Medical, Dental, Prescription & Vision Plans
As University Hospital employee, your medical, dental and prescription drug benefits are provided through the State Health Benefits Program (SHBP). We offer excellent benefits health plan options that will suit the needs of you and/or your household.
Plan Eligibility: Effective after May 21, 2010, the current minimum State Health benefits requirement of 20 hours per week changed to 35 hours per week for newly hired staff members. Employees hired on/or prior to May 21, 2010, who work less than 35 hours per week will continue to receive their health benefits provided there is no break in service or change in hours.
NOTE: Part time employees who do not meet the above Plan Eligibility may enroll in health benefits under SHBP Chapter 172 provided the employee is a member of a State-administered retirement system. The employee pays the full cost of the health plan coverage.
Medical Plans
|
PPO Plans |
HMO Plans |
Tiered Network Plan |
High Deductible Health Plans (HDHP) |
|
NJ DIRECT 15
|
HORIZON HMO |
Horizon OMNIA |
NJ DIRECT HD 4000 |
Preferred Provider Organization (PPO)
Uses own network of providers and offers out of network benefits
Plan Highlights:
- Administered by Horizon BCBSNJ
- Provides both in and out-of-network care
- Health care contribution is a percentage of the premium based on your salary, plan and level of coverage. If you enroll in NJ Direct or NJ Direct 2019 the premium will be based on your salary. Please click here to download the contribution table.
- A medical insurance card is issued
In Network:
- No primary care physician is required
- No referrals are required for in-network providers
- Preventive care/eligible charges are covered in full
- Co-pays for emergency room visits vary depending on plan enrolled, there is no charge if admitted
- No deductible is required
- No filing of claim forms when using in-network services
- Medical Plan Websites (listing of primary care physicians and specialists)
Out of Network:
- Permitted to choose any physician outside the network
- Does not cover most well-care and preventative services
- Deductibles apply per person up to the applicable maximum family deductible
- After the deductible is met, the plan pays 70% coinsurance of what is a “reasonable and customary” expense. The employee is responsible for the remaining balance.
- Claim forms are filed by the member and sent directly to the insurance company.
Health Maintenance Organizations (HMOs)
Uses own network of providers and does not offer out-of-network coverage.
Plan Highlights:
- Administered by Horizon BCBSNJ
- Required to select a primary care physician
- In-network services only
- Referrals required for most specialists
- Health care contribution is based on your salary, plan and level of coverage
- Preventative care/eligible charges are covered in full
- Co-pay Horizon HMO – SHBP/SEHBP (horizonblue.com) charge for emergency room visit varies depending on HMO plan selection; there is no charge if admitted
Tiered Network Plans
High quality practitioners within the carrier’s managed care network.
Plan Highlights:
- Administered by OMNIA
- Choose from Tier 1 and Tier 2 providers
- Referrals are not required
- Health care contribution is based on your salary, plan and level of coverage. If you enroll in OMNIA the premium will be based on your salary. Please click here to download the contribution table.
- Preventative care/eligible charges are covered in full
- Co-pays for emergency room visits vary depending on plan enrolled, there is no charge if admitted
- Medical Plan Websites (listing of primary care physicians and specialists)
High Deductible Health Plans (HDHP)
Plan Highlights:
- Administered by Horizon BCBSNJ and Aetna
- Healthcare contribution is a percentage of premium based on your salary, plan and level of coverage.
- Option to select $1,500 or $4,000 deductible; if enrolled in a member/spouse, parent/child(ren) level of coverage, the deductible is doubled
- After deductible is met, the plans pay the applicable coinsurance of reasonable and customary expenses
- Prescription drugs are subject to the applicable deductible
- There is a Health Savings Account (HSA) available at time of enrollment
Please refer to the following SHBP member handbooks and related links for additional detailed information:
NJ State Health Benefits Program (SHBP) Booklet
Medical Application (online enrollments through Benefitsolver)
Login to Benefitsolver
Register for Benefitsolver
Part time coverage under SHBP:
Health Benefits Coverage For Part-Time Employees Fact Sheet #66
Dental Plans
The New Jersey State Employee Group Dental Program consists of the Dental Expense Plan and the Dental Plan Organizations (DPOs).
Members must remain in the designated dental plan for twelve (12) months from the effective date of coverage.
|
Aetna DPO |
Aetna DPO |
Dental Expense Plan
Plan Highlights:
- Administered by Aetna Dental
- $50 deductible per person; $100 deductible per family applies to in-network services only
- $75 deductible per person; $150 deductible per family applies to out-of-network services only
- Annual dollar maximum: $3,000 per member for services rendered in-network; $2,000 annual dollar maximum per member for services rendered out-of-network
- Claim forms are required
- Eligible expenses: basic preventive, periodontics, prosthedontics
- Eligible expenses covered at percentage of reasonable and customary charges after deductible has been met
- Not eligible: Supplies for home use, charges that are more than reasonable and customary
- Orthodontic eligibility:
- Plan enrollment for ten (10) months
- Dependents under age nineteen (19) qualify
- Not available for procedures started prior to coverage being effective
- $1,000 individual lifetime benefit maximum for in-network; $750 individual lifetime benefit maximum for out-of-network
- Biweekly premium
Please refer to the SHBP Employee Dental Plans Member Handbook for additional detailed information.
Dental Provider Organization (DPOs)
Plan Highlights:
- Coverage restricted to DPO providers in-network only
- No benefits maximum
- Preventive/routine care services are covered at 100%
- Co-payment for specialist care
- No claim form is required
- Dental ID card(s) are issued
- Biweekly premiums deducted from pay
- Orthodontic eligibility:
- Patients under age 18 (at the start of treatment) – co-pay is $1,000 or 50% of reasonable and customary charges, whichever is less
- Patients over age 18 or over (at the start of treatment) – co-pay is $1,750 or 50% of reasonable and customary charges, whichever is less
Please refer to the SHBP Employee Dental Plans Member Handbook for additional detailed information.
Employee Group Dental Plans
Dental Rates
Dental Application (online enrollments through Benefitsolver)
Login to Benefitsolver
Register for Benefitsolver
Prescription Drug Plan
Plan Highlights:
- Administered by OptumRx
- Prescription Drugs are available through a participating retail pharmacy or through Express Scripts mail order service
- Express Scripts Prescription Drug Plan is not available with any of the High Deductible Health Plans (HDHP)
|
Source of purchase |
Amount of supply |
Cost |
|
Retail pharmacy |
30 – day |
Co-pays vary depending on plan selection and drug tier |
|
Mail order |
90 – day |
Co-pays vary depending on plan selection and drug tier |
Please refer to the Prescription Drug Plan Member Handbook for additional detailed information.
* NOTE: The contribution amount will change any time there is a change in an employee’s annual base salary.
Vision Plan
University Hospital offers benefit eligible employees the option to enroll in a Vison Insurance plan offered through VSP. VSP offers a Basic plan and a Buy-Up plan.
Plan Highlights:
- Eye exam for a $10 copay
- Prescription Glasses (at a participating vision center from a selection of frames) for $20
- $150 allowance for contact lenses
- Reimbursed $150 for Basic Plan or $250 for Buy-Up Plan for your vision expenses.
- Click this link to download and ID card or for additional plan information University Hospital VSP.
- Login to the UH employee portal at https://portal.ec.uhnj.org/ and access the Self-Service Banner to enroll. Click Here to download the enrollment instructions.
- Summary Plan Description which includes your Bi-weekly premiums.