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University Hospital
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 Benefits


2017 Open Enrollment Information

Get quick answers to your Benefits questions at benefits@uhnj.org

Welcome to the Human Resources Benefits Open Enrollment Website! This site contains important information designed to assist you in making choices about your:

  • 2017 Health Plans
  • 2017 Dental Plans
  • Tax$ave Program
  • Commuter Tax$ave Program

During the State Health Benefits Program (SHBP) Open Enrollment (October 3rd until November 11, 2016), you may make general changes (adding and deleting dependents, changing coverage levels, etc.) or enrolling in a different medical or dental plan. However, remember, you are able to make certain changes for yourself or your dependents for any qualifying life event throughout the year.

Applications and applicable required documentation must be received in the Benefits Services Office no later then November 11, 2016 with coverage effective January 1, 2017.

2017 Health Plans  

Cost

Employees will pay the greater of 1.5% of their annual base salary or the percentage of premium share cost. University Hospital employees are paid bi-weekly (26 pay periods per year).

Health Plan Highlights

There are no medical plan changes for Plan Year 2017. Eight Preferred Provider Organization (PPO) plans, two Health Maintenance Organization (HMO) plans, two Tiered Network Plans and four High Deductible Health Plans will be offered for Plan Year 2017.

For plan year 2017, the Division of Pensions and Benefits is implementing a “Pilot Incentive Program” for tiered-network plans: the Aetna Liberty Plan and the Horizon OMNIA Health Plan. State employees are automatically eligible to participate in the program.

The Pilot Incentive Program is available to first-time enrollees who must remain enrolled for two years, from January 1, 2017, through December 31, 2018. This program does not extend to children over the age of 26 or COBRA members. The incentives vary depending on level of coverage: Single-coverage employees receive $1,000; Member and Spouse, or Parent and child-covered employees receive $1,250; and Family-covered employees receive $2,000. This incentive is paid by gift card within the first quarter of Plan Year 2017, and is deemed reportable income for tax purposes

IMPORTANT: The incentive shall be forfeited and returned to the SHBP if the subscriber fails to remain enrolled in the Tiered Plan for at least two plan years, except when a subscriber becomes ineligible for healthcare due to layoff, involuntary separation, reduction to part-time status, or classification into an ineligible position. If the subscriber voluntarily retires or changes health plans due to catastrophic or emergency health needs as determined by the Division after a full year, then the incentive shall be forfeited on a pro-rata basis.

Other Changes

Effective November 1, 2016

Out-of-Network Physical Therapy — Visits with an out-of-network provider will be limited to the average in-network cost for physical therapy visits paid by the carriers. Plans administered by Aetna only will cover a maximum of $55 per visit and plans administered by Horizon Blue Cross Blue Shield of New Jersey only will cover $52 per visit. Aetna and Horizon both have extensive provider networks, so members should consider switching to an in-network practitioner.

Preferred Drug Step Therapy — If a provider prescribes a higher cost or non-preferred prescription drug, the doctor will be required to change the prescription to a covered generic or preferred drug. In the event a generic or preferred drug is ineffective, there is an exception policy under the guidelines of the plan.
 

Effective December 1, 2016

Generic Substitution — Members will be required to pay the difference between the cost of a generic and the cost of the brand drug with a generic equivalent is dispensed, unless the brand drug is deemed medically necessary and appropriate under the guidelines of the plan.

Prescription Drug Formulary – SHBP will be using Express Scripts’ National Preferred Formulary (NPF) which is a listing of drugs, classified by therapeutic category or disease class, that are considered preferred therapy for a given population and that are to be used by providers in prescribing medications. Medications not on the NPF will not be covered by the plan unless the non-formulary drug is deemed medically necessary and appropriate under the guidelines of the plan.


Effective January 1, 2017

Emergency Room Copayments — will increase to $100 for NJ DIRECT15, Aetna Freedom15 and Horizon and Aetna HMOs. This does not apply to dependents under age 19 or members referred to the ER by a physician.
 

