Garden State Health Plan – Aetna Whole Health NJ network
This plan is available to SEHBP active employees and under 65 retirees.
SEHBP Garden State Health Plan
Welcome. Thanks for joining us to learn more about the state of New Jersey's Garden State Health Plan, newly offered to you by Aetna in 2022. In this video, we'll cover the Garden State Health Plan, the Aetna Whole Health New Jersey network, plan benefits, and extras you receive with Aetna.
What is the Garden State Health Plan? And what is the Aetna Whole Health New Jersey network? And how did they work together?
First, we'll take a look at the Garden State Health Plan. This plan was developed and is being offered as a result of recent legislation. It will be available starting July 1st, 2022, and will be offered to all employees covered under the New Jersey School Employees' Health Benefits Program, active employees, new hires, and pre-65 retirees.
As we take a closer look at this new plan, you'll see that the benefits offered mirror those of the current Educators Health Plan with two key differences. First, the Garden State Health Plan is a network-based plan. This means that in order to receive the highest level of benefits available under the plan, you'll need to use New Jersey providers within the Aetna Whole Health New Jersey network. The second key difference is cost savings. You'll pay a lower premium.
The Garden State Health Plan is built around a network of providers, all within the State of New Jersey. This is called Aetna Whole Health New Jersey network. Before we look at the numbers, let's talk about how care is delivered within the network.
The Aetna Whole Health New Jersey network is a new way of looking at healthcare, and it's set up to improve the quality of care, provide a better experience for you and your family, and save you money. Your doctors, specialists, and hospitals, all work together to keep you healthy, not just treat you when you're sick or injured. And because your care is connected across the network, your care team can keep tabs on your office visits, screenings, and lab results, spot issues, even before you make an appointment, build care plans personalized to you, help you cut down on unnecessary care and costs. This all leads to more proactive, better coordinated care and to a healthier you.
Here's a high-level look at the network numbers. The Aetna Whole Health New Jersey network includes providers across all 21 New Jersey counties. They are currently more than 5,900 primary care doctors, over 29,000 specialists, over 33 hospitals, more than 240 urgent care facilities. This means you and your family can find the care you need when you need it.
We'll switch gears and take a look at the plan benefits and custom ID cards. As this chart shows, with the Garden State Health Plan, you can receive care within the network or from providers who aren't part of the network. However, you'll pay more out of your own pocket for care when you go to a who isn't part of the Aetna Whole Health New Jersey network. Some highlights of the plan are preventive care, received in the network is covered at 100%. This includes routine physicals well-woman and well-child visits, screenings and vaccines. Next, you'll notice there's no annual deductible when you stay in the network. This means services will be covered right away. You don't have to pay money out of pocket first to meet a deductible. For some services, you will need to pay a copay. You'll pay $10 for a visit to your primary care doctor and only $15 for a visit to any specialist in network. Your cost share will be 30% after deductible for using New Jersey providers not part of the Aetna Whole Health New Jersey network. The copays for urgent care and emergency care received in network are $15 for a visit to an urgent care center or $125 if you need to visit the ER. In the Garden State Health Plan, you'll pay nothing out of pocket for participating hospital inpatient stays, outpatient surgery, or lab, x-ray, and complex imaging services. They're covered by the plan at 100%. Also note that when you stay in the network for care, the most you'll ever have to pay for any covered service is 10% of the cost. And the total amount you'll ever have to pay in a year, that is the annual out-of-pocket maximum, is $500 for individual coverage or $1,000 for family coverage.
From start to finish, this plan is designed to make healthcare accessible and affordable. Remember, if you do travel outside of New Jersey, you'll be covered for emergency services only, all other services will not be covered.
Even the member ID card for the Garden State Health Plan is unique. It's a custom gold-colored ID card and you'll receive it in the mail after you enroll in the plan. You'll also be able to print a copy of the ID card from your member website at AetnaStateNJ.com, or pull it up on your smartphone using the Aetna Health app. The ID card will list the plan and network name as well as some of your out-of-pocket costs for services.
Because the Garden State Health Plan is offered through Aetna, there are extras built right into the plan. These extras are designed to help you stay healthy, get the information and support you need, even save you money on health-related items.
