Local Education Employees
SEHBP Open Enrollment Webinar: Local Education Employees
This presentation is for those who’re eligible for the School Employees’ Health Benefits Program otherwise known as the SEHBP. You may be a new hire, an employee working for an employer that is joining the SEHBP, a retiree or someone who would just like information about the Horizon Blue Cross Blue Shield SEHBP plans that may be available to you.
If you’re an eligible active employee hired prior to July 1st2020, you can choose from any of the three Horizon SEHBP plans: the New Jersey Educators’ Health Plan (sometimes referred to as the NJEHP), the NJ DIRECT10 plan or the NJ DIRECT15 plan. If all of these plans are available to you, you’ll see them as a choice in the online enrollment system.
If you’re an active employee hired on or after July 1st2020 or a retiree (or their spouse) who’s not Medicare eligible, then you’re eligible for the New Jersey Educators’ Health Plan.
All three Horizon SEHBP plans cover the same eligible medical services AND you can receive services outside of New Jersey. All three plans also use the same provider network nationwide and you don’t need to select a primary care physician or get referrals to see specialists.
For active employees who’re eligible for all three of the Horizon plans, the usual question is, “what are the differences between the three Horizon SEHBP medical plans”. The difference is in how much you pay out of your pocket as you receive eligible services throughout the year and how much you pay out of your paycheck.
Under all of these plans you typically save money out of your pocket when using an in-network provider for eligible services.
When using an out-of-network provider, you’re responsible for paying: out-of-network deductible before the plan pays; coinsurance which is a percentage of the reasonable and customary allowance; and the difference between what the out-of-network provider bills and the reasonable and customary allowance.
For details about your cost-share as you receive eligible services under each of the plans, please refer to the SEHBP Overview which includes a Plan Comparison Chart. The Overview, and more information about the SEHBP plans and programs can also be found on our website at HorizonBlue.com/SHBP.
Active employees may be able to compare the estimated annual amount out of their paycheck for the SEHBP Horizon plans on the Premium Contribution Calculator on our website. If your employer uses an alternate contribution arrangement, you can check with your employer. Retirees can check with the NJ Division of Pensions and Benefits.
To find an in-network provider where you typically pay less out of your pocket, you can visit our website at HorizonBlue.com/SHBP
If you’re looking for in-network care outside of New Jersey, you’ll enter the provider’s location, and use “NJX” when asked for the plan prefix. You’ll have access to our BlueCard PPO network with over 1.3 million providers participating nationwide, and with the Global Core network for providers located outside the U.S.
With all of the Horizon medical plans, you have access to medical and behavioral telemedicine services at the touch of a button through the HorizonBlue App. And you can also ask your doctor if you can talk to them via video, chat or phone. When receiving telemedicine services from an in-network doctor, you may have an in-network cost share. If you receive telemedicine services from a provider that’s not in our network, you’re responsible for the out-of-network deductible, coinsurance, and any amount billed above the reasonable and customary allowance.
You also have access to in-network Retail Health Centers where on-site board-certified nurse practitioners can prescribe medications, and diagnose and treat common ailments like colds or seasonal allergies.
Additionally, you have access to a nationwide network of Urgent Care Centers when you need medical care to treat wounds, sprains and other conditions that need immediate attention but aren’t life-threatening. When you use an in-network Urgent Care Center you’re only responsible for your low in-network cost share.
Lab services can be accessed through our preferred labs nationwide with LabCorp and Quest.
Eligible immunizations can be received from an in-network physician or at one of our participating New Jersey pharmacies.
Eligible members can join a Direct Primary Care Doctor’s Office and get unlimited access to personalized care, on-site blood work, and basic medications for acute conditions all at no cost!
You also have additional programs and resources available under the Horizon plans.
You can receive a $20 incentive for every month you meet the HorizonbFit program requirements. Complete any combination of visiting a fitness facility, working out at home or walking 10k steps and recording it in the system for at least 12 days a month to earn your incentive. Once you have your ID card, you’ll be able to register in the program.
