• Middlesex County
Medical Benefits:
• Survivor Benefit: The surviving spouse (and eligible dependents) of an employee who with 10 (10) years or more years of service with Middlesex County dies while on the payroll of the County shall be entitled to a continuation of health benefit coverage from the date of death (until the surviving spouse reaches age 65 or remarries or obtains or is able to obtain benefit coverage from another source and dependents until they are age limited) under the same terms and conditions as applied while the employee was alive, including payment of contributions in accordance with the rates set forth in P.L.2011 Chapter 78. Any modification or termination of these benefits shall be administered in accordance with County Policy.
• Modification of Chapter 79 Contributions for Retirees: The County agrees to modify the exemption from the requirement of pay contributions upon retirement such that employees who completed 10 (ten) years of service or more of creditable service in a State of New Jersey administered pension system at any time during calendar year 2011 and who become eligible for health benefits from Middlesex County based upon 25 or more years of service will not be required to make contributions pursuant to the rates set forth in P.L 2011 Chapter 78 for their health benefits upon retirement, consistent with County Policy.
• Prescription Drug Coverage: Effective 1/1/2018, the following changes in the Medical Benefits should be implemented, except that the changes to the medical plan specified below shall not apply in retirement to any employee who retires on or before January 1, 2019 or who has 25 years of creditable service in a State of New Jersey Pension System on or before December 31, 2011 and retires on or before December 31, 2024. Instead, these employees will have an Rx copay of $5.00 for generic drugs and $10.00 copay for brand name drugs in retirement.
This will be the last contract that this provision applies.
• Middlesex County Utilities Authority
• Retiree Benefits
• Active Employees who Retired January 1, 2019, through December 31, 2020, with less than 25 years of creditable service in the state of New Jersey’s administered pension system and have a minimum of 15 years of service, with the Authority at the time of retirement as of June 28, 2011, as a Premium Free Retiree will receive the new 2018 medical ($10PCP/Spec) and new 2018 RX ($0/$15/$30 with the National Formulary and Step Therapy benefit).
• Active Employees who Retired after January 1, 2019, and ongoing with 25 years of creditable service in the state of New Jersey’s administered pension system and have a minimum of 15 years of service with the Authority at the time of retirement as of June 28, 2011, as a Premium Free Retiree will receive the present 2017 medical ($2/$5PCP/Spec) and the present 2017 active RX ($5/$10 without the National Formulary and Step Therapy benefits).
• Active Employees who Retired during 2018, and ongoing with less than 25 years of creditable service in the state of New Jersey’s administered pension system and are 62 years or older with a minimum of 15 years of service with the Authority at the time of retirement, as a Direct Bill Retiree will receive the new 2018 medical ($10PCP/Spec) and the new 2018 RX ($5/$10/$30 with the National Formulary and Step Therapy benefits).
• Active Employees who Retire with Regular, Ordinary and Accidental Disability Retirement benefits on or after January 1, 2018, will receive the new 2018 medical ($10PCP/Spec and the new 2018 RX ($5/$10/$30 with the National Formulary and Step Therapy benefits).
• Survivor Benefits
• Eligibility for continuation of health benefits shall begin after (1) year of employment with the Middlesex County Utilities Authority and is based on the number of years of service.
• Upon the death of an active employee with less than 10 years of service, the surviving spouse and eligible dependents are entitled to continued health benefit coverage for 36 months under the Federal Comprehensive Omnibus Budget Reconciliation Act of 1985 (COBRA), if surviving spouse chooses to do so.
• Upon the death of an active employee with 10 or more years of service, the Middlesex County Utilities Authority would continue health benefit coverage. The coverage cost to be paid by the Authority is determined by multiplying the total cost by a multiplier of .04, which remains fixed for years (2) through (5) and will increase by .04 for every year thereafter. Employees with prior (PERS) service will be credited with a multiplier of .02 for each year of service, only if they’ve completed 10 years of service with the Authority. Once determined the surviving spouse will pay the difference.
• It is the responsibility of the surviving spouse to notify in writing, Middlesex County Utilities Authority of a life changing event, (remarriage, dependents marry or turn 26), within (30) days.
• Survivors may choose to discontinue coverage at any time. However, once benefits are discontinued, they cannot be reinstated.
• Middlesex College
• Full-time Administrators, Confidential Staff, AFT Faculty, Teamsters, AFSCME and FOP hired before July 1, 2020 should review documents labeled "Opt-In".
• All employees hired on or after July 1, 2020 are only eligible to enroll in the NJ Educators Health Plan ("NJEHP") or Garden State Health Plan ("GSHP"), as per State Law Chapter 44, and should review those documents only. All other benefits plans besides NJEHP and GSHP are not available for employees of any classification hired on or after July 1, 2020.
• Middlesex County Improvement Authority and Roosevelt Care Center
• Existing Middlesex County Improvement Authority and Roosevelt Care Center Retiree benefits will remain the same. Employees retiring October 1, 2018 through December 31, 2019 will also receive the present retiree benefits. Those employees retiring on or after January 1, 2020 will receive new Prescription Drug copays ($5 Generic/$10 Brand) with no National Formulary or Step Therapy. Medical benefits will be the pre-October 1, 2018 copays.
• Middlesex County Mosquito Commission.
• Existing Middlesex County Mosquito Commission Retiree benefits will remain the same. Existing retirees will keep their present medical benefits, however as of January 1, 2019, prescription drug coverage will be provided by CVS. There will be a $5 Generic copay and a $10 Brand copay. There will be no National Formulary or Step Therapy.
• Employees retiring January 1, 2019 through December 31, 2019 will also receive the present retiree benefits. Those employees retiring on or after January 1, 2020 or thereafter will receive new Prescription Drug copays ($5 Generic/$10 Brand) with no National Formulary or Step Therapy. Medical benefits will be the pre-January 1, 2019 copays.
• Middlesex County Board of Social Services.
• Active Employees who Retire after January 1, 2024 with less than 15 years of creditable service in the state of New Jersey’s administered pension system as of December 31, 2011 as a Premium Free Retiree will receive the 2023 medical ($10 PCP/Spec) and 2023 Rx ($0/$15/$30 with the National Formulary and Step Therapy) benefits.
• Active Employees who Retire during 2024 and on going with 15 or more years of creditable service in the state of New Jersey’s administered pension system, as of December 31, 2011 as a Premium, Free Retiree will get the 2022 active medical ($2/$5 PCP/Spec) and the 2022 Retiree Rx benefits ($0/$3 without the National Formulary and Step Therapy).
• Active Employees who Retire any time during 2022 and ongoing with less than 25 years of creditable service in the state of New Jersey’s administered pension system and are 60 years or older as a direct Billed Retiree, will receive the 2023 health ($10 PCP/Spec) and the 2023 Rx ($0/$15/$30 with the National Formulary and Step Therapy) benefits.
• Active Employees who Retire with Disability benefits on or after January 1, 2024 will receive the new 2024 health ($10 PCP/spec) and the 2023 Rx ($0/$15/$30 with the National Formulary and Step Therapy) benefits.