Let's take a look at some of these extras. The Healthy Lifestyle Coaching program, which lets you work with a wellness coach by phone or online to improve the way you feel today and every day. The 24-hour nurse line for 24/7 access to a registered nurse when your doctor isn't available. They can provide information and advice and help you decide when and where to seek care. Teladoc, which is a convenient, affordable care option for non-emergency health concerns. It allows you to talk with a licensed doctor by phone or video chat 24/7. They can diagnose, recommend treatment, and prescribe medication when needed. Others stay healthy tools include Aetna Back and Joint Care, which provides personalized exercise therapy programs you can do anywhere. The Aetna Enhanced Maternity Program for extra support, whether you're thinking about starting family, already pregnant, or facing infertility. Transform Diabetes Care, which uses tools, technology, and support to help members better manage their condition.
As an Aetna member, you'll also enjoy discounts on health-related products and services. These include discounts on eyewear and exams, healthy lifestyle programs and tools, natural products and services, and hearing aids and exams. All these programs are available at no extra cost, with the exception of Teladoc, where some services require a copay per visit. NJWELL is available to both active employee and a covered spouse or partner. Each can earn a $250 reward for completing a biometric screening, health assessment, and other wellness activities.
Whenever you need to find information about the Garden State Health Plan, your go-to resource is the custom member website at AetnaStateNJ.com. Here's what you'll find.
Under medical, you'll see a plan overview and coverage details. Under member tools, there's contact information, the provider search tool, and a link to your personalized Aetna member website.
Under extra programs, you'll see more information about all of the Aetna extras and discounts we just talked about. And under presentations, you'll see a copy of this presentation, so you can review it at your convenience. And when you need to locate a provider in the Aetna Whole Health New Jersey network, you can use the Aetna Provider search tool. You'll find it on AetnaStateNJ.com, under both the medical and member tools sections. When prompted, choose to continue as a guest. Then you'll pick Aetna Whole Health New Jersey Choice POSII when asked to select a plan. From there, you can enter a provider's name or choose the type of provider you're looking for, such as specialist, hospital, or urgent care.
Finally, we'll look at the service and support you can expect with a Garden State Health Plan. We already touched on the custom member website at AetnaStateNJ.com. It provides a wealth of information about the Garden State Health Plan and the Aetna Whole Health New Jersey network. You can also link from this site to your personalized Aetna member website. There you can check the status of a claim, print an ID card, and much more. To access all the features of your Aetna member website on the go, you can download the Aetna Health app. Use it to pull up your ID card, find network providers and more when you're on the go. Download available on the Apple App Store and Google Play Store.
And finally, the Garden State Health Plan offers next-level customer service with an Aetna Concierge team. This team is dedicated to servicing State of New Jersey members. You can contact an Aetna concierge at 1-877-StateNJ or 1-877-782-8365 for support Monday through Friday from 8:00 AM to 6:00 PM Eastern Time or anytime through the Aetna member website.
At Aetna, our goal is to support our members wherever they are on their healthcare journey. Our plan, network, programs, and services are all designed to meet you where you are and help you to take the next step, whether you're just starting out, thinking about growing your family, facing a health challenge, or simply looking for ways to get a little healthier each day. We're here for you. As a Garden State Health Plan member, you can always call us if you have questions or visit the custom member website at AetnaStateNJ.com. We're excited about this new plan offering for members of the State of New Jersey School Employees' Health Benefits Program, and we welcome you to Aetna.
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SHBP & SEBHP employees and retirees have choices for dental. Aetna offers two dental plans:
- Dental Expense Plan (DEP | PPO) – in- and out-of-network coverage
- Dental Plan Organization (DPO | DMO) – in-network coverage only
Aetna State of NJ Health Benefits Program and School Employees Health Benefits Program Dental Plans
Welcome. Thanks for joining us to learn more about Aetna dental plans. If you're a current employee, a retiree, or a new employee with the state of New Jersey, you're in the right place.
Aetna®, along with the state health benefits program and the school employees health benefits program are offering two active member dental plans and two retiree dental plans. Even if you like the plan you're in, it's a good idea to review your plan selections every year. Aetna offers cost-effective, easy to understand nationwide dental programs for you to choose from.
