2025 EMPLOYEE BENEFITS GUIDE
Welcome TO YOUR BENEFITS
ENROLLMENT
Mercer County Special Services School District recognizes how important benefits are to you. That’s why we’re committed to helping you and your family enjoy the best possible physical, financial, and emotional well-being.
It’s also why we provide you with a comprehensive, highly competitive benefits package, with the flexibility to make the choices that best meet your needs.
We encourage you to take the time to educate yourself about the benefit options available to you. Use this guide to better understand the benefits offered by Mercer County Special Services School
then be sure to enroll during your enrollment period, so you receive the benefits you want in place for you and your family.
Once you have made your elections, you will not be able to change them until the next Open Enrollment period, unless you experience a qualified change in status (see the next page of this guide for more information).
Eligibility and Making Plan Changes
Who is eligible to enroll in benefits?
You are a benefits-eligible employee if you are full-time and working 25 or more hours per week.
Please remember that only eligible dependents can be enrolled; this includes your spouse, civil union partner or your eligible dependent(s) to age 26 for medical and prescription drug coverage, as long as they do not have benefits coverage elsewhere. Through NJ State Chapter 375 employees can enroll eligible dependent(s) to age 31, for medical and prescription coverage.
Eligible dependents are covered until the end of the year in which they turn 23 for dental coverage. Dependents that are full-time students (12 credits or more) are eligible to stay on the dental plan until the end of the year in which they turn 25, or the date of graduation, whichever comes first.
If you have any questions or would like to enroll an eligible dependent, please contact your HR Benefits Team for an enrollment form and restrictions.
Making Changes During the Plan Year: Qualifying Life Events
Unless you experience a qualified change in status, you cannot make changes to the benefits you elect until the next Open Enrollment period. Qualified status changes include marriage, divorce, birth or adoption of a child, change in child’s dependent status, death of spouse, child in residence due to an employment transfer for you, your spouse, commencement or termination of adoption proceedings, or change in your spouse’s benefits or employment status.
If an eligible dependent had other coverage and such coverage is lost, the eligible dependent may be eligible for enrollment during a “special enrollment period,” which is usually the 31-day period following the date that other coverage was lost, due to a qualified change in status.
You must notify your HR Benefits Team within 31 days of experiencing a qualified status change.
Medical Benefits: Horizon
The below medical plan options are offered through Horizon. Each plan includes prescription drug benefits, outlined on page 6. Note that the Garden State Plan does not cover services outside of New Jersey, with the exception of emergency care.
In-Network vs. Out of Network
Save money with in-network doctors and facilities
Horizon Blue Cross Blue Shield of New Jersey has a vast network of doctors, health care professionals, hospitals and medical facilities. When you choose to receive care in network, you will usually pay less out of pocket.
Out-of-network benefits may include a higher deductible, coinsurance and/or copayment. You may also have to pay the difference between the allowed amount and the actual charge for the service.
If you do not have out-of-network benefits, you are responsible for the total cost of care, unless it is a medical emergency.
Cost Example: Jane’s Surgery
Jane will have surgery at an ambulatory surgical center (ASC). There are two ASCs in her area; one is in Horizon BCBSNJ’s network and the other is not. Her plan pays for in-network and out-of-network services differently. Which ASC should Jane use, based on her plan, to keep her costs down? See the grid to the right for a cost breakdown.
This example is based on average charges for ASC services and common
plan designs. Actual costs may be different based on location and insurance plan design.
Jane’s Decision
Jane chose the in-network facility, which saved her $3,765 on her surgery.
Prescription Drug Benefits: Benecard
Prescription drug coverage will be included with your medical coverage. This coverage will be offered through Benecard, a full service pharmacy benefits administrator that provides an exceptional customer service experience to employees.
Mandatory Generics
Under the Benecard prescription plan, the pharmacist must dispense the generic equivalent medication when one is available.
