What You Need to Know About the State Health Benefits Plan in 2018

Updated September 7, 2017

ATTENTION CWA State Health Benefits Plan Members: Your employer will distribute open enrollment information during the month of October. Our union is sending this update now, so you can begin evaluating your health care needs and determine if any changes are appropriate for your personal situation. As the State puts out more information during the month of October, we will send additional updates to the membership.
Union-Led Efforts Result in NO Increase in Premium Rates

Because of the work of the union members on the State Health Benefits Plan Design Committee (SHBPDC), rates for all State Health Benefits plans will NOT go up for Plan Year 2018. This is the first time that healthcare costs have not increased since the passage of Chapter 78 and the cause of this savings was the unions, NOT the Christie Administration.

CWA members are represented on the Plan Design Committee by the 6 Union representatives, including 3 AFL-CIO Representatives: Hetty Rosenstein (CWA), Bob Little (AFSCME), and Patrick Nowlan (AFT/AAUP).  The Union side of the PDC has created innovative approaches to healthcare that have saved money, but NOT at the expense of workers.  Instead, the unions have created efficiencies and have changed the management of the prescription system, so that the State is not being gouged by the Pharmacy Benefits Manager.

In addition to the innovations that have kept premiums from rising, you may also be able to take advantage of union-developed programs to save a significant amount of money on healthcare. Here’s how:


Better Care at No Cost with Direct Primary Care

The Direct Primary Care Medical Home (DPCMH) pilot project is a concierge-like healthcare plan that was designed by CWA and the other unions’ representatives.  The DPCMH is an add-on to any of the NJ Direct or tiered network plans, that you can join anytime during the year and that you can have AT NO CHARGE.  If you select one of the pilot medical practices, where the doctors are being paid a SALARY, instead of being paid more based upon the more patients that they see, you will pay absolutely NO COPAYS no matter how many times you see the doctor. It provides:

  • Unlimited access to a personal physician for members and their families.
  • Same-day and next-day appointments
  • Evening and weekend hours
  • Longer appointments
  • Little to no time in the waiting room
  • Access to the doctor via cell phone, e-mail, and digital messaging
  • On-site lab draws at no cost.
  • On-site dispensing of a 7-day supply of medications for acute conditions at no additional cost to you
  • On-site immunizations at no cost.
  • Some practices provide complete family care for children and parents at the same office.

Two healthcare companies currently provide these services: R-Health and Paladina Health.  There are R-Health practices in Cherry Hill, Voorhees, Ewing, Hamilton, Moorestown, Haddonfield and Washington Crossing. This fall, R-Health will open a practice in New Brunswick and additional practices are opening all of the time.  If you would like to come to a presentation and meet with a doctor, sign up at: www.r-health.md/nj. Paladina Health has a brand new state-of-the-art office in Hamilton and will also open an office in Clifton this fall. If you would like information and find out about open houses, sign up here: https://www.paladinahealth.com/form/membership-info-SONJ-members


Tiered Network Incentives Continue

Both Horizon and Aetna have designed specific tiered networks for the State Health Benefits Plan— Horizon OMNIA and Aetna LIBERTY.  If you choose to go into either of these plans, your premium will drop by 25%. If you are a state employee (or a local government employee where the union has negotiated incentives), you will also receive an incentive rebate of $1000 for single coverage, $1500 for Parent-Child or Spouse coverage, and $2000 for Family Coverage. This incentive is paid by gift card within the first quarter of Plan Year 2018, and is deemed reportable income for tax purposes.

Before you switch plans to Omnia or Liberty, please research your doctors and hospitals carefully. You will save if you go to Tier 1 providers but you could pay more if you go to Tier 2 providers. You must use doctors and hospitals that are in the plans.  If you use a Tier 1 doctor or hospital, you will have a $5 copay for a primary physician and a $15 copay for a specialist.  If you use a Tier 2 doctor or hospital, you will have a deductible and 70% will be paid for. BUT— except for emergencies or if you are out of state— if you voluntarily go to a doctor or practice that isn’t in Tier 1 or 2 it won’t be covered.

You are okay if it is emergency services in or out of state – then it is treated as Tier 1.

If you have a doctor that you are very attached to, who is not a Tier 1 doctor and who does not use a Tier 1 hospital, CWA does not recommend that you switch to a tiered network plan. (But check – because if your doctor or hospital isn’t in Horizon’s Omnia, s/he or it may be in Aetna’s Liberty.)

If your doctor is in the Tiered Network, and if you can use Tier 1 doctors and hospitals, you will save a great deal of money.  (Please note: the Tiered network charges $7 generic and $16 brand for prescription copays which may be slightly higher than your copays in a Direct plan.) You can check and see if your doctor(s)/ hospitals are in Aetna Liberty at aetna.com/docfind/custom/statenj and Horizon Omnia at doctorfinder.horizonblue.com.

To find out more about the Tiered Networks, go here: http://www.nj.gov/treasury/pensions/hb_open_enrollment_2016/sbc/sbc019.pdf and here: http://www.nj.gov/treasury/pensions/hb_open_enrollment_2016/sbc/sbc020.pdf


Combine Direct Primary Care with a Tiered Network Plan

THE SWEET SPOT— See if you can combine the DPCMH with a Tiered Network plan. EVERY primary care doctor who is in R-Health or Paladina practices is automatically a Tier 1 doctor in the Tiered Network plans. If you switch to the Tiered Network and combine it with the DPCMH, you would save 25% off of your premium, you would get the $1000 – $2000 incentive, and you would get CONCIERGE primary health care with no co-pays, no gate keeper, in office lab draws, no wait times, and a personal physician who you and your family can develop a relationship with.This incentive is paid by gift card within the first quarter of Plan Year 2017, and is deemed reportable income for tax purposes.


NJ Wellness

“I like my doctor and I want to stay in the Direct 15 plan. Is there anything that I can do to save money?”

Sign up for the NJ Wellness Plan – NJWELL – and you can earn up to $250 annually in incentives.  By enrolling in NJWELL and participating in health assessments, screenings, flu shots, online coaching, and activities participants can earn points towards gift cards. Information on NJWELL can be found at: http://www.state.nj.us/treasury/pensions/njwell/


Recommendations

CWA has been on the cutting edge of trying to push back health care costs without cost-shifting.  Chapter 78 has harmed our members, caused healthcare to be too expensive, and has encouraged cost-shifting instead of cost containment.

The Direct Primary Care Medical Home model of health care is a pilot project that has the potential to save hundreds of millions of dollars in healthcare cost while providing the best healthcare available.  If this is something that works for your family, we recommend that you investigate it.  The Tiered Network will only work for people who are willing to switch doctors or who, UPON REVIEW, see that their doctors are in the Tiered Network.  The Networks are very large, and so it may be that this will work for you.  CWA urges our members to consider these options.

A new Administration and a reasonable Governor will hopefully lead to a more reasonable cost sharing on healthcare– but if you can, you should consider reducing your costs with these union-negotiated plans.