Health Benefits

Health Benefits

Eligibility


-RIH will provide eligible new employees with Medical, Dental, and Prescription Insurance Coverage. 
-Coverage begins on the 1st of the month succeeding that on which they are employed, for example, your start date is October 14, your first day of coverage is November 1. 
 This does not include custodians, maintenance, and grounds as they have a 90-day probationary period.
-If you are starting at the beginning of the school year, you will have coverage effective September 1st 
 *See RIHEA/RIHAA Agreements for specific eligibilities for part-time employees, minimum work schedule is 0.8 FTE. 

Employee health benefits contributions are made in accordance with all applicable NJ statutes. 
You can calculate your contribution by entering your information into the 2021 Employee Contribution Calculator 
**YOU MUST ENABLE MACRO'S FOR THE CALCULATOR TO WORK** 


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New Employee plan options 
 

Medical - 1 Plan through Aetna - NJ Educators Plan (SHIF)
   - NJ Educators Plan Summary

Prescription
-1 Plan through Benecard
   - Benecard Pamphlet.pdf

Dental
- 1 Plan through Delta Dental 
   - Delta Dental Booklet.pdf

Enrollment Forms 
Aetna (SHIF)
Delta Dental
Benecard
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Current Employee plan options

If you were hired after 7/1/20, you are eligible for the following plan:

Aetna NJEHP w/Benecard Prescription 

If you were hired 7/1/07 - 6/30/20, you are eligible for the following plans:
Aetna NJEHP w/Benecard Prescription  
Aetna Open Access 15

If you were hired prior to 7/1/07, you are eligible for the following plans:
Aetna Open Access 10

Aetna Open Access 15
Aetna NJEHP w/Benecard Prescription 


*All plan options viewed side by side 
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Terms You Need to Know:

Coinsurance
The sharing of certain covered expenses by the plan and the plan participant. For example, if the plan covers an expense at 80 percent (the plan’s coinsurance), your coinsurance is 20 percent of the provider’s charge.
Coinsurance Limit
The coinsurance limit is the maximum that you must pay out-of-pocket for your coinsurance share each calendar year.
Copayment (copay)
The specified dollar amount or percentage is required to be paid directly to an in-network provider.
Deductible
The amount of covered expenses that a member must pay each plan year before the plan begins to pay benefits.
Dependent
A member’s spouse, civil union partner, a same-sex domestic partner (as defined by P.L. 2003, c.246), or child(ren) under the age of 26. Children include natural, adopted, foster, and stepchildren. If a covered child is not capable of self-support when he or she reaches age 26 due to mental illness or a physical disability, coverage may be continued subject to approval.
In-Network Provider or Participating Provider
Any physician, hospital, skilled nursing facility, or other individual or entity involved in the delivery of health care or ancillary services that contracts to provide covered services to plan participants for a negotiated charge.
Out-of-Network Provider
This term generally is used to mean providers who have not contracted with a health plan to provide services at negotiated fees; or, with an HMO, an in-network provider who is furnishing services or supplies without a referral from the patient’s PCP.
Out-of-Pocket Maximum
The out-of-pocket maximum is the maximum amount you must pay toward covered medical expenses in a calendar year. Once you reach this maximum, the plan pays 100 percent of your remaining covered expenses for the rest of the year.
Urgent Care
Services are received for an unexpected illness or injury that is not life-threatening but requires immediate outpatient medical care that cannot be postponed. An urgent medical condition requires prompt medical attention to avoid complications and unnecessary suffering or severe pain, such as a high fever.