About generic drugs
A generic drug is identical (or bioequivalent) to a brand name drug in dosage form, safety, strength, route of administration, quality, performance characteristics and intended use. Although generic drugs are chemically identical to their branded counterparts, they are typically sold at substantial discounts from the branded price.
Generic drugs are reviewed and approved by the U.S. Food and Drug Administration (FDA), just as brand drugs are. According to the FDA, compared to its brand counterpart, a generic drug:
• is chemically the same
• works the same in the body
• is as safe and effective
• meets the same standards set by the FDA
The major difference is that the generic drug often costs much less.
Step Therapy
Under the Benecard prescription plan, you must use the most cost-effective treatment prior to processing alternative therapies.
About Step Therapy
Step Therapy allows those with medical conditions that require taking prescription drugs regularly to receive the treatment they need in an affordable way.
The Step Therapy program groups prescription drugs into two categories: first-line and second-line drugs.
• First-line drugs are generic and often lower-cost prescription drugs proven to be safe and effective. Step Therapy patients are encouraged to try these drugs first, because they usually provide the same health benefit as a more expensive drug, at a lower cost.
• Second-line drugs are brand-name drugs that are generally only necessary for a small number of patients. Second-line drugs are the most expensive option.
Dental Benefits: Horizon
Healthy teeth and gums are important to your overall wellness. That’s why it’s important to have regular dental checkups and maintain good oral hygiene. You have two dental plans to choose from. You can elect to receive dental coverage even if you are waiving Mercer County Special Services medical coverage. Learn about the dental plans available to help you maintain your oral health.
Preventive & Diagnostic Services
• Exams, Cleanings, Bitewing X-rays
• Fluoride Treatment (child)
Basic Services
• Fillings, extractions
• Endodontics (root canal)
• Periodontics, oral surgery
• Sealants
Major Services
• Crowns, gold restorations
• Bridgework
• Full and partial dentures
Benefits MAC: Conner Strong & Buckelew
Do you need help resolving a benefits issue?
The Benefits Member Advocacy Center (“Benefits MAC’), provided by Conner Strong & Buckelew, can help you and your covered family members navigate your benefits.
Contact the Benefits MAC to:
• Find answers to your benefits questions
• Search for participating network providers
• Clarify information received from a provide or your insurance company, such as a bill, claim, or explanation of benefits (EOB)
• Guide you through the enrollment process or how you can add or delete coverage for a dependent
• Rescue you from a benefits problem you’ve been working on
• Discover all that your benefits have to offer!
You can contact Benefits MAC in any of the following ways:
• Via phone: 800-563-9929, Monday through Friday, 8:30 am to 5:00 pm
• Via the web: www.connerstrong.com/ memberadvocacy
• Via e-mail: cssteam@connerstrong.com
• Via fax: 856-685-2253
Member Advocates are available Monday through Friday, 8:30 am to 5:00 pm (Eastern Time). After hours, you will be able to leave a message with a live representative and receive a response by phone or email during business hours within 24 to 48 hours of your inquiry.
Urgent Care vs. Emergency Room
Save money by visiting an urgent care center for conditions that are not life-threatening!
About Urgent Care Centers
Urgent Care centers can be the perfect option for those that need medical attention for conditions that are not life threatening. You may opt out of an ER visit and instead visit Urgent Cares for the following:
• Minor fractures
• Back pain
• Minor headaches
• Nausea, vomiting, diarrhea
• Blood work
• Ear or sinus pain
• Cough or sore throat
• Lab services
• Animal bites
• Stitches
• Sprains and strains
• Mild asthma
• Allergies
• Minor allergic reactions
• Cold or flu symptoms
Emergency rooms will treat these problems also, but typically minor conditions such as these are not prioritized and those suffering from them can experience lengthy wait times.
Did you know?
90 percent of urgent care patients wait 30 minutes or less to see a provider, and 84 percent are in and out within an hour. Urgent care centers are typically more affordable than an ER visit, and there are convenient locations situated in places like shopping centers and commercial plazas.
