Garden State Health Plan for NJ school employees

All employees who are covered under the SEHBP are eligible to choose this program.  This includes new employees hired on or after July 1, 2020 and non-Medicare retirees.

The open enrollment period is from May 2 – May 20, 2022.  It is called a special open enrollment because it is only for members who would like to choose the Garden State Health Plan (GSHP).  The change will be effective July 1, 2022.  There will still be a regular open enrollment in October, when you will be able to make additional changes to your coverages that will take effect January 1, 2023.

Aetna will be the provider.

The Garden State Health Plan will operate under the Aetna Whole Health ™ - New Jersey Network.   This will be a New Jersey only based network. There will be no covered providers outside of New Jersey (except in the case of an emergency). The plan design (coverages, copays, etc.) is similar to the New Jersey Educators Health Plan (NJEHP).  For more information go to https://aetnastatenj.com/medical.php .

Aetna is hosting a series of webinars to educate members on the GSHP offered throughout the open enrollment.  Here are the dates and times:

Please click here https://web.cvent.com/event/07ee495b-11ae-4f9a-96ab-10ebad420b2b/regProcessStep1 to sign up for a webinar!

No. If you do not participate in the open enrollment, you and your dependents will stay in your current plan.

Yes.  The GSHP is an option for all members.  Employees hired on or after July 1, 2020 can choose between the NJEHP and the GSHP.  Employees hired prior to July 1, 2020 have the right to move between the NJEHP, GSHP and their collectively bargained insurance plans during open enrollments offered at least once a year by their employer. 

Contributions for the GSHP are one half of the percentages of the NJEHP down to 1.5% of salary (or pension).  Please see the attached chart to see what your contributions would be under the GSHP.

No.  This is a New Jersey provider based plan only. 

Participants of the GSHP who have a medical emergency out of state will be covered under this plan.  Aetna provided the following descriptor on their website:  Generally speaking, an emergency is a situation in which you could reasonably expect that the absence of immediate medical attention could result in serious jeopardy to your health, or if you are a pregnant woman, to the health of your unborn child.

Please see this link for reference:

https://www.aetna.com/faqs-health-insurance/emergency-care-faqs.html

The New Jersey Division of Pension and Benefits has changed the process to make changes to members' health benefits through the SEHBP.  Members can visit the Virtual Benefits Fair or log in via their MyNewJersey account to review plan options and decide if they need to make any changes.  Members will need to register for Benefitsolver in order to have access to your health benefits account.

The Aetna Whole Health New Jersey network has in-network providers throughout the entire state that include:

• 5900+ primary care doctors
• 29,000+ specialists
• 33 Hospitals
• 240+ urgent care facilities

An explanation of that network can be found here.

Outside of the network identified above, the remainder of the providers throughout New Jersey would qualify for out-of-network coverage. For example:  Bergen County has three in network hospitals:  Valley Hospital, Englewood Hospital and Medical Center and Holy Name Medical Center.  All other hospitals in Bergen County are out of network.   

It is important that members review the network providers when making a selection.  Aetna has developed an online provider directory where you can check to see if your providers are in the network.  Please click here and choose “continue as a guest” to enter your home location.

Note: as with all insurance plans, providers sometimes move in and out of networks.  The presence of a doctor or facility in the network now does not guarantee they will always remain in-network.

For the details around the difference between in-network and out-of-network coverage, please review this flyer.

Important reminder: there is no coverage outside the state of NJ, except in emergency situations. 

No.  Employees hired after July 1, 2020 are required to select the New Jersey Educator Health Plan or equivalent.  The GSHP is a voluntary selection for all employees, including those who are otherwise required to choose the NJEHP.