FREQUENTLY ASKED QUESTIONS
Q. Will the percentage of the premium (for Direct 10/15 members) and the percentage of salary (for Educators / Garden State members) that employees are responsible for paying remain the same as in the current state plans?
A. The employee contribution calculations have not changed. The Direct 10 and Direct 15 plans will still be subject to Chapter 78 calculations, and the NJEHP and GSHP will be subject to Chapter 44 calculations as laid out in the state regulations.
Q. It was mentioned that premium costs can't be officially shared until the agreement with Horizon is finalized, but can a cost/savings calculator still be provided to employees in advance of the enrollment period with "anticipated" pricing?
A. Unfortunately, we are not able to release anticipated rates, but the calculator will be available once the agreement has been Board approved. The cost difference will only impact Direct10 and Direct15 employee contributions, as Chapter 78 is based on a percentage of the premium. The cost difference does not impact the NJEHP and the GSHP, as the employee contribution is based on a percentage of their salary.
Q. Because the new plans "mirror" the state plans regarding coverage, should we anticipate that the premium costs will increase at the same rapid rate at the start of each new enrollment year, or at a slower rate?
A. As we make the change, our benefit premiums will be reviewed and projected on the district’s utilization (claims history). We are unable to predict future renewals, but under the SEHBP the majority of the groups are underperforming (meaning their claims experience is very high) and leading to dramatic changes in renewals. If a district has very high claims, it is a benefit to be in an insurance fund with other districts to offset those costs. If a district has lower claims, it is no longer a benefit to be part of that fund.
Q. The materials provided indicate that the new premiums "are 1% lower for medical, and .5% lower for prescription." Are we correct in interpreting that to mean that a $35,000 state plan premium (for example) would cost approximately $34,650 under this plan (i.e. a savings of $350)? Any clarification on the savings that employees can anticipate is appreciated.
A. The savings will vary by plan. The current Direct10 Family plan will see a reduction of about $55 per monthly premium. However, that is only through the end of the year. The state has already announced that starting 01/01/2026, there will be a significant rate increase on all health and prescription plans. The rates of the new plans will remain in effect until 07/01/2026 and we are avoiding another double digit increase from the SEHBP in January 2026
Q. At the start of each new coverage year (ex: 7/1/26), will Horizon continue to honor the salary % contribution cap in accordance with the rates prescribed by the state in Ch. 44, or do they reserve the right to increase the salary % contribution cap at their discretion?
A. Any employee contributions are based upon the contract between the bargaining unit and the employer, or any state regulation. This is not set by the insurance carrier. There are no differences to the Chapter 44 contributions, as that is currently dictated by NJ State Regulations.
Q. What are the anticipated dates of the open enrollment period that will be held if/when the new insurance plan is approved by the Board of Education? And to clarify: will those who are not currently covered by the district's insurance policy have the opportunity to enroll at this time?
A. Open Enrollment will need to occur during the month of May. Firm dates have not been established yet, but will be communicated shortly. It will be a full open enrollment so employees will have the option to newly enroll, change coverage (if eligible), and adjust their dependents' status. Please note that if you are not making any changes, there is nothing for you to do. Your current plan selection and dependents will automatically be moved into the new plan.
Q. What is the process for adding dependents onto coverage? Also, is there a specific window of time after the qualifying life event when EEs need to make their change? And how will this affect the cost of their monthly premiums?
A. You can add a dependent to the plan during open enrollment. If you need to do so outside of the open enrollment period, you need to experience a Qualifying Life Event (QLE). This includes situations like the birth of a child, adoption or marriage. You must notify HR within 30 days of the QLE to ensure that it meets the requirements and to make the change. The effect on the premium could increase if it requires a change in contract type.
Q. Would employees that were hired after 7/01/20 now be eligible to enroll in the Direct 10/15 plans?
A. No, the same eligibility requirements remain in place. This is stipulated under Chapter 44 of NJ regulations and is not subject to change.
Q. What would happen to the coverage for dependents that reach 26; would their coverage still end on 12/31 of the year they turned 26? Or would their medical/prescription coverage end at the end of the month when they turned 26, much like how it ends for dependents that reach age 23 for the dental and vision coverage?
A. There is no change in how this is handled. The rules and regulations that are currently in place will remain in effect. A dependent coming off the policy due to age will be covered until the end of the year for medical and prescription benefits.
Q. What does the formulary mean in reference to prescriptions?
A. The formulary is a list of prescription drugs that an insurance carrier uses to identify what drugs are covered, the tier they are covered at, and if they require distribution limits or prior authorization.
Q. Will EEs have access to view their benefit information on the Horizon site like they do on the State’s site Benefitsolver?
A. No, BenefitSolver is a benefit administration system used by the state of NJ. However, employees will have access to all their benefit and claim information on the Horizon BCBSNJ website member portal. Many employees currently use this as it provides significantly more information. We have also launched our benefits website, which will be updated with the new plan documents as we get closer to 07/01/2025.
Q. Will employees still be eligible to participate in NJWELL and bFIT?
A. Employees will still access the Horizon bFit program. We will no longer have access to the NJWell program, as that is exclusive to groups that participate in the state program.