Health Benefits Frequently Asked Questions

Where can I find more information on the plans or if my doctors participate?
To find more information what is covered under the plans, go to the State of New Jersey Division of Pensions and Benefits website and look at open enrollment for local education plans: http://www.state.nj.us/treasury/pensions.
 
What is a PPO and an HMO?
A PPO is a Preferred Provider Organization. This means that you have a primary care provider who directs you to specialists as needed without having to have a referral. This can be a little more expensive because you have the flexibility of going without referral based appointments.
An HMO is a Health Maintenance Organization. This means that you would need to go to your primary care physician and if they need you to go to a specialist, you would need a referral to go to the next office. This is now relatively easy and can be cheaper than most plans.
What documents are needed to add or remove a dependent?
In order to add or remove a dependent, please read below for the specifics on what documents you need to have with you when you enroll your dependent as well as specifics on who qualifies for a dependent and why.
 
Spouse
  • A photocopy of Marriage Certificate;
  • A photocopy of front page of most recently filed Federal tax return (Form 1040)
Civil Union Partner
  • A photocopy of NJ Civil Union Certificate or valid certification from another jurisdiction that recognizes same-sex civil unions;
  • A photocopy of front page of most recently filed NJ tax return that includes the partner OR photocopy of a recent (within 90 days of application) bank statement or bill that includes the names of both partners and is received at the same address.
Domestic Partner
  • A photocopy of NJ Certificate of Domestic Partnership dated prior to February 19, 2007 or a valid certification from another jurisdiction that recognizes same-sex domestic partnerships;
  • A photocopy of front page of most recently filed NJ tax return that’s includes the partner or a photocopy of a recent (within 90 days of application) bank statement or bill that includes the names of both partners and is received at the same address.
Children (under age 26)
Natural or Adopted Child
  • A photocopy of the child’s birth certificate showing the name of the employee as parent
  • If your child has a different last name or is newly adopted, an Affidavit of Dependency form must be completed and returned with the health and dental application(s). Please provide your child’s social security number as soon as it is available.
Step Child
  • A photocopy of the child’s birth certificate showing the name of the employee’s spouse/partner as a parent and a photocopy of the marriage/partnership certificate showing the names of the employee and spouse/partner
  • If your child has a different last name or is newly adopted, an Affidavit of Dependency form must be completed and returned with the health and dental application(s). Please provide your child’s social security number as soon as it is available.
Dependent over age 26: Children with Disabilities
  • If a child is not capable of self-support when he or she reaches age 26 due to mental illness, mental disability, or a physical disability, he or she may be eligible for a continuance of coverage.
  • Coverage for children with disabilities may continue only while:
(1) you are covered through the SHBP or SEHBP, and
(2) the child continues to be disabled, and
(3) the child is unmarried, and
(4) the child remains dependent on you for support and maintenance and lives with you.
You will be contacted periodically to verify that the child remains eligible for continued coverage.
  • A Continuance for Dependent with Disabilities form and proof of the child's condition must be provided to the Division of Pensions and Benefits no later than 31 days after the date coverage would normally end. Since coverage for children ends on December 31 of the year they turn 26, the Continuance for Dependent with Disabilities form must be filed prior to January 31 of the year following the child's 26th birthday.
To request continued coverage, contact the Office of Client Services at (609) 292-7524 or write to the Division of Pensions and Benefits, Health Benefits Bureau, 50 West State Street, P. O. Box 299, Trenton, New Jersey 08625 for a Continuance for Dependent with Disabilities form.
Over Age 26 Dependent
  • Certain children over age 26 may be eligible for continued coverage until age 31 under provisions of Chapter375. P.L. 2005 (e.g. children with special needs). The employee will be responsible for the entire cost of the coverage and will be billed directly.
Please remember that dual coverage is prohibited. State statue prohibits two members who are enrolled in SHBP/SEHBP plans from covering each other. In addition, eligible children may only be covered by one participating SHBP/SEHBP subscriber.

 

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