Health Benefits Report
While we continue to work on the unconscionable rate increase with anyone who will listen including legislators, other labor unions, the League of Municipalities, the Association of Counties and even the governor’s office — we need you to be prepared to walk into this situation educated and with eyes wide open.
As we always tell you, your health care decisions are specific to you and your family. These are personal to you, and we will not tell you that there is a one-size-fits-all approach. The state has many plan offerings, and this might be the year to switch plans if it fits your family’s needs. Please review the plan designs and premiums on the SHBP web site: https:// www.state.nj.us/treasury/pensions/hb-active-shbp.shtml.
One option you might want to evaluate is a tiered network or, as Horizon calls it, an Omnia plan. The premise of this plan is that there are two tiers of providers and no out-of-network benefits. You can access participating providers through their website at https://www.horizonblue.com/shbp/plans/medical-plans/local-government-employee-plans/omnia-health-plan-0. This plan provides for low out-of-pocket costs when you utilize the Tier 1 network, but in Tier 2 you must pay the first $1,500 out of pocket, then copays that currently start at $15 per visit. This plan is more restrictive but might be a fit for you.
While there are devastating consequences for using out-of-network providers in this plan, there is a potential premium share savings of $2,500 per year for a member at top pay with family coverage.
We are continuing our work to mitigate these rate increases, but you need to know that some of the proposals have draconian cost-shifting components that would increase some copays by 300 percent. Obviously, we have a reasonable outlook but cannot allow the mistakes of the division and Horizon to permanently impact the health care of our members.
Please make sure you monitor all our media outlets, as you are permitted to make open enrollment changes beginning Oct. 31. We will get information to you as it develops.