Health Benets Coverage –
Enrolling as a Retiree
Information for:
State Health Benets Program
School Employees’ Health Benets Program
Page 1 April 2024 Fact Sheet #11
ELIGIBILITY
The Retired Group of the State Health Benets Pro-
gram (SHBP) or School Employees’ Health Benets
Program (SEHBP) oers medical, prescription, and
dental coverage to certain retiring members and their
eligible dependents. Members must have been full
time employees who were eligible for health insur-
ance coverage until their retirement date.
Note: Part-time State employees and part-time facul-
ty members enrolled in the SHBP/SEHBP under the
provisions of P.L. 2003, c. 172 (Chapter 172) should
refer to the Health Benets Coverage for Part-Time
Employees Fact Sheet for information regarding re-
tired health benet coverage eligibility.
Eligible members include:
• State employees, employees of State universi-
ties/colleges and autonomous State agencies
and commissions, as well as local government
employees who were covered by, or eligible for,
the SHBP and who are eligible for a retirement
benet from a New Jersey State-administered
retirement system immediately following termi-
nation of employment.
• Members of the Teachers’ Pension and Annuity
Fund (TPAF) and school board or county college
employees enrolled in the Public Employees’
Retirement System (PERS) who retire with 25
years or more of service credit in the retirement
system* or who retire on a Disability Retirement,
even if their employer did not cover its employ-
ees under the SEHBP. This also includes those
who elect to defer retirement with 25 or more
years of service credit in the retirement system.
• Members of the TPAF and PERS who retired
from a participating board of education, voca-
tional/technical school, or special services com-
mission, with less than 25 years of service credit,
as long as the employer continues to participate
with the SEHBP.
• Upon turning age 65, members of the TPAF and
PERS who retired with less than 25 years of
service credit from a non-participating board of
education, vocational/technical school, or spe-
cial services commission who have continuously
participated in the health benets plan of their
former employer since their retirement and are
enrolled in Medicare Parts A and B.
• Participants in the Alternate Benet Program
(ABP) who were covered by, or eligible for, the
SHBP/SEHBP as active members.
• Certain local police ocers or reghters with 25
years or more of service credit in the retirement
system* or retiring on a Disability Retirement if
the employer does not provide any payment or
compensation toward the cost of the retiree’s
health benets, in accordance with P.L. 1997, c.
330 (Chapter 330). A qualied retiree may en-
roll at the time of retirement or when eligible for
Medicare.
ENROLLMENT
Participating employers will continue to cover you
in the active employee group for one month beyond
your termination of employment. Eligible members
whose employer does not participate in the SHBP
or SEHBP will be enrolled as of their retirement date
provided that you remain on payroll up until your re-
tirement date.
Most eligible members enrolled in coverage as ac-
tive employees will automatically be enrolled as re-
tirees; If you are Medicare-eligible, you must enter
your Medicare proof in mynjbenetshub so that your
account does not pend in the auto enroll process.
Exceptions to the auto enroll process include those
members who have: changed their retirement date;
waived coverage as an active employee; some
Disability Retirements; full-pay retirees; or mem-
bers who retire from non-participating employer lo-
cations. Members in any of these categories must
apply for coverage online using mynjbenetshub
to be enrolled. Mynjbenetshub can be accessed
via your myNewJersey account or by navigating to
mynjbenetshub.nj.gov If you are waiving cover-
*See the “Combining Service Credit from More than One Retirement System” section.
Fact Sheet #11 April 2024 Page 2
Health Benets Coverage – Enrolling as a Retiree
This fact sheet is a summary and not intended to provide all information.
Although every attempt at accuracy is made, it cannot be guaranteed.
age because of other coverage, you must do so on-
line using mynjbenetshub at the time of retirement
in order to be eligible for enrollment if/when you lose
the other coverage. If you do not submit an appli-
cation online using mynjbenetshub within 60 days
of your retirement date, you will not be permitted to
enroll at a later date, unless you are subsequently
approved for a Disability Retirement (see the “Dis-
ability Retirement” section.)
If you are not eligible for employer-paid coverage,
the premium will be deducted from your monthly
retirement check, or you will be billed on a monthly
basis if the amount of your retirement check is not
enough to cover your premium.
