partner, or Domestic Partner

Children until Age 26

Over Age Children until Age 31 (and Rates)

Over Age Children with Disabilities

Documentation requirements when enrolling dependents for coverage Adobe PDF (33K)

If an eligible dependent is not enrolled within 60 days of the time they first become eligible for coverage, a Retired Group member may enroll them on a timely basis — normally 60 days after receipt by the Division of Pensions and Benefits of of a properly conpleted Enrollment Application and supporting diocumentation.


RETIREE PRESCRIPTION DRUG COVERAGE
Retiree Prescription Drug Coverage is included with retired group Medical Plan enrollment

(Medicare Eligible Retirees please also see the Express Scripts Medicare Prescription Drug Plan information below)

Express Scripts is the pharmacy benefits administrator for all Retired Group members of the State Health Benefits Program and School Employees’ Health Benefits Program.

Prescription Drug Plans Member Handbook — Plan Year 2013 Adobe PDF (391K)

Express Scripts SHBP/SEHBP Web SiteRegistration Required

Express Scripts Prescription Plan Mobile Phone App — Registration Required


Medicare-Eligible Retirees see below

Express Scripts Mail-Order Form Adobe PDF (95K)

Express Scripts Prescription Drug Reimbursement Form Adobe PDF (112K)

 

Retiree Prescription Drug Copayment and Out-of-Pocket Costs

PRESCRIPTION DRUG BENEFITS FOR ALL PLANS Plan Year 2014

State and Local Government Retirees

Local Education Retirees

 

Medicare Part D Prescription Drug Coverage

SHBP/SEHBP Medicare Part D Prescription Drug Coveragefor Medicare-Eligible Retirees

Express Scripts Medicare Prescription Drug Plan — Prescription drug coverage for SHBP/SEHBP Retired Group members enrolled in Medicare

Express Scripts Medicare Prescription Formulary Adobe PDF (1MB) Additional Coverage for Tier 3 Non-Preferred Brand Prescription Drugs Adobe PDF (44K)

Change to Diabetic Supplier under Medicare Part B - Effective May 1, 2013

Questions and Answers about the Express Scripts (Medco) Medicare Prescription Drug Plan

Medicare & You — from the Social Security Administration - Adobe PDF (3MB)

Medicare Premiums: Rules for Higher-Income Beneficiaries — from the Social Security Administration - Adobe PDF (400K)

Private Medicare Part D Prescription Drug Coverage and Rates

Medicare Part D Creditable Coverage Letter

Medical Plan Rates for retirees enrolled in Private Medicare Part D Plans are available by request to the Division's Office of Client Services


RETIREE DENTAL EXPENSE PLAN

Retiree Dental Expense Plan — General Information

Retiree Dental Expense Plan Member Handbook — Plan Year 2013 Adobe PDF (315K)

Retiree Dental Expense Plan Rates — Plan Year 2014 Adobe PDF (12K)


RETIRED GROUP MEDICAL PLAN RATES
The cost of Retiree Prescription Drug Coverage is included with the Medical Plan Rates

RATES FOR RETIREES WHO PAY THE FULL COST OF THEIR COVERAGEPlan Year 2014

If you worked for the State, click here Adobe PDF (9K)

If you worked for a Local Government employer (county, municipal, etc.), click here Adobe PDF (12K)

If you worked for a Local Education employer, click here Adobe PDF (9K)

If you or a dependent are enrolled in a private Medicare Part D plan , click here

Health Benefit Personal Billing Most retirees who pay for health benefits coverage have the premium deducted from the monthly retirement allowance. If there is no monthly retirement allowance, or it is insufficient to cover the premium, members are billed monthly.

Retiree Bill Sample — For Retired Group members with personal billing.

Billing "lockbox" payment address information for retirees with personal billing.

RATES FOR STATE RETIREES WHO SHARE THE COST OF THEIR COVERAGE WITH THE STATE — Plan Year 2014

Retiree Wellness Program — If you worked for the State and attained 25 years on or after July 1, 2007 and before
June 28, 2011 (or retired on a disability retirement on or after August 1, 2007 and before June 28, 2011) and are enrolled in a SHBP medical plan, click here.

Premium Sharing —If you worked for the State, attained 25 years prior to July 1, 2007 (or retired on a disability retirement on or before August 1, 2007) and share the cost of Aetna Freedom10 or NJ DIRECT10 coverage with the State, click here Adobe PDF (29K)

Note: State Premium Sharing arrangements are based on these labor bargaining groups

If you or a dependent are enrolled in a private Medicare Part D plan, click here.

CHAPTER 330 RATES

See below for Chapter 330 information and rates

OVER AGE CHILDREN

Rates for Over Age Children until Age 31 - under Chapter 375, P.L. 2005

COBRA RATES

Rates for COBRA Enrollees


INFORMATION and RATES FOR CHAPTER 330 ENROLEES

ABOUT CHAPTER 330, P.L. 1997 — for Retired Law Enforcement and Firefighters

Fact Sheet #47, Health Benefits Coverage Under Chapter 330 Adobe PDF (30K)

CHAPTER 330 RATESPlan Year 2013

If you are a former law enforcement officer/firefighter covered under Chapter 330, Click here Adobe PDF (18K)

 


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