News


New Jersey State Policemen’s Benevolent Association President Pat Colligan sent the following message to the members of the NJSPBA updating them on the latest developments on the State Health Benefit Plan.:

Today, the members of the State Health Benefits Plan Design Committee attempted to mitigate the unconscionable rate increase with 5 resolutions that would have saved at least 20% of the 24% rate increase proposed by the State’s Actuary.

The labor members of the design committee proposed the following changes that were immediately rebuffed by Governor Murphy’s appointees on the board all ending in a 6-6 tie. These motions will now have to go to super conciliation, which will further delay any reduction in the State Health Benefits premiums.

1.    Evaluate a cohort of “point solutions” that were implemented during the covid pandemic which by the divisions own statements are not producing substantial outcomes. This includes the current navigation and advocacy program that is named in the rate renewal reports as accountable for up to 6.5 percent of the rate increases.

2.    Institute a Medical Specialty Pharmacy program that would immediately allow the State’s pharmacy benefits manager, OPTIM RX, to utilize their current program for the next plan year while they procured an outside vendor that was not associated with the state’s pharmacy benefit manager, the third party administrator. Members of the PDC were in attendance at a presentation on September 3, 2021, where information was provided that this program would provide $1.18 BILLION dollars over three years.

3.    A resolution exploring reference based pricing which was recommended in the Governor’s Task force report. This would make the payments made to hospitals and other providers transparent and controlled by the plan and not the third party administrator. This would easily produce savings of 10% on the medical spend.

4.    Expansion of titles for the First Responders Primary Care Medical Home this would allow more members access to high quality primary care which would decrease rates over time.

5.    Create a claims stabilization reserve fund that would disallow the state from “sweeping” the accounts every year especially when they have excess funds at the end of the year.   

The State members believe that all of these are outside the scope of the plan design committee, a statement that is false. While the claims stabilization reserve resolution, may be under the authority of the Commission, the other four are undoubtedly plan design issues. This is just another example of the inability of the Treasury and the Division to hold their vendors to account.

In other business, the plan design committee approved the continuing resolutions that continue formulary management, lower copays for retirees, a tiered network incentive, and out of network pt costs controls.

Two other resolutions were passed that were part of a package that the State unions struck whereby they will see a 3% increase in their contribution rates. These were a $30 increase in urgent care copays and a $15 increase in specialist copays for the state members in the CWA Unity and Direct plans. When questioned on the value of these changes the state would not answer on the specialist and stated it was .2% on the urgent care, meaning that the plan design changes had no bearing on the cost.

Immediately after the PDC meeting the Commission met and defied requests to delay the rate renewal process. The labor commissioners were ignored and questions left unanswered.

We will continue to work on a plan for our members going forward to try to mitigate the drastic increases our members will face in 2023. We will keep you advised of any new developments and a plan of action before open enrollment. It is obvious that through their actions that the state thinks more about their relationships with their vendors than they do with public workers.

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.