If you are eligible for health care coverage at retire-
ment, you are eligible to enroll in dental care cov-
erage online using mynjbenetshub (see the Dental
Plans — Retirees Fact Sheet).
Disability Retirement
Members who apply for a Disability Retirement and
whose employer participates with the SHBP/SEHBP
will be eligible for retiree group coverage under the
SHBP/SEHBP while the retirement application is
being processed. Members will be billed for the full
cost of their health benets pending the approval of
their Disability Retirement. Members who work for
the State or a Board of Education and who have at-
tained 25 years or more of service will not be billed
for any premiums until a decision is made. Members
of participating locations entitled to employer-paid or
retirement system-paid health insurance will receive
a refund of any of the health benets premiums they
paid to the program for coverage after the eective
date of retirement, minus any premiums that are
owed by the retiree.
Members will receive a letter from Businessolver of-
fering retired health benets and instructions on how
to create an account through mynjbenetshub. The
member must login to mynjbenetshub to enroll into
health benets.
Multiple Coverage is Prohibited
State law prohibits two members who are each en-
rolled in SHBP/SEHBP plans from covering each
other. Therefore, an eligible individual may enroll in
the SHBP/SEHBP as an employee or retiree, or be
covered as a dependent, but cannot be both. Eligible
children may only be covered by one participating
subscriber.
Example: A husband and wife both have cover-
age based on their employment. One may choose
Family coverage, covering the spouse and children
as dependents, making them ineligible for any other
SHBP/SEHBP coverage; or one may choose Single
coverage and the spouse may choose Parent and
Child(ren) coverage.
Note: If you are eligible for SHBP/SEHBP Retired
Group coverage but have other coverage through
your spouse/partner, you must waive the coverage
online using mynjbenetshub (see the “Waiving
Coverage if Covered by Another Plan” section). Oth-
erwise you will be considered terminated from the
SHBP/SEHBP and you will not be permitted to re-en-
ter the program.
Medicare Coverage is Required if Eligible
Upon retirement, if you and/or your dependent are
age 65 or have been on Social Security Disability for
24 months or more, you are required to enroll in Medi-
care Parts A and B. If you have not enrolled in both
parts of Medicare, you should contact Social Security
to apply 90 days prior to your retirement date.
In most cases, the Centers for Medicare and Medic-
aid Services (CMS) will advise the SHBP/SEHBP of
your enrollment. If you are retiring from a non-par-
ticipating location, or receive correspondence from
the SHBP/SHEBP requesting proof of your Medicare
enrollment, you are required to provide a photocopy
of your Medicare ID card, or a letter of conrmation
from Social Security stating the eective dates of
Medicare Parts A and B and your Health Insurance
Claim Number (HICN) or Medicare Beneciary Iden-
tier (MBI) number.
If you and/or your dependents become eligible for
Medicare and do not enroll in Parts A and B, your
SHBP/SEHBP coverage will be terminated. Once
terminated, your coverage will only be reinstated
prospectively after the appropriate documentation is
received.
If you are paying the full cost of your SHBP/SEHBP
coverage, that cost generally decreases when you
and/or your dependents enroll in Medicare Parts A
and B because most medical plans charge lower pre-
miums for Medicare-eligible members.
Medicare Part D
Retired members of the SHBP or SEHBP who are
enrolled in Medicare are automatically enrolled in the
OptumRx Medicare Part D Prescription Drug Plan
(PDP).
You may waive the OptumRx Medicare PDP only if
you are enrolled in another Medicare Part D plan. To
waive coverage, you must submit a written request
along with proof of other Medicare Part D coverage
to the New Jersey Division of Pensions & Benets
(NJDPB).
If you enroll in another Medicare Part D plan, you will
lose your prescription drug benets provided by the
SHBP/SEHBP; however, your medical benets will
continue.
Note: If you are enrolled in a Medicare Advantage
Plan, you can only waive your prescription drug cov-
erage for another group Medicare Part D plan. If you
waive coverage for an individual Medicare Part D
plan, your SHBP/SEHBP Medicare Advantage Plan
will be terminated.
