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Employee Benefits Employee Benefits

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Eligibility/Open Enrollment Eligibility / Open Enrollment

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Claim Resolution Claim Resolution

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Important Notices Important Notices

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Self-Pay Retirees/Medicare Self-Pay Retirees / Medicare

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Coverage Continuation Coverage Continuation

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Eligibility/Open Enrollment

Eligible Employees:

  • School District Employees that work 25 hours or more per week are eligible for health benefits (single, member & spouse/partner, parent/child or family coverage) with the exception of bus drivers hired after July 1, 2011.

 

  • Bus drivers that work more than 25 hours per week hired after July 1, 2011 are eligible for single coverage health benefits only. A higher level of coverage (member & spouse/partner, parent/child or family) may be purchased by the employee. Bus driver's are not eligible for vision coverage.

Dependents:

  • Spouse, Domestic Partner, Civil Union
  • Medical and Prescription- Young adults are covered until the end of the calendar year in which age 26 is attained.
  • Dental- Dependent children are covered until the end of the calendar year in which age 23 is attained.
  • VSP Vision- Unmarried dependent children are covered until the end of the calendar year in which age 23 is attained.
  • A newborn child is covered for 31 days from the date of birth. To continue coverage beyond this initial period, the newborn child must be enrolled within the initial 31 day period.
  • To continue coverage for a handicapped child evidence of the child’s incapacity and dependency must be provided to the carrier at least 31 days prior to the termination of coverage.

Waiting Period
All 10 month employees hired for a 9/1 start date have no waiting period. All other employees have a 60 day waiting period for benefits.


Moorestown Education Association (MEA)

For members of the Moorestown Education Association, the two following medical plans will be the “Base Plans”

  • Aetna ACPOS II $15 copay plan with the 10% Rx coinsurance
  • Aetna HMO $15 copay plan with the Rx Retail copays $5/$10/$20

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.


Non-Affiliated Staff (Internal)

  • For Non-Affiliated Staff hired prior to January 1, 2016 the Aetna ACPOS II $15 Copay Plan with the 10% Rx Coinsurance is the “Base Plan”.
  • For Non-Affiliated Staff hired after to January 1, 2016 the Aetna ACPOS II $1500 HDHP with the 20% Rx Coinsurance is the “Base Plan”.

Non-Affiliated Staff (External) 

  • For Non-Affiliated Staff hired prior to January 1, 2016 the Aetna ACPOS II $15 Copay Plan with the 10% Rx Coinsurance is the “Base Plan”.
  • For Non-Affiliated Staff hired after to January 1, 2016 the Aetna ACPOS II $2500 HDHP with the 20% Rx Coinsurance is the “Base Plan”.

Anyone electing a higher cost plan has to pay the difference in premium.


Moorestown Administrators Association (MAA)

For Administrators hired prior to July 1, 2014, the Aetna ACPOS II $15 with 10% Rx Coinsurance is the “Base Plan”.

For all Administrators hired after July 1, 2014, the following will apply-

  • For current Board employees who accept a Board administrative position and become a member of Association shall have their base health care coverage established through Aetna ACPOS II High Deductible Health Plan $1,500 OR Aetna ACPOS II $15 with the 10% Rx Coinsurance – Single Coverage.
  • For all Administrators hired from outside the district shall have their base health care coverage established through Aetna ACPOS II High Deductible Health Plan $2,500 OR Aetna ACPOS II $15 with 10% Rx Coinsurance – Single Coverage.

Anyone electing a plan above their identified base plan will have to pay the difference in premium.


 

Coverage for Handicapped Dependents:

An over age child who is disabled due to mental illness, mental retardation, or a physical disability and dependent upon you for support can remain covered as a dependent if the child’s disabled status is approved. Use the forms below to request coverage for a handicapped dependent:

Aetna Coverage for Handicapped Dependents:

Delta Dental Coverage for Handicapped Dependents:

 


OPEN ENROLLMENT

Each Spring eligible employees are able to make changes to their benefit plan selections.  Any changes made become effective on July 1st.

During Open Enrollment-

  • During open enrollment, all eligible employees and their dependents that previously declined the medical, prescription, or dental benefits can enroll at this time.
  • All current participants already enrolled can make changes to their current plan selections and change to any plan being offered.
  • Anyone wishing to add a dependent, or terminate coverage for themselves or a dependent would need to do so at this time by completing an enrollment/change form.

