As a result of the December 2014 Super Conciliator ruling , the SEHBP Plan design Committee agreed that the $5 million overpaid copayments for 2015 would be refunded to the retirees by reducing the Rx copayments to the amounts listed in the table below for 2016:
|NJ SEHBP RETIREE PRESCRIPTION PLAN – 2016
AETNE 10 / NJ DIRECT 10/ AETNA 15 / NJ DIRECT 15
OUT-OF-POCKET MAXIMUM $1411/$2822
|Supply||Generic||Preferred Brand||All other Brands|
|Pharmacy 30 Days
|Mail 90 Days
The Plan Design Committees for both the SEHBP and SHBP (under Ch 78) are responsible for the establishment of the health plans that are offered to the active and retired members of group. They establish any plan changes which include prescription copayments. When the committee members (equal number representing labor and administration) could not reach agreement on the copayments for retiree prescriptions for 2015, the tie was broken by a Super Conciliator, who ruled in favor of labor. The return of overpayments was agreed to by the Plan Design Committee at their October 5th meeting.
In addition, should the parties not agree on the copayments for the 2017 Plan year, they will revert back to the 2014 levels on January 1, 2017.