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New tiered health care network plans offered during October 2016 open enrollment

Submitted by Staff on Tue, 10/11/2016 - 15:57

The Open Enrollment period for State Health Benefits Plan (SHBP) begins on October 1, 2016 and ends on October 31, 2016. Open enrollment dates may be extended.

Read all the details in the Report on the State Health Benefits Plan 2017

During Open Enrollment active employees in the SHBP can make changes to their dependents or enroll in a different health plan. All changes made during Open Enrollment will take effect on January 1, 2017 for state and local SHBP members. Here’s a link to the State’s website:


The tiered network plans, Aetna's Liberty plan and Horizon's Omnia plan, are voluntary and no members will be required to select one of these plans, they are just additional options offered through the SHBP. AFTNJ and the other Unions voted in favor of the creation of the Tiered Networks because we think this is an option that will fit the needs of many, but not necessarily all, of our members. 

State employees who switch to one of the tiered network plans during Open Enrollment as new subscribers beginning January 1, 2017 for a minimum of two years will receive incentive payments of $2000 for those with family coverage, $1250 for parent/child or employee/spouse coverage, and $1000 for single coverage. The payments will come during the first quarter of next year.

Tiered network plans are for not for everyone. However, if you will use Tier 1 doctors and hospitals, then this plan may save you money at considerably reduced premium share.  You will save 25% over the cost of Direct 15 (the highest enrolled state plan) and you will get the incentive.  Here is an example: let’s say that you are paying $400 a month toward your Direct 15 Family coverage.  If you took the Tiered Network, you would pay $300 a month plus you would get a $2000 incentive gift card for signing up.  You would save $1200 in premiums a year and you would get $2000.   Over the course of the two-year commitment, you would save $2400 in premium, and $2000 in incentive—$4,400. 

If your doctor(s) are not Tier 1 doctors, however, the Tiered Network may not be for you.  You can check and see if your doctor(s) are in the Aetna or Horizon plans by looking at their website.  Make sure that you also check the Hospitals listed.  Only Aetna has Pennsylvania and New York Hospitals in their Tier 1.

Fine print on the two year commitment - The incentive shall be forfeited and returned to the SHBP if the subscriber fails to remain enrolled for at least two plan years, except that if a subscriber is made ineligible for healthcare through layoff, involuntary separation, reduction to part-time status, or classification into an ineligible position.  If a subscriber voluntarily retires or changes health plans due to a catastrophic or emergency health need as determined by the Division of Pensions and Benefits after a full year, then the incentive shall be forfeited on a pro-rata basis.

Please research your doctors/hospitals carefully. The Tiered Network has the potential to save your family a great deal of money— if it is right for you.  But it can also cost you money if it isn’t. 

Here’s a link to the State’s webpage on Tiered Network plans, including links to the Horizon and Aetna tiered plans:




Any active employee member in any PPO or tiered network plan can join the Direct Primary Care pilot. You can join any time during the year— not just during open enrollment. This program does not change the plan you are in, it provides specialized primary care within your plan at no cost.

Direct Primary Care features primary care doctors who will have significantly fewer patients than now (average today of 2,500 to 3,000 patients per doctor versus no more than 1,000 for Direct Primary Care), same day/next day appointments, 24/7 access to your doctor, and appointments that are as long as they need to be. In many ways this pilot gets back to the days when physicians could spend time with patients.

When you or a family member visits a Direct Primary Care office you will never have a copay.

The above information is only an excerpt from the 2017 Report: Download the full report

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