From NJEA.org
Today, the School Employees Health Benefits Commission (SEHBP) released preliminary rates for the 2024 plan year, and the numbers are very encouraging for a new plan created three years ago to help control health insurance costs for school employees. The New Jersey Educator Health Plan (NJEHP), which currently covers 52% of active employees and all retirees not yet in Medicare, is projected to cost 3.8 percent less in 2024 than it does this year. Compared to the older Direct 10 and Direct 15 legacy plans, which are projected to increase by 26.8%, that result is even more stunning.
In an environment where double-digit premium increases are unfortunately common across the industry, a decrease is nearly unheard of. But this new plan, proposed and advocated for by NJEA as part of the Ch. 44 law passed and signed in 2020, is breaking that trend. That law – which made health insurance much less expensive for school employees – also promised at least $300 million in savings to the state and local employers over three years. The statement at today’s public meeting from the state’s actuary AON makes is clear that the state is very optimistic that we have exceeded that target. That will be confirmed in the final report, which is due by the end of July
Because the difference in rates between the NJEHP and the Direct 10 and Direct 15 legacy plans is so great, and because of the price shock that would come for districts and individuals still using the legacy plans, the actuary presented the Commission three options for how to set rates next year. NJEA supports the option to partially blend the rates for at least two years, to ease the transition to fully separate rates and to give more time for employers and individuals to better understand the advantages of the NJEHP.
NJEA’s officers, President Sean M. Spiller, Vice President Steve Beatty and Secretary-Treasurer Petal Robertson released this statement:
“Three years ago, when NJEA promised that Ch. 44 would be a win-win-win outcome for New Jersey, we meant it. We spent more than two years researching the root causes of high health insurance costs for our members, then creating and fighting for a solution that eventually became law. Our plan has brought major savings to our members, to districts and to the state. We are confident, based on the actuary’s public statement today, that we have exceeded the $300 million in savings promised by the law.
“It’s equally clear that the plan we helped create is helping to bend the health insurance cost curve down over the long term. In addition to the hundreds of millions it has saved the state and local employers, which directly benefits all taxpayers, it has put thousands of dollars back in the pockets of individual school employees, while continuing to ensure access to high-quality, affordable medical care.
“We have proved with this plan that when educators lead on matters that affect our profession, we make progress. At a time when our profession faces so many challenges, from an educator shortage, to high levels of stress and burnout, to an inadequate pension system, we are ready to work with willing partners in government to achieve more win-win-win solutions that benefit our members, our communities and the students we educate.”
Great Detailed Info on Chapter 44 HERE
My district is in the School Employee Health Benefits Program. How is the NJEHP different from Direct 10 and Direct 15?
The new plan is still valued at a platinum level plan and is similar to Direct 10 and Direct 15. The notable changes are an increase in copayment for the emergency room visits that do not result in a hospital admission, the out-of-network deductible and coinsurance, and a different reimbursement schedule for out-of-network providers. For prescription drugs, there is an increase in most copayments as well as mandatory use of generic drugs when they are available.
My district has a private plan. How is the NJEHP different from my current plans?
The NJEHP is valued as a platinum level. While it is easy to compare this plan to the SEHBP program, it is not easy for the approximately 400 districts that do not participate in the SEHBP. Each non-SEHBP plan has a unique set of benefits. You should work with your local president and your NJEA UniServ field representative to determine how the NJEHP compares to your current plan or plans.
What will the premium sharing be for my health insurance?
Those plans that have been collectively negotiated in your district will continue to be offered. The premium sharing for these plans will be based on what Ch. 78, Tier 4 levels or whatever other rate has been negotiated in your contract. The premium sharing for those plans remains negotiable.
Premium sharing for the NJEHP is based on a percentage of salary set in the law. For full details, see the chart on the next page.
Can I try the NJEHP for a year?
It depends. All new employees hired on or after July 1, 2020, must participate in the NJEHP or the GSHP. Employees hired prior to July 1, 2020, have the right to move between the NJEHP and their collectively bargained insurance plans during open enrollments offered at least once a year by their employer.
How much money will I save if I participate in the NJEHP?
The law guarantees your contribution in the NJEHP will be less than or equal to what you would have paid under P.L. 2011, Ch. 78. In most cases, even where a local has negotiated a reduced premium sharing for another plan, a member will save a significant amount of money if they select the NJEHP.
Will I have to change my doctors in the NJEHP?
No. The SEHBP NJEHP will use the same network of doctors in the state and outside of the state as the Direct 10 and Direct 15 plans. If you receive your benefits from a carrier outside the SEHBP, the network must be nationally established and substantially equivalent to the SEHBP network.
The NJEHP requires the mandatory use of generic drugs (when they are available.) What if I can’t take the generic medication?
If you have tried using generic medication without success, there is an appeal process. You should contact your provider’s office to discuss it. If your appeal is approved, you will not pay the difference.
Will my prescription drugs be covered?
The NJEHP covers prescription drugs and uses a closed formulary. When there are multiple medications available to treat the same medical condition, a prescription company creates a closed formulary list, which directs prescriptions to more cost-effective, clinically equivalent medications. The medications are determined by a team of physicians and pharmacists who review all medications on a regular basis. You should consult with your doctor for alternatives if your current prescription is not covered.
The NJEHP requires the mandatory use of generic drugs (when they are available.) What if I can’t take the generic medication?
If you have tried using generic medication without success, there is an appeal process. You should contact your provider’s office to discuss it. If your appeal is approved, you will not pay the difference.
