News


We have been receiving reports that the health benefit deductions from the January pension checks are incorrect in some cases. We encourage you to verify the proper deduction from the Chapter 330 Rate Charts on the Division of Pensions and Benefits web site. 
 
We are working with the division to determine the proper deductions should be.

We have just received information that the Division of Banking and Insurance has denied a request from Horizon to utilize American Specialty Health Network to administer Chiropractic, Physical Therapy, Occupational Therapy, Acupuncture and Speech Therapy for all Horizon customers both in and out of the State Health Benefits Plan.

The New Jersey State PBA led the initiative to disallow the implementation for three main reasons. First, the belief that the model that would be implemented would restrict access to much needed, non surgical options. Next, to help limit use of opiates for musculoskeletal injuries, which are suffered by our members on a regular basis. The last reason was because of the practices that were outlined in a 2012 consent order involving the network.

This denial does not mean that Horizon cannot make future application for these services and we ask our members to remain vigilant and responsive in our continued effort to protect our health benefits.

Last Friday, May 11, 2018 a NJ Court of Appeals invalidated the contract awarded to OptimRx as the Pharmacy Benefit Manager (PBM) for the New Jersey State Health Benefit Plan as well as the SEHBP. This was done as a result of a suit filed by Express Scripts International, the former PBM for the SHBP/SEHBP. The court ruled that the submissions by OptimRx were not acceptable (see article below).

I spoke to the Division today who has assured me that there will be no changes until at least 1/1/2019. That is to say that your prescription plan, if enrolled in the State Health Benefits Plan, will remain status quo with no interruptions in service.

As the matter develops, we will keep you informed through all of our communication outlets.

NJ.com article
http://www.nj.com/politics/index.ssf/2018/05/nj_court_kills_67b_contract_prescription_drug_cont.html#incart_2box_nj-homepage-featured

Appellate Court Decision
https://www.judiciary.state.nj.us/attorneys/assets/opinions/appellate/published/a4751-16.pdf?cacheID=Ob6HBRu

Today, President Colligan attended a joint meeting of the labor members of the State Health Benefits Design Committee and the State Education Health Benefits Design Committee along with Senate President Steven Sweeney to discuss a new concept in health care delivery for SHBP members.

At the meeting, a concept in health care delivery, direct primary care medical homes, was discussed. In this model, members would be able to utilize a cadre of doctors and would be centered around the whole health of the patient.

The SHBPDC labor side agreed to endorse a concept and attempt to develop a plan contingent on agreement of the labor and management side. It is important to know that the committee has not agreed to any specifics and a majority of the committee is required to design any plan.

At a subsequent press conference, President Colligan stood shoulder to shoulder with the members of the design committees and other public sector leaders to introduce the concept. We will keep you informed and will have a full description of the optional pilot concept in the near future