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Health Care Bulletin for Members of the State Health Benefits Program

Submitted by Staff on Thu, 10/12/2017 - 10:21


Some Things to Know for 2018 about State Health Benefits

No Premium Increase for the First Time in Forever.

Every year premiums for the State Plan go up and members usually see this starting in January with a larger health care deduction from your paycheck. That’s about to change. On January 1, 2018 there will be no increase, due in part to the Unions (including our Union) representing you and other state and local government employees in the Plan. In fact, there’s a pattern of the State actually saving money on health care over the past few years that the Unions intend to investigate.

Upcoming Contract Negotiations

Working with our sister unions at Rutgers, we intend to seriously address the high cost our members pay for health insurance and we are dedicated to improving state health policy to better address both cost and quality.

Health Benefits Changes for 2018:

1. New Pharmacy Benefit Manager (PBM), effective 1/1/18

Express Scripts (ESI) is out and OptumRx is in. Through the normal bidding process of state government, there will be a new vendor for your prescription benefits. You should have already received a notice to this effect. If you will be impacted by any changes to the drug formulary, then you should receive additional communications from OptumRx. Questions: contact OptumRx directly (844-368-8740) or the State (609-292-7524) or UHR (848-932-3990).

2. Tiered Plan Incentives Extended for 2018

Introduced in 2016, the Tiered Plan has a 25% lower premium than Direct 15, but no out-of-network benefits. The cost of the plan is lowered by dividing the provider network (hospitals and doctors) into two tiers (Tier One providers cost less than Tier Two) and by eliminating out-of-network benefits. It’s not for everyone, but if you are sure that Tier One providers will work for you then it may be an option to consider. The incentives, introduced last year, ($1,000 for Single coverage; $1,250 for Spouse/Partner or Member/Child(ren) coverage; and $2,000 for Family coverage) will continue for those who are new employees this year or for those who switch into a Tiered Plan (Horizon Omnia or Aetna Liberty) during open enrollment or pick up coverage as the result of a “life event.” Those who chose a Tiered Plan last fall, as a new employee or by a “life event”, will be retroactively eligible for the incentives. Contact us if you think you may be eligible.

October is Open Enrollment Month:

Here are the upcoming dates for the benefit fairs on Rutgers campuses sponsored by UHR:

* October 12, 10:00 a.m. to 4:00 p.m. – College Avenue Student Center, Multipurpose Room

126 College Ave, New Brunswick, New Jersey 08901

* October 16, 11:00 a.m. to 4:00 p.m. – Clinical Academic Building, Room 1302

125 Paterson Street, New Brunswick, New Jersey 08901

* October 17, 10:00 a.m. to 3:00 p.m. – Camden Campus Center, Multipurpose Room

326 Penn Street, Camden, New Jersey 08102

* October 24, 10:00 a.m. to 4:00 p.m. – Medical Science Building, Grand Foyer Lobby

185 South Orange Avenue, Newark, New Jersey 07101

* October 25, 10:00 a.m. to 4:00 p.m. – Busch Student Center, Multipurpose Room

604 Bartholomew Road, Piscataway, New Jersey 08854

We encourage you to attend if you have any specific questions for Horizon or Aetna – both should be present at each event. The Union has also helped to arrange for OptumRx to be present, in case you have questions regarding the transition of the prescription benefits.

Here’s a link to the University Human Resources open enrollment webpage:

Contact UHR: 848-932-3990 or via email at

Two New Health Pilots for the State Plan

1. Direct Primary Care Medical Home (DPCMH)

This pilot began in 2017 and is being run statewide. It allows a member to have 24/7 access to a primary care doctor with no co-pays. The goal of the pilot (exclusive to members of the State Plans, including Rutgers) is to transform how doctors are paid, allowing them more time with patients to achieve better health and avoid costlier forms of care. This program is in addition to your selected state health plan, though members in an HMO cannot participate.

Here are links to the providers to find locations and learn more details about the pilot. A new location in New Brunswick for R-Health (not affiliated with Rutgers) is now accepting pre-enrollment for November.


Paladina Health:

2. Rutgers Wellness Incentive (RU WELL)

This pilot has a targeted launch of January 1, 2018 and is a direct result of your Union’s efforts in Trenton. The pilot will allow you and another household member (spouse/child) to achieve up to $750 each per year in incentives for maintaining good health and/or by moving yourselves into better health through control and improvement of existing health conditions. Space will be limited to a few thousand employees. If you would like more information as it becomes available, let us know – .

Useful Websites and Contact Information

State of New Jersey - Division of Pensions and Benefits

Open Enrollment Homepage:

Plan Comparison Chart:

Premium Calculator (note that all Rutgers employees are at “Year 4” rates):



Rutgers University Human Resources:

Rutgers AAUP-AFT: ; (732) 964-1000

Consolidated Contact Info for the State and other Plan Administrators:

Please contact the Union if you have any difficulty accessing benefit information or timely responses from the State, UHR or any of the Plan Administrators listed above.

Rutgers AAUP-AFT
11 Stone Street
New Brunswick, NJ 08901
Phone: (732) 964-1000
Fax: (732) 964-1032
Main union email:


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