Medical | Aetna State of New Jersey SHBP & SEHBP Members

What is the Garden State Health Plan (GSHP) Aetna Whole Health NJ network?

You have a new plan option this year called the Garden State Health Plan (GSHP) that uses the Aetna Whole Health℠ — New Jersey network of providers. It’s a fresh way of looking at health care to help improve the quality of care, provide a better experience and save you money. You’ll have access to a special network of NJ primary care doctors, specialists and hospitals focused on you.

Your care team will work with you to:

Help keep you healthy or improve your health, not just treat you when you’re sick or injured
Better coordinate your care and keep tabs on your prescriptions, lab results, health history and more
Spot problems and build personalized care plans to treat you
Encourage you to play an active and informed role in your health and health care decisions

Downloads

Aetna Whole Health flyer (PDF)

Concierge flyer (PDF)

GSHP enrollment brochure (PDF)

With our Aetna Whole Health New Jersey Network, we offer access in all 21 counties of New Jersey, so you and your families can find care where you need it.

This network includes a team of dedicated clinicians who support our members and engage you throughout your health journey.

5,900+ primary care doctors
29,000+ specialists
33 hospitals
240+ urgent care facilities

Aetna Whole Health NJ Network (PDF)

Know your benefits.

This plan lets you visit any doctor in the Aetna Whole Health NJ network without a referral. It's entirely up to you. Below is a listing of some of the benefits:

Table of plan details.
Garden State Health Plan – Aetna Whole Health NJ	In network	Out of network
Deductible	$0	$350 Individual $700 Family
Out-of-Pocket Maximum	$500 Individual $1,000 Family	$2,000 Individual $5,000 Family
Coinsurance	10%	30%
Preventive Care	Covered at 100%	Not covered*
Primary Care Doctor Visit	$10	30% after deductible
Specialist Office Visit	$15	30% after deductible
Chiropractic (30 visits combined in & out network)	$15	Maximum dollar limit $35
Diagnostic - (Labs and X-rays)	$0	30% after deductible
Emergency Room	$125	$125
Urgent Care Center	$15	30% after deductible
Ambulance	10%	30% after deductible
Durable Medical Equipment	10%	30% after deductible
Physical Therapy	$15	Maximum dollar limit $52
Mental Health Service - Inpatient	$0	30% after deductible
Mental Health Service - Outpatient	$15	30% after deductible

If you travel outside of New Jersey, you will only be covered for emergency services.
Out-of-network services are based on 200% of the CMS (Centers for Medicare & Medicaid Services) fee schedule.
If your out-of-network provider charges more than the allowable amount, you will be responsible for any expenses incurred above that amount, in addition to your out-of-network deductible, coinsurance or copay. Any amount that you pay above the allowable charge will not apply to your out-of-pocket maximum.
This is not a complete list of all covered services. Exclusions and limitations apply to some services.
If you have questions about your prescription drug coverage, you can find information on the NJ Divisions of Pensions and Benefit website at https://www.state.nj.us/treasury/pensions/hb-active-sehbp.shtml.

*Annual Ob/Gyn checkup, annual mammography, annual PAP smear and well-child immunizations up to 12 months old covered at standard out-of-network coinsurance level for the plan after applicable deductible.

GSHP flyer (PDF)

Who is eligible for the GSHP?

This plan is being offered to all School Employees’ Health Benefit Program (SEHBP) members in the State of NJ for active and under age 65 retirees.

What if I am a Medicare retiree and my dependent is under 65?

If you are over 65, then you would be enrolled in the Aetna Medicare Advantage plan and your dependent would be enrolled in the GSHP.

Find in-network doctors and hospitals with our search tool

Use the custom Provider Search tool to find doctors, hospitals and other health care providers that participate in the Aetna Whole Health NJ network.

Visit the custom Provider Search
Select the NJ Aetna Whole Health – New Jersey Choice POS11
Choose what type of provider or facility

Visit your custom Provider Search to find a provider

Garden State Health Plan- Aetna Whole Health NJ

Custom Gold ID Cards for Garden State Health Plan members
Remember to use Aetna Whole Health NJ providers
If you travel outside of New Jersey, you will only be covered for emergency services

We've got your back

We know health care is personal and full of tough questions.

Aetna Concierge is here to help answer your questions, call 1-877-StateNJ or 1-877-782-8365 (TTY:711) Monday through Friday, 8 AM to 6 PM ET.

Aetna Concierge has answers to help you make sense of your health plan. They can help:

Educate you on plan benefits
Select a provider
Explain the programs specifics
Help members navigate the health care experience
Look up claims and answer questions
Connect you to the right resources

At Aetna, we’re with you wherever you are on your health care journey.

Aetna Concierge flyer (PDF)

Table of plan terms and their definition
Plan term to know	Definition
In network	A network is a group of health care providers. It includes physicians, specialists, hospitals, surgical centers and other facilities. Providers that participate in Aetna Whole Health NJ network.
Out of network	Depending on your plan, you usually pay more for out-of-network services. With some plans, you may be responsible for the full cost of out-of-network care unless it’s a true emergency.
Deductible	The amount you pay for covered health care services before your plan starts to pay.
Coinsurance	A fixed percentage you pay for a covered health care service.
Copay	A fixed dollar amount you pay for a covered service.
Out-of-pocket maximum	This is the most you pay for covered health care services in a plan year. Once you hit your maximum, the plan pays 100% of covered expenses for the rest of the year.

Medical Plan

Garden State Health Plan

Member-focused health care that's focused on you.