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Health benefits
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2020 SEHBP rates set Retiree Dental Expense Plan (DEP)
In September, the School Employees’ Health Benefits Commission (SEHBC) approved rates for the School Employ- ees’ Health Benefits Program (SEHBP), from which many of our retired members received their benefits, for Plan Year 2020.
Rates will take effect January 1. To view the rates for 2020, visit https://www. state.nj.us/treasury/pensions
Non-Medicare retirees
The SEHBC acted on rates that reflect no changes in benefit levels for the health plans this year. However, there will be a change in the carrier for all non-Medicare retirees. Aetna will no longer be offered as an option. Horizon Blue Cross
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Blue Shield (BCBS) will be the only carrier for these plans. How- ever, Aetna will continue to carry their current dental plans.
For those retirees who pay for their medical benefits out-of- pocket, the overall renewal rate decreased by 4.8 percent for all non-Medicare retirees. Retirees who contribute toward the cost of post-retirement medical benefits will see this decrease.
Medicare-eligible retirees
There will be no change in the levels of either medical or OptumRx prescription benefits.
Aetna will continue to be the only carrier for Medicare-eligible retirees in the Aetna Educators Medicare Advan- tage plan. The Aetna Educators Medicare Advantage plan will continue to use Medi-
care providers and still require members to use a Medicare-eligible doctor. However, there are three additional benefits that are enhancements to the original Medicare offerings:
NJWELL – Previously, retirees enrolled in SEHBP were not permitted to partic- ipate. Now, retirees and their spouses/ partners will be able to take advantage of the incentives offered to all members who strive to stay healthy.
Copay Reimbursement – Members and their covered spouses/partners will be reimbursed their $10 copay for up to 25 physician visits each year. This unique ben- efit can provide each with an additional
$250 in returned out-of-pocket expenses. Optional care – Members and their covered spouses/partners may have an
optional home visit by a nurse practitioner to set up a personal care plan. The plans will include access to a 24/7 registered nurse helpline to assist members with their healthcare needs and questions.
Members who wish to use traditional
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Division of Pensions and Benefits, SHBP/SEBBP COVID-19 Response
The Division of Pensions and Benefits, together with our vendor partners Aetna. Horizon BCBSNJ, and OptumRx, are taking action to ensure that State Health Benefits (SHBI>) and School.Employees Health Benefits (SEHBP) members have the support and resources they need during the COVID-19 situation, which remains dynamic and evolving.
The Division of Pension and Benefits has advised the Third Party Administrator for the SHBP and SEHBP that, effective immediately, all cost sharing foremergem:y room (in or out of network hospitals). urgent care (in network), or provider office visits (in network) associated with medically necessary testing for COVID-19 are to be waived. The Third Party Administrator has been directed to inform contracted providers about the waiving of cost sharing.
The Phannacy Benefit Manager has been directed, effective immediately, to lessen restrictions on early refill for Rx on maintenance medications so that individuals have access to medically necessary medications without waiting until the end of prescription cycle.
Questions about Testing Coverage through Horizon BCBS
- Should I get tested if I don’t have symptoms?
Please note that testing asymptomatic individuals is not medically indicated and is against the current advice of the Centers for Disease Control and Prevention (CDC) and World Health Organization(WHO). CDC recommends voluntary home quarantine for those who have traveled to/from countries where COVID-19 has spread or who have been exposed to individuals with the virus.
- If I do get tested for COVID-19, will I pay co-payment or co-insurance?
All cost sharing for emergency room (in or out of network hospitals), urgent care (in network). or provider office visits (in network) associated with medically necessary evaluation and testing for COVID-19 are to be waived. Home.on BCBS will instruct providers that they should bill all evaluation and testing services related to COVID-19 to ICDl0 Code Z20.828 and instruct all providers that no cost sharing is to be collected from SHBP/SEHBP members.
Q. Will treatment or a COVID-19 vaccine be covered by insurance?
At this time. there is no specific antiviral treatment or vaccine for COVID-19. Members should call their doctors to ask about care to help relieve symptoms as they would for other viral respiratory infections. Horizon BCBSNJ will continue to cover medically necessary health care costs to treat infectious diseases, including COVID-19, based on the terms of the SHBP/SEHBP.
Q. Are telemedicine services covered to ensure access to care while reducing the opportunities for disease transmission?
SHBP/SEHBP members will have no cost, 24n access to licensed nurses who can assess and assist members with symptoms that are consistent with suspected COVID-19 infection available through the Horizon Blue app, the secure member portal, or by phone at 1-888–624-3096.
Q. Will Horizon BCBSNJ waive prior authorization requirements for treatment of COVID-19?
The Division will ensure that Horizon will:
- Waive prior authorizations fora visit to a primary care physician, urgent care center, or emergency room for evaluation of upper respiratory symptoms. fever, shortness of breath or other conditions that may represent COVID-19.
- Waive prior authori7.ations for diagnostic tests and for covered services that are medically necessary and consistent
with CDC guidance if diagnosed with COVID-19.
- Waive prior authoriz.ation for lab studies or diagnostic testing required during an ER evaluation or inpatient hospital stay.
Questions about Testing Coverage through Aetna Medicare Advantage
Q. What resources are available to Aetna Medicare Advantage Member?
Effective immediately, SEHBP and SHBP Aetna Medicare Advantage members will have access to the following resources:
Aetna will provide all diagnostic testing related to COVID-19 at no cost to you. This policy will cover the test kit for patients who meet CDC guidelines for testing, which can be done in any approved laboratory location. Aetna will waive the member costs, if any, associated with diagnostic testing at any authorized location for SEHBP and SHBP Medicare members.