The medical plans provide you with one routine eye exam per calendar year, but the medical plans don’t provide coverage for glasses, contacts, etc. However you can receive discounts on wellness products like vitamins, gyms, eyeglasses and more when you register through Blue365.
Members have access to My Health Manager where you can create a Personal Health Record, take an Online Health Assessment and receive feedback on how to improve or maintain your health and more.
In addition we have health and wellness programs and resources available for Maternity Management through Precious Additions.
Our Behavioral Health team is here to support you 24/7, 365 days a year. You’ll have access to urgent care within 24-48 hours, transition management, ambulatory follow-up, telehealth, support and education.
We also have virtual behavioral telehealth solutions to provide you with support through self-directed virtual services supporting your emotional well-being; virtual medication assisted treatment for those experiencing substance use disorders; virtual therapy and coaching for members experiencing depression, anxiety and stress associated with behavioral and medical co-morbidities like diabetes and heart disease.
Check out our website at HorizonBlue.com/shbp for details on all of our various programs, resources, services and more.
The NJWELL wellness program runs from November 1st to October 31st each year and is available to SEHBP active employees, and a covered spouse or partner.
You can earn rewards valued at $250 by participating.
To earn the reward, you’ll need to complete an online health assessment, complete a biometric screening and earn points in a variety of categories.
You’ll have from November 1st until October 31st to meet the program requirements to earn your reward for each NJWELL year.
Please note that this is a taxable benefit.
You can find details about the NJWELL wellness program on our website.
Horizon Health Guide is our personalized member service experience for all your benefits and care needs. Horizon Health Guide is a high-touch personalized service that provides employees with a single point of contact to access health care and benefits; it integrates service and care management to meet all types of care needs, and seamlessly connects you to relevant resources and programs to get you the answers you need.
You can reach out to a Horizon Health Guide Monday through Friday from 8am to 6pm at 800-414-7427.
After you’re enrolled in a Horizon plan, you have access to the Horizon member portal by registering and logging-in at HorizonBlue.com/SHBP to view or print your Horizon ID card, view benefit information, check claim status, and see who’s covered on your plan. And please remember to update Coordination of Benefits information for each covered dependent every year. You can also use the 24/7 Nurse Chat, receive telemedicine services 24/7, find in-network providers and schedule an appointment on the Horizon member portal.
And after you’ve registered on the member portal, you’ll be able to download the free HorizonBlue App on your smartphone for quick and easy access to your information.
We’ve come to the end of our Horizon SEHBP medical plan presentation. You can find current information about the Horizon SEHBP plans and more at HorizonBlue.com/shbp or by contacting a Horizon Health Guide at 800-414-7427.
Thank you for viewing this presentation and have a great day!
All 2022 SHBP/SEHBP medical plans include:
- Well Care and Preventive Care: Services such as annual physical and annual gynecological exams, well baby/child medical care and preventive care immunizations are covered 100% when using an in-network doctor.
- Behavioral Health and Substance Use Disorder: Counseling services are covered for mental/emotional health and alcohol/substance use disorder.
- Horizon Health Guides: Your Horizon Health Guide can help with all your health care needs:
- Answering questions
- Making medical appointments
- Solving issues
- Helping with claims
- Finding care
- Making health and wellness benefit suggestions tailored to you.
- Telemedicine: Talk to a doctor 24/7/365 using Horizon CareOnline℠.
- Nurse Chat: Chat with a nurse 24/7 using your computer, mobile device or the Horizon Blue app.
- Precious Additions®: A prenatal education program supported by My Health Manager®, powered by WebMD®, gives you access to online tools and resources.
Your health plan may also include care outside of NJ through these options:
- BlueCard®: For care in the U.S., Puerto Rico and U.S. Virgin Islands.
- Blue Cross Blue Shield Global Core: For care when you travel abroad.
- Away From Home Care: Access to care for Horizon HMO members who are away from home.
Call your Horizon Health Guide at 1-800-414-SHBP (7427), weekdays, from 8 a.m. to 6 p.m., Eastern Time (ET), or sign in to chat or send an email. You can use the Horizon Blue app, too!