Health Benefits

Health Benefits

The board will provide eligible employees with medical benefits through Horizon, Benecard, and Delta Dental. Employee health benefits contributions shall be made in accordance with all applicable NJ statutes.  You can calculate your contribution by entering your information into the Employee Health Benefit Contribution Calculator

Enrollment includes eligible dependents, a spouse, civil union partner, or eligible same-sex-marriage partners and/or eligible children. (Note: Check with the NJ Division of Pension and Benefits--Civil union coverage may be subject to federal tax.)

New employees shall be enrolled in health care insurance on the 1st of the month succeeding that on which they are employed, with the exception of custodians, maintenance, grounds, and/or security aides requiring a 90-day probationary period. (See RIHEA/RIHAA Agreements, for specific eligibilities for part-time employees, minimum work schedule is 0.8 FTE.)

Medical Plans
Horizon Direct Access Design 8 - $10 co-pay (only for employees hired before 2007)
Horizon Direct Access Design 8 - $15 co-pay
Horizon POS Design 1 - $5 co-pay
Horizon OMNIA 10
Horizon HSA My Way - High Deductible Plan (Includes Prescription Coverage) can be combined with a Health Spending Account  (HSA Enrollment Form)   

Horizon Medical Benefits ~ Understanding Your Costs 
Horizon Claim Form

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 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, 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 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.