Please note this is a Passive Open Enrollment. If you are currently enrolled in any of the plans and do not request any changes to be made, you will automatically retain your current coverage(s).

Enrollment/Change forms are located on the FORMS tab on the Employee Benefit Communication Center.

2018 Moorestown BOE Aetna Open Enrollment Brochure – for a copy - Click Here. 

2018 Moorestown BOE Express Scripts Formulary List - for a copy - Click Here.

2018 Moorestown BOE Dental Open Enrollment Brochure – for a copy - Click Here.

Special Open Enrollment: Please note that once the Open Enrollment period has ended you will only be able to make a change during the year if you have a qualifying life event which permits a Special Open Enrollment, such as marriage, divorce, birth of child or adoption, or loss of other coverage. Please contact the Business Office within 31 days if you have a qualifying life event and wish to makes changes to your coverage.


 Plan Options

The school district offers several plan choices to eligible employees so that employees can pick the plan that best meets their needs.

  • To view your medical plan options, please click on the MEDICAL tab.
  • To view your dental plan options, please visit the DENTAL tab.
  • To View your prescription plan options, please visit the PRESCRIPTION tab.

 


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.  For copies of the SBC’s for both your medical and prescription coverage, please visit the Healthcare Reform tab.

Understanding Insurance Terminology

What is the difference between copayments and coinsurance? How does a deductible work? Insurance terminology can be confusing. Click Here for a Glossary of Terms for some common insurance terminology.


Monthly Plan Options & Rates Effective 7/1/2018 to 6/30/2019

2018 Aetna Medical and Rx for MEA and General Staff - Click Here

2018 Aetna Medical and Rx for Administrators - Click Here

Delta Dental and Vision (VSP)- All Staff


Important Information Regarding Your Health Coverage

Dependent Coverage

Under the Patient Protection and Affordable Care Act:  A child is defined as an enrollee’s child until age 26, regardless of the child’s marital, student, or financial dependency status  even if the young adult no longer lives with his or her parents. (for your medical and prescription coverage)

  • Medical Coverage –Young adults will be covered through the end of the calendar year in which they turn age 26.
  • Prescription Coverage –Young adults will be covered through the end of the calendar year in which they turn age 26.
  • Dental Coverage-Dependent children are covered until the end of the calendar year in which age 23 is attained.

As dependents age out of the program, they may be eligible for coverage under the NJ Dependent to 31 program or COBRA.  Please see the Coverage Continuation tab for further information.


Continuation of Health Benefits Insurance Under COBRA– concerns the federal program known as the Consolidated Omnibus Budget Reconciliation Act (COBRA). COBRA allows you or your covered dependents to extend health benefit coverage under the employee group in certain cases where you would otherwise lose that coverage. For more information, click on the link above.


Medicaid and CHIP

If you are eligible for health coverage from your employer, but are unable to afford the premiums, some States have premium assistance programs that can help pay for coverage. These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage, but need assistance in paying their health premiums.

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed on the notice below, you can contact your State Medicaid or CHIP office to find out if premium assistance is available.

If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your  dependents might be eligible for either of these programs, you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, you can ask the State if it has a program that might help you pay the premiums for an employer-sponsored plan. For more information-

Medicaid and Children’s Health Insurance Program

If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov.



Aetna Coverage for Handicapped Dependents

Dental Coverage for Handicapped Dependents


 

  • Designation of Primary Care Providers by Participants or Beneficiaries:

    The Moorestown Township Board of Education Aetna HMO plan requires the designation of a primary care provider. You have the right to designate any primary care provider who participates in the Aetna network and who is available to accept you or your family members. Until you make this designation, the network carrier may designate one for you. For information on how to select a primary care provider, and for a list of the participating primary care providers, please visit www.aetna.com.

    For children, you may designate a pediatrician as the primary care provider.

    Coverage for Obstetric or Gynecological Care:

    You do not need prior authorization from our health insurance carrier or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in our network who specializes in obstetrics or gynecology.  The health care professional, however, may be required to comply with certain procedures, including obtaining prior authorization for certain services, following a pre-approved treatment plan, or procedures for making referrals.  For a list of participating health care professionals who specialize in obstetrics or gynecology, please visit www.aetna.com.

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