Let’s take a look…
The Aetna Dental Expense Plan and Retiree Dental Expense Plan are offered to members by Aetna. These plans are great for members who like the freedom to go in and out of the Aetna network. With these plans, members can see any licensed dentist, no referral required. The Dental Plan Organization and Retiree Dental Plan Organization are great nationwide plans for members who like to budget their costs with a lower monthly premium compared to the Dental Expense Plan. These plans are in-network only dental plans and members select a primary care dentist when enrolling. Today, we will cover the benefits available to active employees under both the Aetna Dental Expense Plan and the Dental Plan Organization. Let's take a closer look at the plan details.
The Aetna Dental Expense Plan or DEP consists of our Preferred Provider Organization, also referred to as the PPO network of providers with both in- and out-of-network coverage. The plan allows members to choose any licensed dentist for dental care. However, out-of-network providers typically cost more, and services can be balanced billed. The benefits of the in-network Aetna Dental Expense Plan are an annual deductible of $50 for individuals and $100 for families, preventive services such as diagnostic and preventive care, covered at 100%, basic services such as routine fillings and extractions paid at 80%, major services such as crowns paid at 65%, an annual plan maximum of $3,000 for in-network services. And for out of network benefits, the following amounts apply: an annual deductible of $75 for individuals and $150 for families, preventive services such as diagnostic and preventive care covered at 90%, basic services such as routine fillings and extractions paid at 70%, major services such as crowns paid at 55%, an annual plan maximum of $2,000 for out-of-network services. The plan maximum combined for in- and out-of-network services is $3,000, excluding orthodontics.
Orthodontics are covered only for dependents who start treatment before age 19. In-network has a $1,000 lifetime maximum, and out-of-network has a $750 lifetime maximum. Remember to stay in-network whenever possible.
Now, let's move on to the second plan, the Dental Plan Organization or DPO, which uses Aetna's in-network Dental Maintenance Organization, also referred to as DMO. This plan requires members to select a primary care dentist and obtain referrals to see a dental specialist. The benefits of the Dental Plan Organization include no annual deductible, preventive services, such as diagnostic and preventive care covered at 100%, a copay for basic services, such as routine fillings and extractions, and major services such as crowns. Plus, there's no annual plan maximum. Copays will vary by type of service.
Dental Plan Organization orthodontics are covered for all members. For members under age 18, the lifetime maximum is $1,000 or 50% billed, whichever is less, For members over age 18, the lifetime maximum is $1,750 or 50% billed, whichever is less. In summary, this plan is more cost-effective. You'll pay less out-of-pocket for services, plus it carries a lower premium. Check to see if your provider participates in the Dental Plan Organization, and then be sure to choose a primary care dentist when you enroll.
The Aetna state of New Jersey website at AetnaStateNJ.com is the resource for Aetna dental plan options for state of New Jersey employees, their families, and retirees. To review Aetna dental plan options for current employees or retirees, select dental in the menu bar, then employee dental plans or retiree dental plans. You'll have access to detailed information on both plans by selecting the plus sign next to each plan name.
Not sure which plan is right for you? You can view the Dental Benefits at a Glance PDF, available for download. If you need to find a primary care dentist, please choose find a doctor in the top menu bar. This will open a new page where you can continue as a guest and enter your zip code. Under dental plans, select Dental Plan Organization for the in-network plans or Dental Expense Plan for the in- and out-of-network plans. Next, select dental care. Then dentists. A list of participating providers will be shown.
If you're selecting the Dental Plan Organization, you'll need to make a note of the primary care ID number on your dental application. As an Aetna member, you can also receive discounts and savings on certain benefits. To learn more, select tools and resources in the menu bar on AetnaStateNJ.com, then select discount programs to view available programs and their offerings.
Once you're a member, you can log in to the Aetna member website to view claims, print an ID card, and access all your benefits information. Thanks for sharing time with us to review Aetna dental plan options. For additional information, please visit the Aetna state of New Jersey website or call our customer service team at 1-877-StateNJ and see how Aetna can make you and your family smile.
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