If you have previously waived your prescription drug
coverage for another Medicare Part D plan, and you
wish to re-enroll in the OptumRx Medicare PDP, you
must send proof of your termination from the other
Page 3 April 2024 Fact Sheet #11
Health Benets Coverage – Enrolling as a Retiree
This fact sheet is a summary and not intended to provide all information.
Although every attempt at accuracy is made, it cannot be guaranteed.
Medicare Part D plan. Acceptable proof is a letter
from the other Medicare Part D plan conrming the
date upon which you are disenrolled. We must re-
ceive this proof within 60 days of the termination from
the other Medicare Part D plan.
PAYMENT OF COVERAGE COSTS
The State and certain employers have negotiated to
pay some or all of the cost of SHBP/SEHBP cover-
age for retirees who meet specic service credit or
retirement criteria outlined in the following sections.
The retiree’s cost is based on the full monthly pen-
sion amount before any deductions, including equita-
ble distribution due to a Qualied Domestic Relations
Order (QDRO).
SHBP- or SEHBP-eligible retirees who do not qualify
for State-paid or employer-paid coverage must pay
the full cost of their health benets coverage. Premi-
ums are deducted from your monthly pension checks.
If the monthly retirement allowance is not sucient to
cover the premium, you will be billed monthly.
Note: For PERS and TPAF members, purchases of
U.S. Government Service or Out-of-State Service
made after November 1, 2008, cannot be used to
qualify for State-paid or employer-paid post-retire-
ment health benets.
State Employees and Employees
of State Universities/Colleges
If you had 25 or more years of service credited in
one pension system before July 1, 1997 (the eec-
tive date of P.L. 1996, c. 8 (Chapter 8)), the State
of New Jersey agreed to pay the full health benets
cost in retirement.
If you had 25 or more years of service credit or had
an approved Disability Retirement between July 1,
1997, and June 27, 2011 (the eective date of P.L.
2011, c. 78 (Chapter 78)), you are governed by the
terms applicable on the date you attained 25 years of
service credit or your Disability Retirement became
eective.
Under Chapter 78, if you had 20 years of service
credit by June 28, 2011, and retire with at least 25
years of service credit, your health benets cost will
be 1.5 percent of your monthly retirement allowance.
If you attain 20 years of service credit after June 28,
2011, and retire with at least 25 years of service
credit, you will pay a contribution toward post-retire-
ment medical coverage based on the applicable per-
centage of premium as determined by your annual
retirement allowance.*
If you retire on a Disability Retirement after June 28,
2011, your health benets cost will be 1.5 percent of
your monthly retirement allowance.*
Retirees covered under certain negotiated labor
agreements who attained 25 years after July 2, 2019,
will pay either a percentage of retirement allowance
or a percentage of premium as determined by annual
retirement allowance, dependent on the plan select-
ed.
Medicare Part B Reimbursement — If you had 25
or more years of service credited in one pension
system before July 1, 1997, the State of New Jersey
agreed to reimburse you at retirement for the stan-
dard cost of any Medicare Part B premiums paid by
you and/or your spouse, civil union partner, or same-
sex domestic partner. If you attained 25 years of ser-
vice credit after July 1, 1997, any reimbursement of
Medicare Part B premiums paid by you and/or your
spouse/partner may be limited by the terms of the
bargaining unit agreement in place at the time of
your retirement or by legislation (Chapter 8) – most
State retirees in this group have Medicare Part B
reimbursement capped at $46.10. State employees
who began employment after July 1, 1995, or who
became eligible for health benets after that date, will
not be eligible for Medicare Part B reimbursement.
School Board and County College Employees
If you had 25 or more years of service credit or retired
on a Disability Retirement before June 28, 2011 (the
eective date of Chapter 78), the State of New Jer-
sey, by law, pays the health benets costs for school
board and county college employees at retirement.
Under Chapter 78, if you are a school board or coun-
ty college employee with 20 or more years of service
credit by June 28, 2011, upon obtaining 25 years
of service credit, your health benets costs will be
State-paid at retirement.
If you attain 20 years of service credit after June 28,
2011, and retire with 25 years of service credit, you
will pay either a percentage of retirement allowance
or a percentage of premium as determined by ann-
ual retirement allowance, dependent on the plan
selected.**
Medicare Part B Reimbursement — If you retire
with 25 or more years of service credit or on a Dis-
ability Retirement, the standard cost of Medicare Part
B premiums will be paid by you and/or your spouse/
partner and reimbursed.
