Changes to Manager Benefit Plans

Effective Tuesday, September 1, 2020, active non-aligned members (e.g. managers) covered by the New Jersey State Health Benefits Program (SHBP) and currently enrolled in the NJ DIRECT15, 1525, 2030, or 2035 plans, will be automatically converted to the new NJ DIRECT/NJDIRECT2019,* medical plan.

If you are in one of these plans, you do not have to take any action:

New Medical Plan Conversion Information – Effective Tuesday, September 1, 2020

• Managerial employees enrolled in NJ DIRECT15, 1525, 2030, or 2035 will be automatically transferred to the new NJ DIRECT/ NJ DIRECT 2019 plan.
• Managerial employees enrolled in a Tiered Network plan will remain in their current plan.
• Managerial employees enrolled in a HMO will remain in their current plan.
• Managerial employees enrolled in a HDHP will remain in their current plan.

* Members hired before Monday, July 1, 2019, will be enrolled in NJ DIRECT. Members hired after Monday, July 1, 2019, will be enrolled in NJ DIRECT 2019.

Open Enrollment – October 2020

Members who do not wish to remain in the NJ DIRECT/NJ DIRECT 2019 plans may change their plan to an HMO, Tiered Network Plan, or HDHP during the annual Open Enrollment period in October. The change will take effect for the 2021 plan year.

NJ DIRECT/NJ DIRECT 2019 – Highlight of Plan Changes

For the new plan, the out-of-network reimbursement rate will be 175 percent of Centers for Medicare & Medicaid Services (CMS) reimbursement amounts with the following exclusions:

• Obstetrical care – for employees receiving obstetrical care as of Friday, May 1, 2020, the reimbursement rate will be 195 percent of the CMS amount for the duration of their care;
• Mental Health – for employees receiving mental health services, the reimbursement rate will be 175 percent of the CMS amount up to the employee reaching the out-of-pocket maximums of $2,000.00 (individual) or $5,000.00 (family). The reimbursement will then be made at 195 percent of the CMS amount for the remainder of that plan year. This exclusion will remain in effect through Wednesday, June 30, 2021.
• Emergency room copayments are: $150.00 for adults; $50.00 for adults directed to the emergency room by their primary care physician; and $50.00 for pediatric (through age 19). These copayments will be waived if admitted to the hospital.
• Members and spouses who participate in NJWELL and complete their necessary health screenings and activities can earn a financial reward of $350.00 each.

The SHBP Plan Design Chart outlines the new plan coverage, including in-network and out-of-network deductibles; coinsurance; and primary care, specialist care, emergency room, and prescription drug copayments.

Employee Contribution Rates and Calculator:

• Union Negotiated Member Contribution Rates
• Union Negotiated Plan State Monthly Percentage Calculator for Plan Year 2020

Questions?

Please email hr-benefits@montclair.edu