In September, the School Employees’ Health Benefits Commission (SEHBC) approved rates for the School Employees’ Health Benefits Program (SEHBP), from which many of our retired members received their benefits, for Plan Year 2025.
Rates will take effect January 1. You may view the rate by visiting the Division of Pensions & Benefits on or before January 1.
Non-Medicare retirees
There will be no change in the levels of either medical or OptumRx prescription benefits for 2025. Rates for non-Medicare Retirees will increase by 11.9% for medical, and 16.3% for prescription for a total of 12.8%.
There continue to be additional benefits that are enhancements to the NJEHP:
Everside Health will change its name to Marathon Health but will continue to be the Direct Primary Care Medical Homes provider. These programs provide primary care services for patients nationwide—in very different ways from a typical primary care practice. Retirees get convenient, personalized care with no co-pays and no out-of-pocket costs. Retirees also get direct access to their doctors, unhurried appointments that give you the time necessary to address your health concerns, and a broad scope of services that can eliminate or minimize costly specialist visits.
Medicare-eligible retirees
There will also be no change in the levels of either medical or OptumRx prescription benefits. Medicare-eligible retirees’ rates will increase by 5.2% for 2025.
The Aetna Educators Medicare Advantage plan will continue to use Medicare providers and still require members to use a Medicare-eligible doctor.
Members that use the Aetna Educators Medicare Advantage plan will have additional benefits:
Aetna Health Rewards—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 benefit 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 Medicare and Horizon BCBS as a supplement may choose from NJ Direct 15/25 or the other options available. If you want to make this switch, you must complete the change using Benefitsolver at http://mynjbenefitshub.nj.gov.
Dental coverage
The dental plans through the state dental coverage will change beginning January 2025.
The Dental Expense Plan (DEP) (also known as the dental PPO plan) will have several changes.
Aetna and Horizon will both be offering a DEP plan.
Implants are being added to the coverage. Members in Tier 3 will pay 50% of the approved cost for In-Network providers and 60% of the approved cost for Out-of-network providers. (Tier 3 applies to most retirees – you are only in Tier 1 or 2 for a period of time if you joined the retiree dental without existing dental coverage.)
The Individual Maximum for Tier 3 members will be increased from $1,500 per person to $3,000 per person for In-network providers and $2,000 per person for Out-of-Network providers.
A second plan, the Dental Expense Plan Plus, will also be offered that includes orthodontics for dependents up to the age of 19. The plan will pay up to $1,000 In-Network Lifetime payment and a $750 Out-of-Network Lifetime payment.
All DPOs will be eliminated except the Aetna DPO. The Aetna DPO is a dental HMO network and you must use an in-network dentist to have coverage.
There will be an open-enrollment in January and February for the new plans. Only Retirees that have not made a change in the last year will be able to make a change. Retirees will receive a post card and a mailer from Aetna and Horizon explaining the new plans. Members in the DEP that want to keep the plan with Aetna with the implants, and higher annual limit do not have to participate in the open-enrollment. Members that want to move into or out of the Aetna DEP or move to the new DEP will have to make the change. Members who are enrolled in one of the eliminate DPOs will all be moved to the Aetna DPO unless they make another choice. Please keep in mind that if you want to make changes to your plan choices, you must sign up for Benefitsolver.