ABP Participants
Participants in the ABP employed by State univer-
sities/colleges and county colleges follow the same
guidelines as explained in the preceding sections. If
there will be a cost to the retiree, it will be based on
50 percent of the highest salary earned in the ve
years prior to retirement. ABP members from State
locations (State colleges and universities) who are
* Members represented by Union IBEW33 or Union IFPTE who retired on a Disability Retirement after January 1, 2017, must pay a contribution toward post-retire-
ment medical coverage based on the applicable percentage of premium as determined by your retirement allowance.
** For SEHBP members who attain 20 years of service after June 28, 2011, and retire on a Disability Retirement, your health benets costs will be State-paid.
Fact Sheet #11 April 2024 Page 4
Health Benets Coverage – Enrolling as a Retiree
This fact sheet is a summary and not intended to provide all information.
Although every attempt at accuracy is made, it cannot be guaranteed.
on long term disability will pay 1.5 percent of 50 per-
cent of their highest salary earned in the ve years
prior to retirement until age 70. ABP members from
education locations (county colleges) who are on
long term disability will have no cost for their retired
health benets until age 70. At age 70, ABP long term
disability ends and the member becomes a retiree, at
which time the cost of health benets will be reeval-
uated based on years of service. See the “Combin-
ing Service Credit from More Than One Retirement
System” section for more information regarding the
attainment of 25 years.
Local Government Employees
Some local employers agreed, under the provisions
of P.L. 1999, c. 48 (Chapter 48) or P.L. 1974, c. 88
(Chapter 88), to pay for all or some of the cost of
health benets for retirees under certain conditions.
Check with your employer to determine whether your
employer adopted the provisions of these laws.
For local employees who retire on an approved Dis-
ability Retirement, or who had 20 or more years of
service credit by June 28, 2011, and later retire with
25 or more years of service credit, the healthcare
contribution in retirement is governed by the resolu-
tion led by the local employer with the NJDPB pur-
suant to N.J.S.A. 52:14-17.38. For employees hired
after May 21, 2010, who are approved for long-term
disability insurance coverage, the minimum contribu-
tion toward health benets coverage in retirement is
1.5 percent.
Under Chapter 78, if you attain 20 years of service
credit after June 28, 2011, and retire with 25 years of
service credit, your cost is based on the contract as
of the date you attained 25 years if your employer ad-
opted Chapter 88. If your employer adopted Chapter
48, you will pay a percentage of the premium based
on your annual pension allowance.
Medicare Part B Reimbursement — Employers that
adopted Chapter 88 also agreed to reimburse those
employees for the Medicare Part B premiums paid
by the member and/or their spouse/partner (see the
“Eligible Dependents” section). Some employers that
adopted Chapter 48 also agreed to reimburse Medi-
care Part B premiums. Check with your employer to
determine eligibility for Medicare B reimbursement.
Chapter 330
To qualify for Chapter 330 coverage, you must have
retired from a law enforcement or reghter position
with 25 or more years of pension service credit, or
on a Disability Retirement, from an employer who
does not provide any payment towards retiree health
coverage or reimbursement of Medicare Part B pre-
miums. You need not be covered by the SHBP while
employed to qualify for enrollment. Those eligible for
coverage under Chapter 330 may pay a percentage
of a premium (the State will pay a at amount equal
to 80 percent of the lowest cost plan and the retiree
will pay the dierence) or 1.5 percent of his/her an-
nual pension, whichever is larger. For more informa-
tion see the Health Benets Retired Coverage Under
Chapter 330 Fact Sheet.
COMBINING SERVICE CREDIT FROM
MORE THAN ONE RETIREMENT SYSTEM
If you meet the eligibility requirements for enrollment
in the SHBP or SEHBP at retirement, you may com-
bine nonconcurrent service credit from more than
one State- or locally-administered retirement sys-
tem* to meet the 25-year minimum for State- or em-
ployer-paid coverage.
