We have previously reported that all Medicare eligible retirees under the SEHBP (teachers) who are enrolled in traditional Medicare with either the NJ Direct 10 or NJ Direct 15 plans will be automatically enrolled into new Aetna Medicare Advantage plans. It has come to our attention that additionally, any retired SHBP (police, fireman, etc.) employees who had been enrolled in the Horizon Medicare Advantage NJ Direct 10 or 15 will also be moved to new Aetna Medicare Advantage plans.
Additional details have become available regarding changes to the School Employee Health Benefits Program (SEHBP). First, the changes previously described were approved by the School Employee Health Benefits Commission and are hence, official. Both the new plan option and the retiree changes will be effective as of January 1, 2019.
Fall Edition - Vol. 14 No. 4
Many members have received a letter from Aetna regarding a new pre-authorization process coming January 1, 2019. Aetna’s contract with Triad/eviCore is expiring on December 31, 2018. A vendor called National Imaging Associates (NIA) will be managing this new pre-authorization program immediately following the Triad contract expiration. The process will apply to all physical medicine procedure codes regardless of what type of provider performs them whether it be a DC, PT or MD. The pre-authorization program will be applied to in-network providers on fully funded plans only.
Yesterday, following an agreement between Gov. Murphy and the New Jersey Education Association, the School Employee Health Benefits Program’s (SEHBP) Plan Design Committee passed several resolutions enacting reforms to reduce costs under the plan. The SEHBP covers all employees of K-12 schools and community colleges that opt into the state program.
November 7, 2018
November 8, 2018
November 8, 2018
Presenter: Lora Tanis, DC, DICCP
Holiday Inn Cherry Hill - 2175 Marlton Pike W, Cherry Hill, NJ 08002 Phone: 856-663-5300