Available Medical and Prescription Drug Plans

 

PPO PLANS *

HMO Plans *

High Deductible Health Plans (HDHP)*

Aetna Freedom15

Aetna HMO

NJ DIRECT HD1500

Aetna Freedom1525

Horizon HMO

NJDIRECT HD 4000

Aetna Freedom2030

 

Aetna Value HD1500

Aetna Freedom2035

 

Aetna Value HD 4000

NJ DIRECT15

Tiered Network Plans*

 

NJ DIRECT1525

Aetna Liberty Plan

 

NJ DIRECT2030

Horizon’s OMNIA Health Plans

 

NJ DIRECT2035

 

 


*Employees enrolling in any PPO, HMO or Tiered Plan may also elect to enroll in the prescription drug program. Employees who elect to enroll in the high deductible health plans are not eligible to enroll in the Employee Prescription Drug Plan. Instead, the prescription drugs are covered under the High Deductible plan and count toward the deductible.

Note: The service areas for Horizon HMO are limited to New Jersey, Delaware and bordering counties of Pennsylvania and New York.


Health Savings Accounts (HSAs)

HSAs are available for the two current providers offering High Deductible Plans. The HSA can be used for qualified medical expenses without federal tax liability. However, if employees are enrolled in the Flexible Spending Account (FSA) through the Tax$ave Program, they cannot participate in a HSA. They have the option to participate in one or the other.

Employees participating in a HDHP could fund their HSA accounts through pre-tax payroll deductions by completing a HSA Contribution Form.

The Health Savings Account is similar to a medical expense FSA. Funds in an HSA are not lost when the plan year is over unlike funds in an FSA. Feel free to view the FSA and HSA  comparison chart.

Waiver of Coverage

Eligible SHBP employees are permitted to waive SHBP medical and prescription coverage at any time during the year provided the employee has other health care coverage. To waive coverage that will take effect January 1, 2017, employees should complete and submit a SHBP State Waiver Form and Health Benefits Application no later than November 11, 2016 and indicate "Open Enrollment" on the waiver and enrollment forms.
 

*Employees who are newly married or enrolling in the SHBP for the first time during open enrollment or who are enrolling their spouse as a dependent, are required to provide a copy of the marriage certificate and a copy of the top half of the front page of the employee's most recently filed federal tax return (Form 1040) that lists the spouse at the time of enrollment. If the Form 1040 does not list the spouse or partner, the employee should provide a photocopy of a recent (within 90 days of application) bank statement or utility bill that includes both name of the employee and spouse/partner and is received at the same address. Employees may black out all financial information and all but the last 4 digits of any Social Security numbers.

Reminder, applications to change, add or waive coverage, along with other required documentation must be submitted to Benefits Services Office no later than November 11, 2016.

 

2017 Dental Plans  

There are no dental plan changes for Plan Year 2017.

Dental Plan Organization (DPO)

Preferred Provider Organization (PPO) *

Aetna (DMO)

Dental Expense Plan (administered by Aetna)

Cigna DHMO

 

Healthplex

 

Horizon Dental Choice

 

MetLife DPO

 


Dental Plan Highlights

DPO Plan (Dental Plan Organization)

DPOs contract with a network of providers for dental services. When an employee or dependent uses a DPO dentist, diagnostic and preventive services are covered in full. Most of the other eligible expenses require a small copayment. Members must use a provider that participates with the DPO selected to receive coverage. Be sure to confirm that the dentist or dental facility selected is taking new patients and participates with the SHBP Employee Dental Plans, since DPOs also service other organizations.


PPO Plan (Dental Expense Plan)

The Dental Expense Plan is a PPO plan that allows members to obtain services from any dentist; however, as a PPO, using an in-network provider will reduce an employee's costs. After satisfying an annual deductible (no deductible for preventive services), members are reimbursed a percentage of the reasonable and customary charges for eligible services.

Employees must remain enrolled in a dental plan for a minimum of 12 months before they will be allowed to change plans. This means that an employee who was not enrolled in a dental plan as of January 1, 2016, will not be permitted to change dental plans during this Open Enrollment.

*The signed and completed application must be received by November 11, 2016 in the Human Resources Benefits Services Office to affect your January 1, 2017 coverage.

Employees who are newly married or enrolling in the SHBP for the first time during open enrollment or who are enrolling their spouse as a dependent are required to provide a copy of the marriage certificate and a copy of the top half of the front page of the employee's most recently filed federal tax return (Form 1040) that lists the spouse at the time of enrollment. If the Form 1040 does not list the spouse or partner, the employee should provide a photocopy of a recent (within 90 days of application) bank statement or utility bill that includes both name of the employee and spouse/partner and is received at the same address. Employees may black out all financial information and all but the last 4 digits of any Social Security numbers. Shrink font same as blurb in medical section-make one paragraph.

