Health benefit rates set for 2023

In September, the School Employees’ Health Benefits Commission (SEHBC) approved rates for the School Employ­ees’ Health Benefits Program (SEHBP), from which many of our retired members received their benefits, for Plan Year 2023.

Rates will take effect Jan. 1. You may view the rate by visiting the following website on or before January 1.

Medicare-eligible retirees

There will be no change in the levels of either medical or OptumRx prescription benefits. Medicare-eligible retirees will not see any change in premiums for 2023.

The Aetna Educators Medicare Advan­tage plan will continue to use Medicare providers and still require members to use a Medicare-eligible doctor.

Members who use the Aetna Educators Medicare Advantage plan will have addi­tional benefits:

NJWELL — Retirees and their spouses/ partners will be able to take advantage of the incentives offered to all members who strive to stay healthy.

Co-pay Reimbursement — Members and their covered spouses/partners will be reimbursed their $10 copay for up to 25 physician visits each year. This unique benefit can provide each with an additional $250 in returned out-of-pocket expenses.

Optional Care — Members and their covered spouses/partners may have an optional home visit by a nurse practi­tioner to set up a personal care plan. The plans will include access to a 24/7 registered nurse helpline to assist mem­bers with their healthcare needs and questions.

Members who wish to use traditional Medicare and Horizon BCBS as a supple­ment may choose from NJ Direct 15/25 or the other options available. If you want to make this switch, you must complete the change using Benefitsolver through the Division of Pensions and Benefits website.

Non-Medicare retirees

There continue to be additional benefits that are enhancements to the NJEHP:

Wondr (Formerly Naturally Slim) is a program to assist members to learn weight loss skills based on behavioral science.

SSDC Services Corporation is a pro­gram designed to help members file for Social Security Disability Benefits. For more information, go to

Amino is a fast, easy, and smart way to find and book healthcare. Skip the phone tag, search online, and get back to what matters.

Hinge Health is a program to assist with back or joint pain relief. The program offers personal exercise therapy plans, a 1-on-1 expert health coach, and pain education (+ a free tablet).

Everside Health, formerly Paladina Health, has acquired RHealth and will continue to be the Direct Primary Care Medical Homes provider.

These programs provide primary care services for patients nationwide—in very different ways from a typical primary care practice. Retirees get convenient, person­alized care with no co-pays and no out-of-pocket costs. Retirees also get direct access to their doctors, unhurried appointments that give you the time necessary to address your health concerns, and a broad scope of services that can eliminate or minimize costly specialist visits.

Prescription drug plans

The prescription plans will see rate changes. Medicare-eligible retirees’ pre­scription premiums will increase 6.1% Non-Medicare retirees will see a rate increase of 26.1 percent. These changes also will take effect Jan. 1.

OptumRx continues to be the SEHBP prescription benefit manager (PBM) in 2023.

Dental coverage

Retirees who elect dental coverage through the state in the dental expense plan will see a 0.1% increase in their pre­miums beginning Jan. 1.

The State of New Jersey will continue to offer additional dental options for retirees through the Dental Provider Organization (DPO) plans. The 2023 rates for the retiree DPO plans can be found by visiting the Division of Pensions website. Retirees who wish to switch their current plans can do so at any time, as long as they have been in their current dental plan for at least 12 months. Please contact the NJ Division of Pensions and Benefits directly if you would like to make a change in your plan.