Employee Benefits

Montclair State University offers faculty and staff numerous choices for health and dental care coverage along with pre-tax medical savings accounts. Healthcare benefits are effective 60 days after your start date depending on your employment classification. Please contact the Benefits office at x4394 with further questions.

Employees enrolled in the SHBP for health and/or prescription drug coverage are required to contribute a portion of the premium, based on a sliding scale and the type of plan with the level of coverage selected.

For NJ Direct 15, a Preferred Provider Organization (PPO), no referrals are needed to see in-network specialists, the copayment for primary doctor visits and visits to a specialist
is $15. The copayment for a visit to an emergency room will
be $50. The emergency room copayment is waived if you are admitted to the hospital

A.

An HMO is an alternative health care system that covers many types of preventive and diagnostic care, such as physicals, immunizations, well baby care and treatments for illness or injury.
Literature for plans offered in your area is available from the Office of Employee Benefits. [back to top]

B. New Jersey Direct 15

New Jersey Direct 15 is a network of health care providers who offer comprehensive health care. If network physicians are used, only a $15.00 co-payment is made to the physician with few exceptions. Out-of-network providers may be used. The reimbursement for out-of-network hospitals and physicians is generally 70% after a low deductible is met.

C. Prescription Drug Program

The Prescription Drug Program helps meet the cost of drugs prescribed for employees and their eligible dependents for use outside of a hospital, nursing home and/ or other institution. Eligible employees will become insured after two months of continuous service. However, faculty coverage starts September 1st.

Retail pharmacy: $3 for generic drugs and $10 for brand name prescription drugs without generic equivalents. There is a $25 co-payment for brand name drugs where a generic equivalent is available.

The State has a benefit for members of the State Health Benefits Plan - a Mail Service Prescription Drug Program. Under the Mail Service Program, your physician can authorize up to a 90-day supply of medication on a single prescription

Mail order pharmacy: $5 for generic drugs and $15 for brand name drugs without generic equivalents. There is a $40 co-payment for brand name drugs where a generic equivalent is available. [back to top]

D. Part Time Employee Health Benefits

Chapter 172, P.L. 2003 provides part-time faculty members and employees at Montclair State University eligibility for enrollment for coverage in the State Health Benefits Program (SHBP), provided that the part-time employee is a member of a State administered retirement system. Under the law, the employee can enroll in NJ Direct 15 and the Employee Prescription Drug Plan. If an eligible employee or faculty member elects to enroll and purchase coverage, the employee or faculty member must pay the full cost of the coverage.

E. Vision Care Plan
Coming soon.
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F. Medicare

If you do enroll in the Medicare Program while you are still employed, or if you were already enrolled when you were hired (and are a participant in the State Health Benefits Program), the State Health Benefits Program will become your primary insurance plan, which means that the State Program will always pay first.

Although Medicare enrollment is not required for those who continue to work, we strongly urge you to contact the Social Security Administration when you or your spouse reaches age 65 so that you understand how to secure Medicare coverage when you leave work.

State law requires that anyone who has retired and is eligible for Medicare must enroll in Medicare Parts A and B in order to be covered under the retiree group of the State Health Benefits Program. The State Program cannot pay for benefits which should have been paid for by Medicare.
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G. Dental Program

A Dental Program is available to all full-time employees after 60 days of employment. You may elect the traditional dental program administered by Aetna Insurance or the State Dental Plan Organization Program. The cost of coverage is borne jointly (50%-50%) by the State and the employee.

1. Aetna offers you treatment by your choice of dentist. There is a deductible of the first $50 incurred by the individual during the calendar year.

2. The Dental Plan Organization (DPO). Generally, the cost for the DPO benefits program is less than the Aetna Plan. The DPO plan is a program designed to encourage timely dental care by providing a prepaid dental program option.

The Dental Annual enrollment period is October for January 1st coverage.

Brochures are available from the Office of Employee Benefits which describe eligible charges and the exclusions of both programs.[back to top]

H. Section 125 Program

Beginning June 28,1996, the State of New Jersey is providing employees participating in the State Health Benefits Program a benefit plan under the provisions of Section 125 of the Internal Revenue Code. Section 125 includes the option of participating in any or all of the following plans:

1. Premium Conversion: The Premium Conversion Plan allows employees to pay any State Health Benefits Program medical and/or dental premiums they have with before-tax dollars.

2. Unreimbursed Medical Spending Account: The Unreimbursed Medical Spending Account allows employees to set aside before-tax dollars to pay for medical and dental expenses Not paid by insurance.

3. Dependent Care Spending Account: The Dependent Care Spending Account allows employees to set aside before-tax dollars to pay for eligible dependent care expenses. [back to top]

I. Safety

All work related injuries must be reported to the Office of Employee Benefits
within 48 hours. Human Resource Services or University Police will assist when service at the Office of Employee Benefitsis not available. They will recommend and approve further treatment. Payment for such service will be made only to doctors who are on a list of approved physicians.

More detailed information can be found at Work-Related Injury Reporting Procedures.
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