Urgent Care is in-network with most major insurance providers, Medicare, Medicaid, worker’s compensation and motor vehicle insurance.
Horizon Member Portal
Introducing an enhanced online member experience
Great news! We’ve redesigned our online tools and resources to make it easier for you to get your health plan information, find care and contact us.
This enhanced online member experience includes:
• A customizable dashboard so you can highlight what’s important to you
• A fresh look and feel that makes finding and viewing information a breeze
• An easier way to find the care that you need
• New tools and resources to help you get the most out of the site and your benefits
Getting started
Sign in at HorizonBlue.com today to check it out. First time signing in? No problem. Just follow the prompts to register.
HorizonbFit
Exercise regularly and get rewarded!
How to earn rewards
HorizonbFit is Horizon’s fitness incentive program for covered members 18 years of age and older. Track your activity to earn a $20 reward each month:
• Work out at home 12 or more days a month, and record and submit your workout using the ActiveFit@Home feature on the ActiveFit app; or
• Walk 10,000 steps a day for at least 12 days a month; or
• Complete any combination of the above activities for at least 12 days a month.
You can earn up to $240 per year in rewards!
Tracking your steps and activity
HorizonbFit has a free mobile app1 called ActiveFit, which makes it easy to report trips to the gym. When the app is open, it uses GPS and Bluetooth services to detect when you enter a participating gym. ActiveFit will automatically log the visit toward your monthly incentive — there’s no additional tracking!
• You can also use ActiveFit to:
• Find participating facilities.
• View which facilities you’ve visited and when.
• Access incentive payment information.
• Track your steps and receive motivational messaging to keep your workouts on track.
You can download ActiveFit for free from the App Store or Google Play.
Staying fit from home
The ActiveFit@Home feature provides a simple way for you to report your at-home workouts. To validate your at-home activity, submit your post-workout selfie by following these easy steps:
• Locate the ActiveFit@Home option in the main menu in ActiveFit.
• Tap the Get Started button to open your camera and take a post-workout selfie.
• Once you preview your photo, click Upload.
The photo, along with a geo-location time stamp, allows your activity to be reviewed and approved. Please allow 24 to 48 hours for your activity to be accepted.
Note: Photos submitted for a date other than the day the photo was taken will be placed in a pending status and may not be accepted. Please ensure that you have downloaded and installed the latest version of the ActiveFit app.
How to enroll
Enrolling is free and easy at HorizonbFit.com — just use your Horizon member ID number to set up your account. If your fitness facility does not participate with HorizonbFit, you can nominate it for inclusion.
If you have questions about the HorizonbFit program or ActiveFit@Home, call 1-201-351-7850, option 1.
Horizon Blue 365
Feel good and save money!
About Blue365
Blue365 is a free health and wellness discount program available to Horizon Blue Cross Blue Shield members that provides exclusive discounts on gym memberships, fitness gear, healthy eating options and more.
Blue365 can help you build a path to living well through:
• Handpicked deals from premium brands that you recognize
• Discounts on other Discounts on other health savings programs across nearly all categories
• Exclusive offers only available to Blue365 members
• Year-round discounts – no limited supplies, no limits on savings
How it works
Once you sign up, you’ll receive weekly emails with great deals and discounts from top national and local retailers. You can also search the Blue365 website to see all current deals. Plus, get ideas for feeling your best from Blue365’s Healthy Tips page.
• Deal categories
• Apparel & Footwear
• Nutrition
• Fitness
• Personal Care
• Hearing & Vision
• Travel
• Home & Family
Ready to start saving?
Learn more about Blue365, including how to sign up for deals, at blue365deals.com/HorizonBCBS
Benefits Carrier Contacts
Legal Notices
Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP)
If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov.
If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available.
If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan.
If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272).
