MEDICAL HEALTH PLANSNJ State Health Benefits Program administered by Horizon Blue Cross Blue Shield of NJ. Customer Service: 1-800-414-7427 As a result of years of hard bargaining between the Paterson Education Association and the Paterson Public Schools, staff members represented by P.E.A. are provided with health coverage through the State Health Benefits Program for eligible employees at no cost to the employee. Immediately upon your date of hire, you must complete a NJ State Health Benefits Application and provide all requested information. After the completion of your medical enrollment, the Health Benefits Program will become effective 60 days from your date of hire. The only exception, 10 month employees who begin work on the first day of school receive health coverage effective their first day of employment. If you do not enroll all eligible members of your family with 60 days from the time you or they first become eligible for coverage, you must wait until the next Open Enrollment period to do so. Open Enrollment for medical is in the month of October. The effective date of all changes is January 1st of the following year. The negotiated plan offers three types of coverage through the SHBP: Traditional (Horizon Blue Cross Blue Shield), New Jersey Plus (Horizon Blue Cross Blue Shield), and five Health Maintenance Organizations (HMO).
1. Traditional Plan-The Traditional Plan provides basic and major medical coverage administered by Horizon Blue Cross Blue Shield. The Traditional Plan reimburses you for the cost of hospitalization, doctor visits, surgery, various medical services, and supplies. There are no restrictions in choosing a physician and the service area is unrestricted. The Traditional Plan does not cover preventive or wellness care (with the exception of mammography). The reimbursement rate is 80% after a $100 deductible for individuals or $200 deductible for employees with dependents per calendar year for medical expenses only. Plan telephone number is: 1-800-414-7427. 2. NJ Plus Plan- The New Jersey Plus Plan combines managed care by utilizing the Out -of - Network option. If an employee remains In Network, there is no deductible and a co-pay of only $5 per visit. If an employee goes Out-of Network, they are reimbursed at 70% after a $100 individual deductible for most expenses per calendar year and $200 for hospital admission. Plan telephone number is: 1-800-414-7427 3. HMO- The State Health Benefits Program offers five different Health Maintenance Organizations:
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