Through Aetna’s Healing Better program, members who are diagnosed with COVID-19 will receive a care package containing CVS over-the-counter medications to help relieve symptoms. The package will also include personal and household cleaning supplies to help keep others in the home protected :from potential exposure.
Through existing care management programs, Aetna will proactively reach out to members most at-risk for COVID-19. Care managers will walk members through what they can do to protect themselves, where to get information on the virus, and where to go to get tested.
Questions about Prescriptions through Optum.Rx
Q. Can I fill my prescriptions early to avoid running out?
To ensure that our members with prescription drug coverage through the SHBP/SEHBP continue to have uninterrupted access to medications, the “Refill Too Soon” (RTS) restriction on prescriptions obtained at retail pharmacies will be suspended through March 31st• Typically, prescriptions need to reach a threshold of remaining days’ supply before a refill can be dispensed again. Suspension of this restriction will enable members and patients to refill prescriptions before reaching this threshold and will ensure sufficient quantities of medication remain available to them.
The Division will continue to rigorously monitor the COVID-19 situation and determine what additional actions beyond March 31st might be necessary.
Additional Resources:
We encourage you to get the latest coronavirus news :from credible information sources listed below.
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- World Health Qrcanization
- Centers for Disease Control and Prevention {CDC)
- National Institutes of Health
- The New Jersey Qmu:tment of Health or call the 24-hour public hotline at 1–800-222-1222
- Waive prior authoriz.ation for lab studies or diagnostic testing required during an ER evaluation or inpatient hospital stay.
Questions about Testing Coverage through Aetna Medicare Advantage
Q. What resources are available to Aetna Medicare Advantage Memben?
Effective immediately, SEHBP and SHBP Aetna Medicare Advantage members will have access to the following resources:
Aetna will provide all diagnostic testing related to COVID-19 at no cost to you. This policy will cover the test kit for patients who meet CDC guidelines for testing, which can be done in any approved laboratory location. Aetna will waive the member costs, if any, associated with diagnostic testing at any authorized location for SEHBP and SHBP Medicare members.
Through Aetna’s Healing Better program, members who are diagnosed with COVID-19 will receive a care package containing CVS over-the-counter medications to help relieve symptoms. The package will also include personal and household cleaning supplies to help keep others in the home protected :from potential exposure.
Through existing care management programs, Aetna will proactively reach out to members most at-risk for COVID-19. Care managers will walk members through what they can do to protect themselves, where to get information on the virus, and where to go to get tested.
Questions about Prescriptions through Optum.Rx
Q. Can I fill my prescriptions early to avoid running out?
To ensure that our members with prescription drug coverage through the SHBP/SEHBP continue to have uninterrupted access to medications, the “Refill Too Soon” (RTS) restriction on prescriptions obtained at retail pharmacies will be suspended through March 31st• Typically, prescriptions need to reach a threshold of remaining days’ supply before a refill can be dispensed again. Suspension of this restriction will enable members and patients to refill prescriptions before reaching this threshold and will ensure sufficient quantities of medication remain available to them.
The Division will continue to rigorously monitor the COVID-19 situation and determine what additional actions beyond March 31st might be necessary.
Additional Resources:
We encourage you to get the latest coronavirus news :from credible information sources listed below.
-
- World Health Qrcanization
- Centers for Disease Control and Prevention {CDC)
- National Institutes of Health
- The New Jersey Qmu:tment of Health or call the 24-hour public hotline at 1–800-222-1222
- Waive prior authoriz.ation for lab studies or diagnostic testing required during an ER evaluation or inpatient hospital stay.
Questions about Testing Coverage through Aetna Medicare Advantage
Q. What resources are available to Aetna Medicare Advantage Members?
Effective immediately, SEHBP and SHBP Aetna Medicare Advantage members will have access to the following resources:
Aetna will provide all diagnostic testing related to COVID-19 at no cost to you. This policy will cover the test kit for patients who meet CDC guidelines for testing, which can be done in any approved laboratory location. Aetna will waive the member costs, if any, associated with diagnostic testing at any authorized location for SEHBP and SHBP Medicare members.
Through Aetna’s Healing Better program, members who are diagnosed with COVID-19 will receive a care package containing CVS over-the-counter medications to help relieve symptoms. The package will also include personal and household cleaning supplies to help keep others in the home protected :from potential exposure.
Through existing care management programs, Aetna will proactively reach out to members most at-risk for COVID-19. Care managers will walk members through what they can do to protect themselves, where to get information on the virus, and where to go to get tested.
Questions about Prescriptions through Optum.Rx
Q. Can I fill my prescriptions early to avoid running out?
To ensure that our members with prescription drug coverage through the SHBP/SEHBP continue to have uninterrupted access to medications, the “Refill Too Soon” (RTS) restriction on prescriptions obtained at retail pharmacies will be suspended through March 31st• Typically, prescriptions need to reach a threshold of remaining days’ supply before a refill can be dispensed again. Suspension of this restriction will enable members and patients to refill prescriptions before reaching this threshold and will ensure sufficient quantities of medication remain available to them.
The Division will continue to rigorously monitor the COVID-19 situation and determine what additional actions beyond March 31st might be necessary.
Additional Resources:
We encourage you to get the latest coronavirus news :from credible information sources listed below.
-
- World Health Qrcanization
- Centers for Disease Control and Prevention {CDC)
- National Institutes of Health
- The New Jersey Qmu:tment of Health or call the 24-hour public hotline at 1–800-222-1222
NJREA Newsletter • December 2019 • njea.org/njrea