If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of July 31, 2024. Contact your State for more information on eligibility –
ALABAMA – Medicaid
Website: http://myalhipp.com/ Phone: 1-855-692-5447
ALASKA – Medicaid
The AK Health Insurance Premium Payment Program
Website: http://myakhipp.com/ Phone: 1-866-251-4861
Email: CustomerService@MyAKHIPP.com Medicaid Eligibility: https://health.alaska.gov/dpa/Pages/ default.aspx
ARKANSAS – Medicaid
Website: http://myarhipp.com/ Phone: 1-855-MyARHIPP (855-692-7447)
CALIFORNIA - MEDICAID
Health Insurance Premium Payment (HIPP) Program
http://dhcs.ca.gov/hipp
Phone: 916-445-8322
Fax: 916-440-5676
Email: hipp@dhcs.ca.gov
COLORADO - Health First Colorado (Colorado’s Medicaid Program) & Child Health Plan Plus (CHP+)
Health First Colorado Website: https://www. healthfirstcolorado.com/
Health First Colorado Member Contact Center: 1-800-221-3943/State Relay 711
CHP+: https://hcpf.colorado.gov/child-health-plan-plus CHP+ Customer Service: 1-800-359-1991/State Relay 711 Health Insurance Buy-In Program (HIBI): https://www. mycohibi.com/ HIBI Customer Service: 1-855-692-6442
FLORIDA – Medicaid
Website: https://www.flmedicaidtplrecovery.com/ flmedicaidtplrecovery.com/hipp/index.html Phone: 1-877-357-3268
GEORGIA – Medicaid
GA HIPP Website: https://medicaid.georgia.gov/healthinsurance-premium-payment-program-hipp Phone: 678-564-1162, Press 1
GA CHIPRA Website: https://medicaid.georgia.gov/programs/ third-party-liability/childrens-health-insurance-programreauthorization-act-2009-chipra Phone: 678-564-1162, Press 2
INDIANA – Medicaid
Health Insurance Premium Payment Program
All other Medicaid Website: https://www.in.gov/medicaid/ http://www.in.gov/fss/dfr/
Family and Social Services Administration Phone: 1-800-403-0864
Member Services Phone: 1-800-457-4584
IOWA – Medicaid and CHIP (Hawki)
Medicaid Website: https://dhs.iowa.gov/ime/members
Medicaid Phone: 1-800-338-8366
Hawki Website: http://dhs.iowa.gov/Hawki Hawki Phone: 1-800-257-8563
HIPP Website: https://dhs.iowa.gov/ime/members/medicaida-to-z/hipp
HIPP Phone: 1-888-346-9562
KANSAS – Medicaid
Website: https://www.kancare.ks.gov/ Phone: 1-800-792-4884
HIPP Phone: 1-800-967-4660
KENTUCKY – Medicaid
Kentucky Integrated Health Insurance Premium Payment Program (KI-HIPP) Website: https://chfs.ky.gov/agencies/ dms/member/Pages/kihipp.aspx
Phone: 1-855-459-6328
Email: KIHIPP.PROGRAM@ky.gov
KCHIP Website: https://kynect.ky.gov
Phone: 1-877-524-4718
Kentucky Medicaid Website: https://chfs.ky.gov/agencies/ dms
LOUISIANA – Medicaid
Website: www.medicaid.la.gov or www.ldh.la.gov/lahipp
Phone: 1-888-342-6207 (Medicaid hotline) or 1-855-6185488 (LaHIPP)
MAINE – Medicaid
Enrollment Website: www.mymaineconnection.gob/benefits/ s/?language=en_US
Phone: 1-800-442-6003 TTY: Maine relay 711
Private Health Insurance Premium Webpage: https://www.maine.gov/dhhs/ofi/applications-forms
Phone: 800-977-6740 TTY: Maine relay 711
