• John DiMartino

Ch. 78 Relief Bill - Non-SEHBP Participants


The "Educator’s Health Benefit Fairness Act" aka the "Chapter 78 Relief Bill" is making its way through the State legislature and is expected to be passed in short order.

The provisions of this bill apply whether you are enrolled in the SEHBP or not.

The bill applies to: local school district, regional school district, county vocational school district, county special services school district, jointure commission, educational services commission, State-operated school district, charter school, county college, any officer, board, or commission under the authority of the Commissioner of Education or of the State Board of Education, any other public entity which is established pursuant to authority provided by Title 18A of the New Jersey Statutes, but excluding the State public institutions of higher education and excluding those public entities where the employer is the State of New Jersey.

Please reference the information below as up-to-date as of the writing of this blog. This is NOT legal advice. For formal compliance please contact your School Board Attorney.

Changes Effective July 1st 2020: Private / Non-SEHBP Participants

  • Mandatory Addition of Educators Health Plan "Equivalent"​

  • Similar to the Direct Zero in Prescription and Out of Network reimbursement.

  • Benefits Summary below:

  • Special Enrollment Period:

  • You must host a special enrollment period prior to 7/1/2020.

  • Speak to your Broker/Consultant about this timeline.

  • New Hire Base Plan Change:

  • All new NJEA members hired on or after July 1, 2020 shall be enrolled in the Educators Health Plan.

  • These new NJEA members will not have the ability to "buy up" to any other additional plans.

  • Collective Bargaining Restrictions:

  • Current Offerings: no changes or restrictions to in-force plans.

  • On or after July 1, 2020, no plans are allowed to added to the current offering that are more expensive than the Educators Health Plan.

  • Plans that are less expensive than the Educators Health Plan will be allowed.

  • Health Plan Contributions:

  • Current Offerings: Will not change and employees will continue to contribute in accordance with local CBA.

  • Educators Health Plan: Employees will contribution on a percentage of salary basis:

  • Additional Reporting Requirements:

  • To enable tracking of health care cost savings by school districts, each school district shall submit an annual data sheet for both the current and prior year showing the following:

  • Total Annual Cost of Health Benefits for Active Employees,

  • Total Employee Cost-Sharing Contribution, and

  • Net Cost to the School District for Health Benefits,

  • Also including the following:

  • Number of Covered Employees,

  • Annual Cost Estimate Per Employee, and

  • Total Cost for each coverage category – Single Coverage, Parent and Child, Employee and Spouse, and Family.

  • In addition, school districts shall provide separate breakouts of the same categories of data for health care coverage under all health care benefits plans offered by the employer. The datasheet shall also indicate whether the school district is enrolled in the School Employees’ Health Benefits Program for medical and prescription drug benefits coverage.

  • Reports shall be due no later than 60 days following each enrollment period to the Department of Education, the Division of Pensions and Benefits.

Changes Effective July 1st 2021:

  • New Plan: Garden State Plan

  • Addition of another new plan is scheduled for 7/1/2021

  • Copays, deductibles, etc will be the same as the Educators Health Plan

  • Network will ONLY cover New Jersey providers, unless a specific type of care must be obtained in a different State

  • Garden State Plan: Contribution

  • Contributions will be 50% of the Educator Health Plan

  • Lowest contribution rate remains 1.5% of salary

If you have any additional questions, please do not hesitate to contact me directly.

John DiMartino

President

jdimartino@lbanj.com

267-467-5224


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