THE CHOICE IS YOURS
Aetna offers easy to understand health benefit plans. Even if you like the plan you’re in, it’s a good idea to review your selections every year.
All our health plans give you access to quality doctors and hospitals, free 24-hour nurse hotline and a secure website to keep all of your personal health records in one place.
Select a plan below to learn more:
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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, 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. The great news is you still have access to Aetna’s large nationwide network. If you visit a provider outside of Tier 1 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 please 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 our custom Provider search to look 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 and pre-certify services hospital stays and outpatient surgery on your behalf.
- The great part is that no referrals are needed to visit the providers in the Aetna Liberty Network.
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.
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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% in network without a copay.
To find more information on the pharmacy copayments connected to your medical plan, 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.
- Find a doctor right now! Visit our custom Provider search to look 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 Member 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, since we negotiate special rates for our members. Aetna 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.
Plan Documents
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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 add pre-tax dollars to a tax-advantaged Health Savings Account (HSA) to put money aside for qualified health care expenses or even save towards retirement.
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
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.
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
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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, 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 will help you decide if you need care from another doctor. If so, he or she will give you a referral to another Aetna network doctor.
Step 3: Pay your share of the cost.
A copay is the fixed dollar amount that you pay at the time of service. It is based on which plan you selected. There may be a different copay if you need a specialist for other services.
Your PCP will:
- Send in any claims for services
- Get approval for coverage of some services when needed
- Usually send referrals electronically to specialists
Plan Documents
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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, no coinsurance responsibility 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.
Go to www.r-health.md/nj/ or call 1-800-797-1289 to learn more about R-Health DPC, select your doctor and schedule your first appointment.
Not sure which plan is right for you?
Summary of Benefits and Coverage
Click here for the Summary of Benefits and Coverage page on the Division of Pension and Benefits website.
Call 1-877-STATENJ (1-877-782-8365) and talk to someone from Member Services who knows all the details about the available Aetna plans.