School Employees Health Benefit Plan Design Committee (SEHBP PDC) Approves Changes for 2019

Posted · Add Comment

Attention NJPSA Members!

School Employees Health Benefit Plan Design Committee (SEHBP PDC) Approves Changes for 2019:

On Monday, September 17, 2018 the School Employees Health Benefit Plan Design Committee (SEHBP PDC) approved changes to the 2019 health plan offerings for Active, Early and Medicare Retirees.  These changes resulted from negotiations with the Murphy Administration. The agreed upon changes track, to some degree, changes that were adopted for state employees in recent years.  These changes must still be approved by The School Employees Health Benefits Plan Commission on Wednesday, September 26th.  The Commission has the responsibility for managing the Health Plan, setting the rates and hearing all appeals.

Once the Commission approves changes and sets the 2019 rates,  the details of the agreement will be shared with NJPSA members.

What We Know So Far

  • Key Highlights for SEHBP:

         For 2019, a new plan will be introduced for the active members and early retirees currently enrolled in the School Employees’ Health Benefits Program (SEHBP). This plan will encourage use of in-network primary and specialty care through a provision that will not require any co-payment from the members for certain health services. For the retirees eligible for Medicare, the current enrollees in the PPO 10 and PPO 15 plans will be migrated to the Medicare Advantage plan. The new plan will be called the SEHBP Educators Medicare Plan. These key changes create significant savings for members and school boards alike.


  • Key Highlights For Medicare Retirees:

         * Members will have the ability to participate in the NJ WELL program and earn $250 per participant;

         * For the first two years of the enrollment in the SEHBP Educators Medicare Plan, the first $250 in co-payments will be reimbursed annually.


  • Key Highlights For Active and Early Retirees:

         * Active and early retirees will have the opportunity to enroll in a new plan, either through Horizon or Aetna, which will allow members to earn $500 by participating in NJ WELL program and pay no co-payment for visits to primary and specialty doctors when staying in network.

         * Encouraging in network utilization alone will result in a plan premium that is 14.5% lower than the legacy plan through a focus on in-network utilization.

Yesterday, Governor Murphy released a press statement announcing this agreement.  

NJPSA will provide more detailed information as soon as it becomes available.