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MEDICAL

The School Health Insurance Fund (SHIF) is the plan administrator for the school district’s health benefits.  Aetna is the medical carrier for Moorestown Township Board of Education employees.   


Benefit Update!

Effective July 1, 2018, the following benefit changes will apply to the MEA/General Staff:

Base Plans

The Aetna POS $15 copay plan with the 10% Rx coinsurance and the Aetna HMO $15 copay plan with the Rx Retail copays $5/$10/$20 are the base plans. Any member who selects a higher cost plan will have to pay the difference in premium in addition to their employee contributions under Chapter 78 Legislation.

* 2018 MEA/Staff Side-By-Side Plan Comparison - Click Here

* 2018 MBOE Enrollment/Change Form - Click Here


Save Money With These Plan Alternatives for BOTH MEA/General Staff & Administration!!!

Lower cost plan alternatives

Moorestown Township Board of Education is now offering employees more choices for their medical plan coverage. Employees can choose the coverage that best meets their needs.  Three cost saving medical plans are being offered that also include prescription benefits.

 

   

Aetna $1500 & $2,500 High Deductible Health Plan

 

  • For this plan, the school district will contribute $1,200 of the single deductible and $2,400 of the family deductible towards a health savings account which the member can use to pay for eligible expenses.
  • Once the In-Network deductible is met ($1,500 individual/$3,000 family), all In-Network medical benefits are covered at 100% for the remainder of the calendar year.
  • Preventative Care (in-network) is covered 100% no deductible applies.
  • Members pay 20% coinsurance for prescription drugs once the deductible is met.
  • For more information about Health Savings Accounts - Click Here

 

 To check out these 5 tips to Maximizing Your HSA - Click Here

ACPOS II Core Choice

  • This plan includes a $500 employer contribution to a Health Reimbursement Account that the member can use to pay for eligible medical and prescription expensessuch as the deductible, medical copays, medical coinsurance, and prescription copays
  • The deductible is based on Calendar Year and must be met prior to certain eligible medical expenses being covered. Once you have met your deductible, you are then responsible for your copay or coinsurance listed on the benefit summary.
  • For many of the Preventative Care (in-network) services, the deductible is waived, such as Primary Care visits, Specialist visits, as Preventive Care, Chiropractic Care, Inpatient Hospital Care, and Diagnostic Laboratory and X-Ray services.

  • For more information on Health Reimbursement Accounts - Click Here


 

Plan Documents

SNJREBF Aetna HMO Summary Plan Description

SHIF Supplemental Summary Plan Description

Choice POS II Plan Description


MEA and General Staff Summary of Benefits Information:

Click on the plan name below to view the 2018-2019 benefit summary.

Base Plans

  • Aetna Choice POS II $15 with 10% Coinsurance RX - MEA

Summary of Benefits (SBC)

Benefit Overview

 

  • Aetna HMO $15 with $5/$10/$20 Rx - MEA

Summary of Benefits (SBC)

 

Low Cost Options

 

  • Aetna Choice POS II $1,500 HDHP with HSA

Summary of Benefits (SBC)

 

  •  Aetna Choice POS II $2,500 HDHP with HSA

Summary of Benefits (SBC)

 

  • Aetna Choice POS II Core with $15/$35/$50 Rx - MEA

Summary of Benefits (SBC)

 

Buy-up Options: Members may choose from one of the following plans and pay the difference in premium in addition to their Chapter 78 contributions:

 

  • Aetna Choice POS II $15 with $5/$10/$20 Rx - MEA

Summary of Benefits (SBC)

Benefit Overview

 

  • Aetna Choice POS II $10 with 10% Coinsurance Rx - MEA

Summary of Benefits (SBC)

Benefit Overview

 

  • Aetna Choice POS II $10 with $5/$10/$20 Rx - MEA

Summary of Benefits (SBC)

Benefit Overview

 

  • HMO $10 with $5/$10/$20 Rx - MEA

Summary of Benefits (SBC)

 


Administrators

Effective July 1, 2018, the following benefit changes will apply to the Administrators:

Base Plans

The Aetna Choice POS II $15 copay plan with the 10% Rx coinsurance and the Aetna Choice POS II $2,500 HDHP plan with HSA are the base plans. Any member who selects a higher cost plan will have to pay the difference in premium in addition to their employee contributions under Chapter 78 Legislation.

2018 Administrators Side-by-Side Plan Comparison - Click Here

* 2018 MBOE Enrollment/Change Form - Click Here


Administrators Summary of Benefits Information:

Click on the plan name below to view the 2018-2019 benefit summary.

