New Jersey State Health Benefits Program

Aetna Liberty Plan

You have the liberty to choose! Select the Aetna Liberty Plan if you want a lower monthly premium and low out of pocket costs when visiting Aetna’s Tier 1 providers. The Aetna Liberty plan is easy to use and allows you access to specific providers in Aetna’s Liberty Tier 1 or Tier 2 networks.

To find more information on the pharmacy copayments connected to your medical plan, view the Pharmacy Copayments document. You may also visit the Division of Pensions and Benefits website.

How the Plan works:

Step 1: Decide if you want to go to an Aetna Liberty Tier 1 or Tier 2 provider. You will pay less visiting a Tier 1 doctor.

• Make sure you consider the Aetna Liberty Tier 1 network. When you use these providers, you’ll pay less out of pocket and save!
• Aetna’s Liberty Tier 1 providers are located in New Jersey, Southeastern Pennsylvania and Metro New York. Even better, you still have access to Aetna’s large nationwide network. If you visit a provider outside of New Jersey, Southeastern Pennsylvania and Metro New York and they are in-network, your eligible services will be considered Tier 2. All providers in New Jersey, Southeastern Pennsylvania and New York are not in Tier 1, so visit DocFind® to confirm if you provider is in Tier 1 of the Aetna Liberty Plan.
• You have the liberty to choose any doctor in Aetna’s Liberty plan networks. But, with so many primary care doctors and specialists in Aetna’s Tier 1 network, chances are your doctor is one of them. You can find out right now! Visit your custom DocFind® site to search by a specific name or by zip code.

Step 2: Visit your doctor or other health care provider.

• Show your Aetna Member ID card when you go.
• Network doctors will submit claims. If you go outside the network, you can download claim forms from your secure Aetna Navigator® website.
• Network doctors will precertify services like hospital stays and outpatient surgery on your behalf. If you go outside the network, you may have to get those permissions yourself. Just call the toll-free number on your Aetna Member ID card to do so.

Step 3: Pay your share of the cost.

• You’ll pay less out of pocket costs visiting a Tier 1 provider. When visiting a Tier 1 provider you pay a flat copay or nothing at all!
• If you visit an Aetna Liberty Tier 2 provider, you will pay a percentage of the cost for most services. But, with so many doctors and facilities in Aetna’s Liberty plan network, chances are that your doctor’s may participate in the Tier 1 network already.

Do you know what plan you want?

Aetna Freedom Plans

Four Aetna Freedom plans:
Preferred Provider Organization (PPO)

• Aetna Freedom 15
• Aetna Freedom 1525
• Aetna Freedom 2030
• Aetna Freedom 2035

Enjoy the freedom to visit any health care professional nationwide – in or out of the Aetna network. Aetna Freedom plans have either a modest deductible or no deductible at all, and require a copay or coinsurance. Preventive care is covered at 100% - without a copay.

To find more information on the pharmacy copayments connected to your medical plan, view the Pharmacy Copayments document. You may also visit the Division of Pensions and Benefits website.

How the Plan works:

Step 1: Decide if you want to go in-network or out-of-network for your care.
You have the freedom to choose any doctor — in or out of the Aetna network. But, with so many primary care doctors and specialists in New Jersey’s Aetna network, chances are your doctor is one of them. You can find out right now! Visit your custom DocFind® site to search by a specific name or by zip code.

Step 2: Visit your doctor or other health care provider.

• Show your Aetna Member ID card when you go.
• Network doctors will submit claims. If you go outside the network, you can download claim forms from your secure Aetna Navigator® website
• Network doctors will precertify services like hospital stays and outpatient surgery on your behalf. If you go outside the network, you may have to get those permissions yourself. Just call the toll-free number on your Aetna Member ID card to do so.

Step 3: Pay your share of the cost.

• You’ll generally pay less if you stay in the Aetna network. We negotiate rates with providers in the Aetna network. But, we cannot control the amount an out-of-network provider may charge.
• Most Aetna Freedom plans have no deductible for in-network services and a modest deductible for out-of-network services.
• You pay a flat copay for most in-network services. If you go outside the network, you pay a percent of the cost.

Do you know what plan you want?

Aetna Value HD Plans

Two Value HD plans:
High Deductible Health Plans (HD)

• Aetna Value HD1500*
• Aetna Value HD4000

An Aetna Value HD plan allows you to get more value with a low premium in exchange for a high deductible. Need to see a doctor — enjoy the freedom to choose any health care professional — in or out of the Aetna nationwide network. You can also build a tax-advantaged Health Savings Account (HSA) to put money aside for qualified health care expenses or even save towards retirement with pretax dollars. In 2017, you may contribute up to $3,400 for individuals and up to $6,750 per family.

You control your health care spending with tools that can help you find the best value for your money. You can also build a tax-advantaged HSA to help pay your share of any health care costs.

For High Deductible Health Plans, prescription drug coverage must be through the SHBP/SEHBP medical plan and are subject to the plan’s deductible and coinsurance amounts. To find more information about your pharmacy coverage, please visit the Division of Pensions and Benefits website.

How the Plan works:

Step 1: Make contributions to your PayFlex® HSA.

• Your contributions are tax free
• Your interest earned is tax free
• You pay no taxes on qualified expenses when you use your funds
• You get investment options when your balance reaches $1,000

What a great value!