Reminder, applications to change, add or waive coverage, along with other required documentation must be submitted to Benefits Services Office no later than November 11, 2016.


Additional Information

Applicable medical, prescription drug and dental premiums will be withheld on a pre-tax basis unless you complete a waiver declining the Premium Option Plan (IRC Section 125) for 2017. The form is available at Human Resources Benefits Services Office.

Now is the time to review your health plan and coverage levels and make all necessary changes that would benefit you and your dependents.


Tax$ave Program - Key Information  

This year’s Open Enrollment period is from October 3rd to November 11, 2016.

University Hospital employees who are eligible to participate in the State Health Benefits Program (SHBP) are eligible to participate in Tax$ave. Employees who already participate must re-enroll during this Open Enrollment period for calendar year 2017.

Grace Period Extension for Eligible Expenses and Extended Claim Filing Period.

  • Employees enrolled in the Unreimbursed Medical or Dependent Care FSAs have until March 15 of the following year to incur eligible expenses for the current plan year.
  • The employee has up until April 30 of the following year to submit these claims.
  • Any contributions that remain in the account unclaimed after April 30 are forfeited.

The maximum annual allowance that can be set aside for the 2017 plan year is $2,500 for the Unreimbursed Medical FSA and $5,000 for the Dependent Care Account.

Employees who enroll in the Unreimbursed Medical plane will receive the WageWorks Healthcare Card®. The card allows the employee to draw on the annual Medical FSA election amount for unreimbursed qualifying medical expenses.

The card may be used for qualifying expenses, such as covered prescription copayments, health plan deductibles, orthodontics, doctor and emergency room copayments, eyeglasses, contact lenses, Lasik surgery, and uncovered dentist or other provider fees.

It may also be used for certain eligible over-the-counter medical expenses at grocery stores, drug stores, and discount stores that are IIAS (Inventory Information Approval Systems) certified merchants. A list of IIAS certified merchants is available at www.wageworks.com


Enrolling in a Flexible Spending Account

Internet: Employees can enroll in the Unreimbursed Medical and/or Dependent Care FSA plans over the Internet at: www.wageworks.com 
The deadline for enrollment over the Internet is midnight, November 11, 2016.

Fax: FSA Enrollment Forms may be faxed by the employee to 866-672-4780. The deadline for accepting faxed enrollment forms is midnight, November 11, 2016.

Mail: FSA Enrollment Forms can be mailed by the employee directly to WageWorks, Enrollment Processing, PO Box 1840, Tallahassee, FL. 32302-1840. The enrollment forms must be postmarked no later than November 11, 2016. Forms postmarked after November 11, 2016 will be returned without action.

You will also have the opportunity to use the FSA Direct Deposit Form to have your Flexible Spending Account (FSA) reimbursement checks deposited directly into your checking or savings account.

Tax$ave 2016 Newsletter
Tax$ave Fact Sheet #44
Flexible Spending Plans Flier
WageWorks Enrollment/Change In Status Form
 

Commuter Tax$ave Program - Key Information  

TransitChek, a division of WageWorks, Inc., administers the Commuter Tax$ave Program under contract with the State of New Jersey. It allows eligible employees to set aside pre-tax dollars to pay for certain mass transit and commuter parking expenses. Eligible employees may apply at any time. The enrollment cycle is continuous beginning the first of each month and ending on the last day of that month. Employees may enroll using one of the following options:

  • Option 1: The current transit cap remains at $130 per month ($1,560 per year). This amount is deducted from salary to pay for mass transit commutation costs (mass transit includes train, bus, ferry and vanpool expenses).
  •  Option 2: $250 per month ($3,000 per year) to pay for parking at work or at park and ride sites. This does not apply to employees already having pretax parking deducted from their paycheck.

The monthly deduction for the Commuter Tax$ave Program will be withheld from one paycheck of each month. Deductions may only be made for use with the employee's personal commutation cost for going to and from work.

Eligible employees may enroll using one of the following options:

  • Option 1: Visit the Commuter Tax$ave website
    • Click the Enroll in Commuter Tax$ave option
    • Company Code: DYV65
  • Option 2: Contact Customer Service 888-618-2435.

Enrollment/Change/Termination Schedule 2017


 
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Get quick answers
to your Benefits
questions at benefits@uhnj.org
 

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University Hospital 150 Bergen St, Newark, NJ 07103 • (973) 972-4300
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