Common use of HEALTH BENEFITS PROGRAM and PRESCRIPTION DRUG PROGRAM Clause in Contracts

HEALTH BENEFITS PROGRAM and PRESCRIPTION DRUG PROGRAM. A. State Health Benefits Program 1. The State Health Benefits Program (SHBP) is applicable to employees covered by this contract. Benefits and coverage provided under the SHBP shall conform to the requirements approved by the State Health Benefits Plan Design Committee, pursuant to its authority under P.L. 2011, c.78. 2. It is agreed that, as part of the SHBP, the State shall continue the Prescription Drug Program during the period of this Agreement. The Prescription Drug Benefit Program may be modified by the State Health Benefits Plan Design Committee, pursuant to its authority under P.L. 2011, c. 78. 3. Active eligible employees are eligible to participate in the prescription drug benefits coverage offered through the SHBP. Active eligible employees are eligible to participate in the CWA Unity PPO plan (as it existed as of May 20, 2019 and as may be modified pursuant to the PDC’s authority and/or the parties’ reopener process), which is the only PPO plan available to eligible active employees. In the alternative, active eligible employees may elect to participate in an HMO which existed in the program as of June 30, 2011, the Tiered Network Plans or the High Deductible Health Plan (HDHP). 4. The State Health Benefits Plan Design Committee shall provide to employees the option to select one of at least three levels of coverage each for family, individual and spouse, and individual and dependent, or equivalent categories, for each plan offered by the program differentiated by out of pocket costs to employees including co-payments and deductibles. Pursuant to P.L. 2011, c. 78, the State Health Benefits Plan Design Committee has the sole discretion to set the amounts for maximums, co-pays, deductibles, and other such participant costs for all plans in the program and has the sole discretion to determine the plan design, plan components and coverage levels under the program. 5. The Traditional Plan and the NJ Plus POS are not available for any active unit members. Effective July 2, 2019, PPO plans other than CWA Unity PPO will no longer be available to active unit members. 6. Effective January 1, 1996, consistent with law, the State will no longer reimburse active employees or their spouses for Medicare Part B premium payments.

HEALTH BENEFITS PROGRAM and PRESCRIPTION DRUG PROGRAM. A. State Health Benefits Program 1. The State Health Benefits Program (SHBP) is applicable to employees covered by this contract. Benefits and coverage provided under the SHBP shall conform to the requirements approved by the State Health Benefits Plan Design Committee, pursuant to its authority under P.L. 2011, c.78. 2. It is agreed that, as part of the SHBP, the State shall continue the Prescription Drug Program during the period of this Agreement. The Prescription Drug Benefit Program may be modified by the State Health Benefits Plan Design Committee, pursuant to its authority under P.L. 2011, c. 78. 3. Active eligible employees are eligible to participate in the prescription drug benefits coverage offered through the SHBP. Active eligible employees are eligible to participate in the CWA Unity PPO plan (as it existed as of May 20July 2, 2019 and as may be modified pursuant revised by the Plan Design Committee to the PDC’s authority and/or enact negotiated modifications by the parties’ reopener process), which is the only PPO plan available to eligible active employees. In the alternative, active eligible employees may elect to participate in an HMO which existed in the program as of June 30, 2011, the Tiered Network Plans or the High Deductible Health Plan (HDHP). 4. The State Health Benefits Plan Design Committee shall provide to employees the option to select one of at least three levels of coverage each for family, individual and spouse, and individual and dependent, or equivalent categories, for each plan offered by the program differentiated by out of pocket costs to employees including co-payments and deductibles. Pursuant to P.L. 2011, c. 78, the State Health Benefits Plan Design Committee has the sole discretion to set the amounts for maximums, co-pays, deductibles, and other such participant costs for all plans in the program and has the sole discretion to determine the plan design, plan components and coverage levels under the program. 5. The Traditional Plan and the NJ Plus POS are not available for any active unit membershave been abolished. Effective July 2, 2019, PPO plans other than CWA Unity PPO will no longer be available to active unit members. 6. Effective January 1, 1996, consistent with law, the State will no longer reimburse active employees or their spouses for Medicare Part B premium payments.

