Retiree Health Benefit Changes Effective July 1, 2024

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We have received calls from retirees on the following two issues over the past weeks:

  • The Aetna-Hackensack Meridian Health Systems Negotiation and,
  • Plan changes effective July 1 for retirees who have one spouse Non-Medicare Eligible and One who is Medicare Eligible.

We will try to educate you with as much information as we know on these two issues.

The Aetna-Hackensack Meridian Health Systems Negotiation:

Healthcare companies routinely find themselves in negotiations with their network of hospitals, doctors and other providers. In many cases the negotiations go smoothly and providers need to make their decision as to whether they will remain in Aetna or Horizon’s network. If not, they will provide services as an “Out of Network Provider.” As of now Aetna and the providers in Aetna’s network are still in negotiations as to the rates they will be paid for their services as “in-network”. That is where negotiations are at this time.

Aetna Medicare Advantage retirees can see any doctor who accepts Original Medicare and is willing to bill Aetna, even if your doctor is not in the network. If your doctor is unsure, you can contact Aetna, and Aetna will contact the doctor for you to help them understand how to accept the plan. It will still be treated as an in-network facility. The number you can call for Aetna can be found on the back of your Aetna Card.

I want to also remind all retirees that you are not subject to open enrollment periods. That is only for active members. A retiree can make changes to your plan at any time as long as they have been in their plan for at least 12 months. So I would encourage you, if you are unsure about your present network, to consider trying the other network. If you have issues with the new network and are unhappy, you can make the change again in another 12 months. It never hurts to try.

Horizon members may be having a similar issue if your health provider is in the Advocare network.  Remember, in most cases, the network of providers for either Aetna or Horizon tends to stay consistent, but your individual provider is operating a business, and they are making business decisions. Your plan — what is covered and how much you pay for services — has not changed, but those who may be providing those services may be moving in or out of Horizon and/or Aetna’s network.

All Dependents must be in the same network.

Also Effective July 1, all dependents under your retirement health benefit must now be in the same Health Network (all Horizon or all Aetna). What that means is that if you or your dependent are Medicare-Eligible, you can no longer be in a different network than the rest of the family. In the past, if all of your dependents were covered under the Horizon NJEHP, and you became Medicare eligible, you may have selected the Aetna Medicare advantage plan, and the other dependents remained on the Horizon plan. Now, given that same scenario, the rest of your covered dependents would be moved to the Aetna NJEHP.

Similarly, if the Medicare-Eligible member selected the Horizon 1525 Supplemental plan, all your dependents would be changed to a Horizon Plan.

For your convenience we have included the links to the retiree health plans below.

Non-Medicare Plans

Medicare Eligible plans

Under Age 65 Rx Plans

Medicare Eligible Rx Plans

Remember, if this is not the network you want for your health needs, you can make a change to the other network provided you have been in your present plan for at least 12 months.