Late December some retirees received an erroneous letter about their prescription coverage being canceled, while other retirees inadvertently disenrolled from their prescription program. It’s important to understand the situations that may affect retiree prescription coverage and the steps you can take to ensure you remain covered.

Medicare Part D

Retirees who are members of the School Employees Health Benefits Plan (SEHBP) and are enrolled in Medicare are automatically enrolled in the OptumRx Medicare Part D Prescription Drug Plan (PDP). Retirees may waive the OptumRx Medicare PDP only if they are enrolled in another Medicare Part D plan.

To request that your coverage be waived, you must submit a Cancel/Decline/Waive Retired Coverage Form, along with proof of other Medicare Part D coverage, to the New Jersey Division of Pensions and Benefits (NJDPB) at the following address:

New Jersey Division of Pensions and Benefits

Health Benefits Bureau
P.O. Box 299

Trenton, NJ 08625-0299

Medicare Supplement Plan (Horizon)

Retirees who choose to enroll in another Medicare Part D plan, such as their spouse’s, will lose any prescription drug benefits provided by the SEHBP. However, their medical benefits will continue.

Medicare Advantage Plans (Aetna)

Retirees who are enrolled in a Medicare Advantage Plan may only waive their prescription drug coverage for another group Medicare Part D plan. Please note: If you waive coverage for an individual Medicare Part D plan, your SEHBP Medicare Advantage Plan for both medical and prescription will be terminated.

Returning to the SEHBP

Retirees who have previously waived their prescription drug coverage for another Medicare Part D plan and wish to reenroll in the OptumRx Medicare PDP must send proof of their termination from the other Medicare Part D plan. Acceptable proof is a letter from the other Medicare Part D plan confirming the date upon which you officially are disenrolled. The NJDPB must receive this proof within 60 days of the termination from the other Medicare Part D plan.

Retirees who have additional questions and/or wish to learn more can visit the division’s website at nj.gov/treasury/pensions or by calling 609-292-7524.

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