#HORIZON DIRECT ACCESS DESIGN 10 HOW TO#

The Unreimbursed Medical Flexible Spending Account (FSA) allows an employee to set aside money to pay for qualified medical and dental expenses not paid by any group benefits plan under which the employee and dependents are covered.Important Note: Enrollment in the FSA does NOT carry over from the previous year. 2023 information will be finalized and updated as soon as information becomes available. Simply choose a Direct Primary Care Doctor from Everside Health (formerly Paladina Health and R-Health) or Sanitas Medical Center and get unlimited access to personalized care with no co-pays, when and where it’s convenient for you.Ī wellness rewards program is offered to active employees of the public sector who participate in the State Health Benefits Program (NJ SHBP) and their covered spouses/partners.Īllows eligible full-time employees to set aside before-tax dollars to pay for certain medical, dental, and dependent care expenses, thereby avoiding federal taxes and saving money. The New Jersey State Health Benefits Program (NJ SHBP) offers employees and their covered dependents the opportunity to join a Direct Primary Care doctor’s office at no additional cost. After satisfying an annual deductible (no deductible for preventive services), members are reimbursed a percentage of the reasonable and customary charges for eligible services. The Dental Expense Plan is a Preferred Provider Organization (PPO) plan that allows members to obtain services from any dentist however, using an in-network provider will reduce an employee’s costs.Be sure to confirm that the dentist or dental facility is taking new patients and participates with the SHBP Employee Dental Plans since DPOs also service other organizations. Members must use a provider participating with the selected DPO to receive coverage. Most other eligible expenses require a small copayment. When an employee or dependent uses a DPO dentist, diagnostic and preventive services are covered in full.

Six different dental plans are offered based on one of two different plan designs - Dental Plan Organizations (DPO) and a Dental Expense Plan (DEP).ĭPOs contract with a network of providers for dental services. This program does not extend to children over the age of 26 or COBRA members.ĭental coverage is offered to eligible employees through the Employee Dental Plans. The incentive shall be forfeited and returned to the SHBP if the subscriber fails to remain enrolled in the Tiered-Network Plan for at least one plan year. The incentive is paid by gift card no later than the end of the current tax year and is deemed reportable income for tax purposes. The program offers a financial incentive of $1,000 to first-time enrollees who remain enrolled for one year for all coverage levels (i.e., Single, Member and Spouse, Parent and Child, or Family coverage). Incentive Program for the Tiered Network Plan The plan overviews provided by Horizon contain a side-by-side view of the basic benefits, copayments, and other out-of-pocket costs for the SHBP medical and prescription drug plans. The NJ SHBP 2023 Plan Overviews are being finalized and posted soon. Members hired after July 1, 2019, will be enrolled in CWA Unity DIRECT 2019. Members hired prior to July 1, 2019, will be enrolled in CWA Unity DIRECT. Members hired after July 1, 2019, will be enrolled in NJ DIRECT 2019. *Members hired prior to July 1, 2019, will be enrolled in NJ DIRECT.

CWA Unity DIRECT/CWA Unity DIRECT 2019**.

» Visit the NJ State Health Benefits Program – Virtual Benefits Fair

#HORIZON DIRECT ACCESS DESIGN 10 HOW TO#

» Learn how to access Benefitsolver (PDF) Important Note: Employees who have already waived coverage do not need to elect to waive each open enrollment period.īenefitsolver is a website portal for employees to review, enroll in their health benefits, make plan changes, add new dependents, and upload documentation. State employees can elect to waive coverage at any time or during Open Enrollment.Dual coverage in the NJ SHBP is not permitted.

State employees are permitted to waive NJ SHBP medical and prescription coverage.Important Note: This is a passive open enrollment! This means that if you are satisfied with your elections, there is no action required with the exception of the FSA accounts. If/or changes are made during the open enrollment, the effective date is January 1, 2023. Open Enrollment provides you with an opportunity to review and make changes (adding or deleting dependents, changing coverage levels, etc.) or enroll in a different medical or dental plan. As state employees, our benefits are administered by the NJ State Health Benefits Program (NJ SHBP).

Horizon direct access design 10