Step 2: Visit a health care professional.
You may use in or out-of-network doctors, hospitals and other health care professionals. Network doctors are a smart value because we’ve negotiated special rates for Aetna members. You can use the Aetna price and quality comparison tools to shop for the best value.

Network doctors will also submit claims and get approvals for you. You never need referrals with an Aetna Value HD plan.

Step 3: Pay your share of the cost.
You must first meet a deductible before the plan begins to pay benefits. You choose whether to pay out of your own pocket or use the funds in your HSA.

*Part-time employees are not eligible for the Aetna Value HD1500 plan.

Get to know Money2℠ for Health

A simple way to make health care payments.
We know making the right choices for your health is not always easy. But making health care payments should be. That’s why we’re excited to offer Money2 for Health, a time-saving tool. This new service will help you make payments to many doctors, specialists or hospitals from one easy place. You can access Money2 for Health directly or on your secure member website.

Click here to learn more about how as an Aetna Value HD member you can use Money2SM for Health to pay your medical bills and save time! (Link the click here to the Money2 brochure).

The PayFlex® HSA Account

You can watch the videos below to learn more:

• Using Your PayFlex Card® Click here to watch
• Staying Connected with PayFlex Mobile® Click here to watch
• Making the Most of Your PayFlex® Account (e-tools) Click here to watch
• Investing With Your HSA Click here to watch

Do you know what plan you want?

Apple is a trademark of Apple Inc., registered in the U.S. and other countries. App Store is a service mark of Apple Inc.

Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies,including Aetna Life Insurance Company and its affiliates (Aetna).

This material contains only a partial description of the Money² for Health program. Information is believed to be accurate as of the production date; however, it is subject to change without notice. Please visit www.health.money2.com/about for the most up-to-date information. The Money² for Health program is administered by Citibank, N.A and subject to the terms of the agreement between PayFlex®, Aetna and Citibank, N.A. Aetna and/or PayFlex will receive a fee from Citi. The program provides access to a payment service, and each member has sole financial responsibility for the patient responsibility portion of his or her claims.

Money², the Money² logo and Powered by Citi are service marks of Citigroup Inc. Citi and Citi with Arc Design are registered service marks of Citigroup Inc.

Aetna HMO Plan

Aetna HMO plan:
Health Maintenance Organization (HMO)

Choose a nationwide HMO plan if you like predictable costs. This HMO plan are so simple to use. Just choose a primary care physician (PCP) to be your first point of contact when you need health care. Then, simply call your PCP whenever you need care. Your PCP will build a relationship with you and get to know your health needs. Your PCP will also refer you to a specialist whenever you need one. How simple is that?

The Aetna HMO plan has no deductible and modest copays for services.
Preventive care is covered at 100% — without the copay.

To find more information on the pharmacy copayments connected to your medical plan, view the Pharmacy Copayments document. You may also visit the Division of Pensions and Benefits website.

How the Plan works:

Step 1: Choose a primary care physician (PCP) from the Aetna network.

• Your PCP is the doctor you go to first. He or she will help you learn about your health and how to manage it.
• Choosing a doctor is a personal decision. That’s why each family member has his or her own PCP.
• Change your PCP anytime. Just call Member Services at the number on your member ID card.

Step 2: See your doctor for checkups, or whenever you are sick or hurt.

• Your PCP is the doctor you go to first. He or she will help you learn about your health and how to manage it.
• Choosing a doctor is a personal decision. That’s why each family member has his or her own PCP.
• Change your PCP anytime. Just call Member Services at the number on your member ID card.

Step 3: Pay your share of the cost.
A copay is the fixed dollar amount that you pay at the time of services and coinsurance is your share of a covered service. It is based on which plan you selected. There may be a different copay if you need a specialist for other services. It’s that simple! There’s not even any paperwork involved.

Your PCP will:

• Send in any claims for services
• Get approval for coverage of some services when needed
• Usually send referrals electronically to specialists

Do you know what plan you want?

Direct Primary Care Medical Home

The Direct Primary Care Medical Home Program is available for active employees and non-Medicare retirees who are enrolled in SHBP/SEHBP's Aetna Freedom Plan or Aetna Liberty Plan

The State Health Benefits Program (SHBP) and School Employees’ Health Benefits Program (SEHBP) have partnered with R-Health, a leader in innovative healthcare solutions, to offer Direct Primary Care (DPC) to their members and covered dependents.

This is a no copay, no deductible, add-on benefit option and works with your current Aetna Freedom and Aetna Liberty Plans.

R-Health physicians provide a full range of services including preventive, urgent, and sick care, health and wellness coaching, chronic disease management, and care coordination. Benefits of joining a DPC medical practice include unlimited access to your own personal physician with no copays or deductibles, same-day or next-day appointments, evening and weekend hours, reduced waiting-room time, and unhurried consultations with your doctor.

R-Health doctors are responsible for less than half the number of patients of a typical doctor’s office, empowering them to deliver the most comprehensive care. The DPC design ensures that doctors are more accessible to members and gives them increased time with each patient, affording them the opportunity to build strong relationships.

R-Health DPC currently has four practices, Haddonfield, Ewing and Moorestown, New Jersey and Washington Crossing, Pennsylvania.

Go to www.r-hedalth.md/nj/ or call 1-800-797-1289 to learn more about R-Health DPC, select your doctor and schedule your first appointment.

Signing up for R-Health is simple.