• Horizon Traditional and OMNIA plan benefits will not change;
• Specific Enhancement to Chapter 78 Retiree Requirement
• Under the enhanced new benefit offered by the MCJHIF, employees who had 15 years or more of creditable service in the State of New Jersey administered pension system at any time during calendar year 2011 will not have to contribute toward the cost of medical/prescription coverage upon retirement. Under the State's Chapter 78 Law, employees needed 20 years of service as of June 28, 2011 for this benefit. All other qualifying retirement requirements remain the same;
  
  Applicable to: Middlesex County, Middlesex County Utilities Authority, Middlesex County Improvement Authority, Roosevelt Care Center and the Mosquito Commission
• Survivor Benefit
• Added benefit - If an active Middlesex County employee with 10 years or more of creditable service with Middlesex County who is currently enrolled in the medical and prescription plan passes away on or after January 1, 2024, the Fund will continue coverage for the surviving spouse and/or any dependent children (age 26 and younger) covered under the plan as of the date of death. This coverage will not exceed 36 months at the applicable Chapter 78 contribution rate. When the 36 extension of coverage expires, the spouse and/or covered children (age 26 and younger) will be eligible for further continuation of medical coverage for up to three years through COBRA.
  
  Applicable to: Middlesex County Improvement Authority, Roosevelt Care Center and the Mosquito Commission
  
  MCUA Employees - benefits are unchanged.

• Effective January 1, 2024 Medical Copays for Aetna, CIGNA, Horizon Choice, and Oxford will be as follows:
• Office Visit Copay - $10 per visit for Primary Care and Specialty Visits;
• Emergency Room Copay - $50 per visit (copay waived if admitted);
• Urgent Care Center Copay - $20 per visit.

