SSB PROD

The New Jersey State Health Benefits Program (SHBP) is now offering Aetna Medical Plans as a choice for active employees effective July 1, 2024. There will be a Special Enrollment Period from April 1, 2024, through April 30, 2024, for employees that currently have coverage, who wish to change their medical plans from Horizon BlueCross Blue Shield to Aetna.

If you do not want to change from Horizon to Aetna, there is nothing you need to do.

There are no other changes permitted during this Special Open Enrollment Period. You cannot make changes to your Dental plans, add coverage if you currently waive, or add/drop dependents.

The new Aetna Plans will have the same plan design, mirroring the current Horizon Plans in 2024. There are no differences in benefits coverage, copayments, co-insurance, and deductibles. Your payroll deduction cost-share will remain the same if you switch to the corresponding Aetna plan. OptumRx prescription coverage will also not change.

The new Aetna Plans and the corresponding Horizon Plans are as follows:

• Aetna Freedom (CWA Unity Freedom) = NJ Direct (CWA Unity Direct)
• Aetna Liberty Plus Tiered Network Plan = Horizon OMNIA Tiered Network Plan
• Aetna HMO = Horizon HMO
• Aetna Freedom High Deductible Plans = Horizon High Deductible Plans

Why you might consider changing from Horizon to Aetna:

• Different Networks- If your frequently used medical providers are out-of-network with the Horizon NJ Direct Plan, resulting in the $400 deductible, and 30% coinsurance, then it would be worth checking to see if they are in-network with the Aetna Freedom Plan. Please check all your current providers, (doctors, hospitals, labs imaging centers, etc.) so you don’t lose more in-network providers than you gain.
• Horizon OMNIA Tiered Network Members- In OMNIA, out-of-state providers are Tier 2. Aetna Liberty Plus does have some Tier 1 providers in Pennsylvania, Delaware, and New York. If you are currently seeing Tier 2 providers out of State, you can check to see if they would be Tier 1 under the Aetna Liberty Plus Plan to reduce out-of-pocket costs. Here too, please check the Tiers of all providers (doctors, hospitals, labs, imaging centers, etc.) so you’re not risking a net increase in out-of-pocket costs at the time of service.

Here are links to the health plans overview for Aetna and Horizon.  We suggest calling Aetna at 1-877-STATENJ or Horizon at 1-800-414-7427 to confirm any Provider network matters.

Any plan changes must be made online through Benefitsolver

Contact Information:

Alena M. DeGeorge
Human Resources
degeorge@rowan.edu