To qualify for coverage based on combined service
in more than one retirement system, you must:
• Retire and be receiving a retirement benet from
each retirement system membership;
• Have 25 or more years of nonconcurrent pen-
sion service credit in total;
• Be eligible for SHBP or SEHBP coverage from
your last employer; and
• Notify the Health Benets Bureau that you have
an aggregate of 25 or more years of nonconcur-
rent service in more than one public retirement
system in New Jersey.
Upon notication, the Health Benets Bureau must
verify your service with the dierent retirement sys-
tems before the nonconcurrent service credit can be
applied to meet the 25-year minimum for State- or
employer-paid coverage.
A retiree from the State, or from a participating local
employer who has agreed by resolution to pay for the
coverage of their retirees, must be eligible for SHBP
coverage immediately prior to retirement from the
last contributing employer in the retirement system.
A school board or county college retiree must be eli-
gible for SEHBP coverage immediately prior to retire-
ment or separation from the school board or county
college. The school board or county college must
have been your last contributing employer.
Notication if You Qualify Due to Service in
Two or More Retirement Systems
If you retire from a position with the State or an em-
ployer who participates in the SHBP or SEHBP, you
will receive a health benets oering letter for Retired
Group coverage. When you respond to the oering
letter, you must indicate that you have over 25 years
of service in two or more State- or locally-adminis-
tered retirement systems. You must identify the re-
tirement systems in order for us to verify your service
credit.
If you retire from a position with a school board
or county college that does not participate in the
*Service time from enrollment in the Dened Contribution Retirement Program (DCRP) is not eligible to qualify for health benets coverage at retirement.
Page 5 April 2024 Fact Sheet #11
Health Benets Coverage – Enrolling as a Retiree
This fact sheet is a summary and not intended to provide all information.
Although every attempt at accuracy is made, it cannot be guaranteed.
SEHBP, the Health Benets Bureau will not know
to send you an oering letter. You must contact the
Health Benets Bureau to notify us you have over 25
years of service in two or more retirement systems.
Be sure to identify the retirement systems in order for
us to verify your service credit.
ELIGIBLE DEPENDENTS
Your eligible dependents are your spouse, civil union
partner or same-sex domestic partner, and your chil-
dren who are under age 26. Documented proof of
eligibility for dependent coverage is required at the
time of enrollment. For denitions of eligible depen-
dents and required documentation, see our website:
www.nj.gov/treasury/pensions
Note: Eligible children may only be covered by one
SHBP/SEHBP participating subscriber (see the “Mul-
tiple Coverage is Prohibited” section).
Coverage for Over Age Children to Age 31
P.L. 2005, c. 375 (Chapter 375), provides for medical
and/or prescription drug coverage for natural, step,
and adopted children over age 26 and under age 31.
For more information, see the Health Benets Cov-
erage of Children until Age 31 under Chapter 375
Fact Sheet.
CHANGES TO DEPENDENT COVERAGE
It is your responsibility to notify the Health Bene-
ts Bureau of any change in family status. If family
members are not properly enrolled, claims will not be
paid. You may submit an online application through
mynjbenetshub to add dependents within 60 days
of a change in family status. Examples of a change
of status qualifying event include marriage, civil
union, birth, adoption of a child, or a change in your
spouse’s/partner’s employment that signicantly af-
fects the health benets coverage provided by your
spouse’s/partner’s employer. When the application is
received through mynjbenetshub within the 60-day
window, the family member will be enrolled retroac-
tively to the date of eligibility.
If the online application to add a dependent is not re-
ceived within 60 days of the qualifying event, the ef-
fective date of coverage will be the rst of the month
following 60 days from the submission of the online
application through mynjbenetshub. For example, if
you are married on January 5, but do not submit an
online application adding your spouse to health ben-
ets coverage until March 15, the coverage eective
date for your spouse will be June 1.
You may remove family members from coverage at
any time (but not retroactively). Decreases in cov-
erage are processed on a timely basis. It is your re-
sponsibility to remove dependents who are no longer
eligible for coverage online through mynjbenetshub.
Divorce or Dissolution of a Civil Union
or Domestic Partnership
Coverage for your spouse ends at the end of the
month in which you divorce. If you dissolve a civil
union or domestic partnership, coverage for your
partner ends at the end of the month in which the
partnership terminates. Any covered children who
will no longer be eligible dependents following the
divorce or dissolution must also be removed.