• Three-tiered copays for prescriptions filled on or after January 1, 2024:
• $0 Copay for a generic drug;
• $15 Copay for a preferred brand drug;
• $30 Copay for a non-preferred drug.
• Prescription plan will have Step Therapy Program and a Formulary.

• Generic

A Prescription Drug that has the equivalency of the brand name drug with the same use and metabolic disintegration. Generic drugs have a $0 copay. This Plan will consider as a Generic Drug any U.S. Food and Drug Administration approved generic pharmaceutical dispensed according to the professional standards of a licensed pharmacist.

If you are currently taking a prescription medication, Click Here to see your drug classification.

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• Preferred Drug

A Prescription Drug that has been clinically reviewed and approved. The drug has been in the market for a time and is widely accepted. This medication has been included based on its proven clinical and cost effectiveness. Preferred drugs have a $15 copay. This Plan will consider as a Preferred drug any U.S. Food and Drug Administration approved brand/generic pharmaceutical dispensed according to the professional standards of a licensed pharmacist.

If you are currently taking a prescription medication, Click Here to see your drug classification.

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• Non-Preferred Drug

A Prescription Drug that usually has the highest copayment. It is generally a higher-cost medication that has recently come on the market. In most cases, an alternative preferred medication is available. Non-Preferred Drugs have a $30 copay. This Plan will consider as a Non-Preferred Drug any U.S. Food and Drug Administration approved brand/generic pharmaceutical dispensed according to the professional standards of a licensed pharmacist.

If you are currently taking a prescription medication, Click Here to see your drug classification.

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• Formulary

The Formulary is now a part of your prescription plan. It is a list of Prescription Drugs covered under this Plan. It is an approach to prescription coverage intended to help with costs and control risks posed by prescription drugs. The Formulary is made up of Generic, Preferred and Non-Preferred drugs. Certain medicines you are taking (or take in the future) may be affected by the new Formulary and may not be covered. Make sure to contact your doctor to see if the alternatives will work for you, otherwise your prescription may not refill when due on or after January 1, 2024. You may be able to stay with your prescribed drug if your doctor documents a medically necessary reason for you to stay with your prescribed drug.

If you are currently taking a prescription medication, Click Here to see your drug classification, and alternatives.

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• Step Therapy (click for more information)

Step Therapy is now a part of your prescription plan. It is an approach to Prescription Drugs intended to control the use and costs of Prescription Drugs. The practice begins with prescribing alternative medication for a medical condition with the most effective drug therapy and progresses to other therapies only if necessary. One or two generic drugs are tried first, and if they do not get the proper results, the prescribed drug will be provided. You may be able to stay with your prescribed drug if you doctor documents a medically necessary reason for you to stay with your prescribed drug.

If you are currently taking a prescription medication, Click Here to see your drug classification.

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If you are taking a prescription drug or have a new prescription, Click Here to obtain information on the status of your prescription drug and the applicable copay.

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If you need help or have questions, call Advantage Consultant Services/preferred partner iHealth Benefits.

Advantage Consultant Services/iHealth Benefits will help you with problems when getting your prescription filled at the pharmacy or mail order. You can call Advantage Consultant Services/iHealth Benefits at (215) 436-9520.

Members affected by the Formulary change and/or Step Therapy should do the following:

• Present your prescription to the pharmacy. If the drug is denied, the pharmacist will:


• Contact Advantage Consultant Services/iHealth Benefits
• ACS/iHealth Benefits will contact your doctor to have a new prescription written for a covered alternative.
• If the doctor disagrees, ACS/iHealth Benefits will fax the “Formulary Change Form” or the “Step Therapy Form” to the doctor’s office for his/her competition.
• The doctor will attach a Letter of Medical Necessity to either of the above forms and fax the two documents to ACS/iHealth at (267) 373-1613.
• Once received, ACS/iHealth will review the documents within 24 hours and approve or deny.
• If approved, ACS/iHealth will put an approval in the pharmacist’s system within 24 hours so the drug will be available going forward.
• ACS/iHealth Benefits will authorize a 30-day supply of originally prescribed drug if necessary.


• Completed authorization forms and medical necessity letters can be sent to:


iHealth Benefits, Inc.
PO Box 7
Lederach, PA 19450

Fax: (267) 373-1613
Email: services@benefits-consultant.com

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