NJASA

Changes Instituted in SEHBP Coverage Because Of Coronavirus Pandemic

As the coronavirus pandemic overwhelms the country, a myriad of questions related to educator’s health benefits and retirement issues are being asked. The New Jersey Division of Pensions has issued several information pieces providing answers to the State Health Benefits Plan and to the operation of the Division’s offices and staff. This column will attempt to reproduce some of that information verbatim or in a summary form to alleviate the need for members to seek answers by calling companies or offices that are either closed, short-staffed or overwhelmed. 

At the present time, the Division of Pension offices are all virtually closed as a result of the Governor’s proclamation shutting down most movement within the State. The only personnel providing service are those working in the Division’s Call Center, which is operating Monday through Thursday from 8:00 a.m. to 4:00 p.m. and is only accepting calls of an emergency nature that directly affect the health and welfare of an active member or retiree. The Division has said that callers should expect extended wait times. The Division has also asked that calls of a routine nature not be made to the office, but delayed to a later date. It is also suggested that those with non-emergency issues check the Division’s website or utilize the MBOS system. 

Recently, the Division issued changes relating to the School Employee’s Health Benefits Plan intended to temporarily increase certain benefits of the plan to improve the medical response to the COVID-19 outbreak. Here is what the announcement of the changes said:

“The Division of Pensions and Benefits, together with our vendor partners Aetna, Horizon BCBSNJ, and OptumRx, are taking action to ensure that State Health Benefits (SHBP) and School Employees Health Benefits (SEHBP) members have the support and resources they need during the COVID-19 situation, which remains dynamic and evolving.

Effective immediately, all cost sharing for emergency room (in or out of network hospitals), urgent care (in network), or provider network office visits (in network) associated with medically necessary testing or treatment for COVID-19 are to be waived.  Horizon BCBSNJ and Aetna have been directed to inform contracted providers about the waiving of cost sharing. Also, all Telemedicine and Telehealth visits will have no member cost share for covered services provided by an in-network health care professional including primary care doctors, specialists, therapists, mental health and substance use treatment professionals, or urgent care doctors.

OptumRx has been directed, effective immediately, to lessen restrictions on early refill of prescriptions and remove other potential barriers to prescription drug coverage for maintenance medications so that individuals continue to have access to medically necessary medications.”   

The above information is taken from a NJ Treasury website item “SHBP/SEHBP Health Insurance Coverage Changes – COVID-19 Response,” which was produced by the Division of Pensions and Benefits, can be accessed using the link:

https://www.nj.gov/treasury/covid19-importantinformation.shtml  

The Health Insurance Coverage item also contains sections of Questions and Answers about testing and treatment through HorizonBCBS, information about testing for Medicare Advantage members, information about prescription coverage through OptumRx and information about Health and Wellbeing resources available to SHBP and SEHBP members.

Future columns will continue to follow actions related to coronavirus issues as long as the pandemic lasts.