CHANGING PLANS
You may submit an online application through
mynjbenetshub to change your plan when the rate
increases, or at any time provided that you have been
with that same health plan for at least 12 months.
WAIVING COVERAGE IF COVERED
BY ANOTHER HEALTH PLAN
You may waive Retired Group health benets cover-
age and retain your right to enroll at a later date if you
are covered as an employee through other employ-
ment or as a dependent of your spouse/partner in
another group health plan. Coverage must be waived
online through mynjbenetshub.
If you lose your other coverage, you may enroll/re-
enroll in health benets coverage within 60 days of
your loss of the other coverage. Proof of loss of the
other coverage is required. Re-enrollment must be
submitted online through mynjbenetshub.
Chapter 330
If you are a member of the Police and Firemen’s Re-
tirement System (PFRS) and will be enrolling under
the provisions of Chapter 330, you must waive any
other coverage you have through active employ-
ment. See the Health Benets Retired Coverage Un-
der Chapter 330 Fact Sheet.
WHEN HEALTH BENEFITS
COVERAGE ENDS
Coverage under Retired Group health benets will
terminate if:
• You formally request the termination in writing or
you request a cancelation of the coverage online
through mynjbenetshub (reinstatment is gener-
ally not permitted).
• Your premiums are not paid;
• Your plan discontinues services in your area
and you do not submit an online application to
the Health Benets Bureau to change to another
plan;
• Your employer withdraws from the SHBP or
SEHBP (does not apply to retirees who qualied
for State-paid coverage, i.e., former employees
of local school districts or county colleges, and
municipal police ocers or reghters who qual-
ify under the provisions of Chapter 330);
• You or your dependents fail to enroll when eligi-
ble in Part A and Part B of Medicare;
Fact Sheet #11 April 2024 Page 6
Health Benets Coverage – Enrolling as a Retiree
This fact sheet is a summary and not intended to provide all information.
Although every attempt at accuracy is made, it cannot be guaranteed.
• You cease to receive retirement benets; or
• You die (see the “Surviving Spouse/Partner
Coverage” section).
SURVIVING SPOUSE/PARTNER
COVERAGE
Coverage of your spouse/partner terminates at the
end of the month in which you die. However, your
spouse or partner will be sent a letter oering con-
tinuation of coverage in the plan of his/her choice at
his/her own cost. If your spouse or partner elects to
continue SHBP/SEHBP coverage, he/she will be re-
enrolled, without a break in coverage, upon the time-
ly receipt of the completed online application through
mynjbenetshub. If your spouse or partner will re-
ceive a monthly pension check large enough to cover
the premium, the premium will be deducted from the
pension payment. If your spouse or partner will not
receive a pension check, or if the pension check is
not large enough to cover the cost, your spouse or
partner will be billed monthly for the premiums.
Some local employers have agreed to pay for the
coverage of spouses or partners of deceased retir-
ees; check with your employer to see if they provide
this benet. The State does not pay for the coverage
of spouses or partners of deceased retirees.
ADDITIONAL INFORMATION
Obtain personalized information about your health
benets coverage through the Member Benets On-
line System (MBOS), available on our website.
Obtain general health benets information by calling
the NJDPB’s Automated Information System at (609)
292-7524.
For questions about SHBP/SEHBP enrollment,
plan changes, premium costs, or adding or de-
leting dependents, contact the NJDPB’s Oce of
Client Services at (609) 292-7524; or by email at:
For questions about participating providers, cover-
age of specic procedures, claims, or for replace-
ment ID cards, contact your medical plan.
Horizon/NJ DIRECT .........1-800-414-SHBP (7427)
Aetna for non-Medicare
Retirees (after 7/1/24) ....1-877-StateNJ (782-8365)
Aetna Medicare
Advantage Plans ........................... 1-866-234-3129
OptumRx
for Non-Medicare Retirees ............ 1-866-220-6512
OptumRx
for Medicare-enrolled Retirees ....... 1-844-368-8765
This fact sheet has been produced and distributed by:
NewJerseyDivisionofPensions&Benets
P.O.Box295,Trenton,NJ08625-0295
(609) 292-7524
For the hearing impaired: TRS 711 (609) 292-6683
www.nj.gov/treasury/pensions