HEALTH BENEFITS PROGRAM and PRESCRIPTION DRUG PROGRAM. A. State Health Benefits Program 1. The State Health Benefits Program (SHBP) is applicable to employees covered by this contract. For the period July 1, 2007 to March 31, 2008 or as soon thereafter as the PPO and HMO plans that are the subject of a Request for Proposal by the State Health Benefits and coverage provided under the SHBP shall conform to the requirements Commission in 2007 are in effect employees will remain in their current plan: Traditional Indemnity, Managed Care/Point of Service (NJ Plus), or an HMO approved by the State Health Benefits Plan Design Committee, pursuant to its authority under P.L. 2011, c.78. 2. It is agreed that, as part of the SHBP, the State shall continue the Prescription Drug Program during the period of this AgreementCommission. The Prescription Drug Benefit Program may be modified provisions of Section 3 below, shall apply effective April 1, 2008 or as soon thereafter as the PPO and HMO plans that are the subject of a Request for Proposal by the State Health Benefits Commission in 2007 are in effect. 2. Effective the first full pay period of July 2007 and continuing through the term of the Agreement, employees will pay 1.5% of their annual base salary as a contribution to be used for the express purpose of sharing the cost of health benefits provided by the State. The parties agree that there shall be no open enrollment period triggered by this contribution. The parties agree that should an employee voluntarily waive all coverage under the State Health Benefits Plan Design Committee("SHBP") and provide a certification to the State that he/she has other health insurance coverage, pursuant to its authority under P.L. 2011, c. 78the State will waive the 1.5% contribution for that employee. 3. Active Effective April 1, 2008 or as soon thereafter as the PPO and HMO plans that are the subject of a Request for Proposal by the State Health Benefits Commission in 2007 are in effect, active eligible employees are eligible will be able to elect to participate in a PPO, with a national network and the prescription drug benefits coverage offered through same benefit design as the SHBP. Active eligible employees are eligible to participate current NJ Plus plan, except as modified in the CWA Unity PPO plan (as it existed as of May 20, 2019 and as may be modified pursuant to the PDC’s authority and/or the parties’ reopener process), which is the only PPO plan available to eligible active employeesparagraph 5 below. In the alternative, active eligible employees may will be able to elect to participate in an HMO. Effective April 1, 2008 or as soon thereafter as the PPO and HMO which existed in plans that are the program as subject of June 30, 2011, the Tiered Network Plans or the High Deductible Health Plan (HDHP). 4. The State Health Benefits Plan Design Committee shall provide to employees the option to select one of at least three levels of coverage each a Request for family, individual and spouse, and individual and dependent, or equivalent categories, for each plan offered Proposal by the program differentiated by out of pocket costs to employees including co-payments and deductibles. Pursuant to P.L. 2011, c. 78, the State Health Benefits Plan Design Committee has Commission in 2007 are in effect the sole discretion to set the amounts for maximums, co-pays, deductibles, and other such participant costs for all plans in the program and has the sole discretion to determine the plan design, plan components and coverage levels under the program. 5. The Traditional Plan and the NJ Plus POS are not available for any active unit membersshall be abolished. 4. Effective July 21, 20192003, PPO plans other than CWA Unity PPO will no longer be available to active unit membersnew hires are not eligible for enrollment in the Traditional Plan. 5. Coordination of Benefits: If a husband and wife are both eligible for coverage under the State Health Benefit Program as employees: a. Each may elect single coverage in any participating health plan, provided that he or she is not covered under a health plan as a dependent of his or her spouse. b. Each qualified dependent is eligible for coverage under one parent only. 6. Effective July 1, 2007, in-network doctor visit co-pays, including specialist co-pays, will increase from $10 to $15. There will be a co-pay of $15 for the first in-network prenatal visit; subsequent in-network prenatal visits are 100% covered. The emergency room co-pay will increase from $25 to $50, which is waived if admitted. 7. Active employees will be able to use pre-tax dollars to pay contributions to health benefits under a Section 125 premium conversion option. All contributions will be by deductions from pay. 8. Effective January 1, 1996, consistent with law, the State will no longer reimburse active employees or their spouses for Medicare Part B premium payments.