Base Plans

  • Aetna Choice POS II $15 with 10% Coinsurance RX - Admin

Summary of Benefits (SBC)

Benefit Overview

  • Aetna Choice POS II $2,500 HDHP with HSA (Hired after 7/1/2014)

Summary of Benefits (SBC)

 

Low Cost Options

 

  • Aetna Choice POS II $1,500 HDHP with HSA

Summary of Benefits (SBC)

 

  • Aetna Choice POS II Core with $15/$35/$50 Rx - Admin

Summary of Benefits (SBC)

 

Buy-up Options: Members may choose from one of the following plans and pay the difference in premium in addition to their Chapter 78 contributions:

 

  • Aetna Choice POS II $10 with 10% Coinsurance Rx - Admin 
  •  

    Summary of Benefits (SBC)

    Benefit Overview

     

    • HMO $10 with 10% Rx - Admin

    Summary of Benefits (SBC)

     


    Health Care Reform: Summary of Benefits and Coverage

    The Summary of Benefits and Coverage (SBC) is a standard document that was developed to help program participants better understand their health benefits and provides a high level overview of your medical and prescription benefit programs.  It also includes a uniform glossary of terms commonly used in the health industry.  The SBC is not a comprehensive plan document and is not intended to replace the medical or prescription benefit summaries on this handbook. For copies of the SBC’s for both your medical and prescription coverage, please visit the Healthcare Reform tab.

    For the SBC Glossary of Terms - Click Here 


     Understanding the Payment Limit

    The Payment Limit is the most you pay during the policy period (January to December) before your health insurance plan begins to pay 100% of the allowed amount for eligible/approved expenses.

    Certain member cost sharing under the Aetna Choice POS II, HMO, and High Deductible Health plans apply towards the Payment Limit. 

    For more information on expenses that apply towards the Payment Limit - Click Here


     Aetna Navigator – Resources to Help You Manage Your Health Benefits On-Line:

    Aetna Members- Get in the know about your health at Aetna Navigator the one spot to manage your health and coverage.

    • Look up a claim status
    • Find a doctor
    • Check account balances
    • Find costs of tests and doctor visits
    • Print your temporary ID card and issue a new one. – Cards can also be issued by calling Aetna Customer Service at 855-281-8857
    • And much more!

    To learn more about Aetna Navigator - Click Here


     Participating Providers

    DocFind provides instructions on using the Aetna Doc Find to locate participating providers.  To search for participating providers in your area - Click Here 

    Finding a provider on Aetna’s website & selecting the right network for your plan.

     

    If you are in any of the following plans:

    ·       Aetna Choice POS II $15

    ·       Aetna Choice POS II $10

    ·       Aetna Choice POS II Core $25/$40

    ·       Aetna Choice POS II HDHP $1,500/$3,000 (HSA)

    ·       Aetna Choice POS II HDHP $2,500/$5,000 (HSA)

     

    you will select Aetna Open Access Plans under Select a Plan and choose the Aetna Choice POS II (Open Access) network.

     

    If you are in any of the following plans:

    ·       HMO $10

    ·       HMO $15

     

    you will select Aetna Standard Plans under Select a Plan and choose the HMO network.

     


    Aetna Extras

    Aetna has many programs to help you stay well and save money.

    • Disease Management
    • Vision Discount
    • Beginning Right Maternity
    • Discount Programs
    • Weight Management

    For more information - Click Here


    Health Benefits Mobile Phone Apps Now Available

    Aetna Mobile App- Aetna HMO and Aetna Medicare Plan (HMO) members
    Connect to Aetna right now from a cell phone, smartphone, or other web-enabled mobile device and access Aetna’s most popular online tools from just about anywhere!

    When someone goes to www.aetna.com from their mobile phone’s web browser, they can: Find a doctor, dentist, or other facility Access your personal health record, Look up a claim, or View your Aetna member ID card It is safe, quick, and easy.  Just type www.aetna.com in your mobile browser or check your device’s App Store for availability.

    For additional details visit the Aetna Mobile information page.

    With Aetna, good health information is always at your fingertips!


     What Are Some General Differences Between the Aetna HMO and Choice POS II (Open Access) Plans?

    Aetna HMO Managed Choice POS (Open Access) Plans
    Selection of Primary Care Physician? Yes, you must select a Primary Care Physician. Your Primary Care Physician will provide your care and will refer you to specialists or facilities for treatment when medically necessary. No need to select a PCP.
    Referrals Required? Yes No referrals needed for specialty care
    Out of Network Benefits? No (Except for emergency care.) Yes. Out-of-network benefits provide reimbursement for expenses for eligible services rendered for the treatment of illness and injury. Most out-of-network care is usually reimbursed at a percentage of the reasonable and customary allowance after an annual member deductible is met. Please see you member handbook for further details.
    Precertification Needed? Yes, precertification is required for some services. Please refer to your member handbook. Yes, precertification is required for some services. Please refer to your member handbook.


    Please remember your insurance benefits are limited to the terms, conditions, exclusions and limitations of the insurance carrier’s policy. Nothing contained on this website shall be deemed to have altered, waived, or extended the coverage provided by the policy. This overview contains a general description of your benefits program for your use as a convenient reference. Complete details of your program appear in the policy, which govern the benefits and operation of your program. The policy supersedes if there should be any inconsistency or difference between its provisions and the information in this overview.

     2016-MOORESTOWN-BOE-HMO-10-RX.pdf

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