MASSACHUSETTS – Medicaid and CHIP
Website: https://www.mass.gov/masshealth/pa Phone: 1-800-862-4840 TTY: 711
Email: masspremassistance@accenture.com
MINNESOTA – Medicaid
Website: https://mn.gov/dhs/health-care-coverage/ Phone: 1-800-657-3672
MISSOURI – Medicaid
Website: http://www.dss.mo.gov/mhd/participants/pages/ hipp.htm
Phone: 1-573-751-2005
MONTANA – Medicaid
Website: http://dphhs.mt.gov/MontanaHealthcarePrograms/ HIPP Phone: 1-800-694-3084
Email: HHSHIPPProgram@mt.gov
NEBRASKA – Medicaid
Website: http://www.ACCESSNebraska.ne.gov Phone: 855-632-7633 Lincoln: 402-473-7000 Omaha: 402-495-1178
NEVADA – Medicaid
Medicaid Website: http://dhcfp.nv.gov
Medicaid Phone: 1-800-992-0900
NEW HAMPSHIRE – Medicaid
Website: https://www.dhhs.nh.gov/programs-services/ medicaid/health-insurance-premium-program Phone: 603-271-5218
Toll free number for the HIPP program: 1-800-852-3345, ext 15218
Email: DHHS.ThirdPartyLiabi@dhhs.nh.gov
NEW JERSEY – Medicaid and CHIP
Medicaid Website: http://www.state.nj.us/humanservices/ dmahs/clients/medicaid/ Phone: 800-356-1561
CHIP Premium Assistance Phone: 609-631-2392
CHIP Website: http://www.njfamilycare.org/index.html
CHIP Phone: 1-800-701-0710 (TTY: 711)
NEW YORK – Medicaid
Website: https://www.health.ny.gov/health_care/medicaid/ Phone: 1-800-541-2831
NORTH CAROLINA – Medicaid
Website: https://medicaid.ncdhhs.gov/ Phone: 919-855-4100
Legal Notices
NORTH DAKOTA – Medicaid
Website: https://www.hhs.nd.gov/healthcare
Phone: 1-844-854-4825
OKLAHOMA – Medicaid and CHIP
Website: http://www.insureoklahoma.org
Phone: 1-888-365-3742
OREGON – Medicaid and CHIP
Website: http://healthcare.oregon.gov/Pages/index.aspx
Phone: 1-800-699-9075
PENNSYLVANIA – Medicaid and CHIP
Website: https://www.pa.gov/en/services/dhs/apply-formedicaid-health-insurance-premium-payment-programhipp.html
Phone: 1-800-692-7462
CHIP Website: https://www.pa.gov/en/agencies/dhs/ resources/chip.html
CHIP Phone: 1-800-986-KIDS (5437)
RHODE ISLAND – Medicaid and CHIP
Website: http://www.eohhs.ri.gov/ Phone: 1-855-697-4347, or 401-462-0311 (Direct RIte Share Line)
SOUTH CAROLINA - Medicaid
Website: https://www.scdhhs.gov
Phone: 1-888-549-0820
SOUTH DAKOTA - Medicaid
Website: http://dss.sd.gov
Phone: 1-888-828-0059
TEXAS - Medicaid
Website: https://www.hhs.texas.gov/services/financial/ health-insurance-premium-payment-hipp-program
Phone: 1-800-440-0493
UTAH – Medicaid and CHIP
Utah’s Premium Partnership for Health Insurance (UPP)
Website: https://medicaid.utah.gov/upp/ Email: upp@utah.gov
Phone: 1-888-222-2542
Adult Expansion Website: https://medicaid.utah.gov/ expansion/ Utah Medicaid Buyout Program Website: https://medicaid. utah.gov/buyout-program/ CHIP Website: https://chip.utah.gov/
VERMONT– Medicaid
Website: https://dvha.vermont.gov/members/medicaid/ hipp-program
Phone: 1-800-562-3022
VIRGINIA – Medicaid and CHIP
Website: https://coverva.dmas.virginia.gov/learn/premiumassistance/famis-select
https://coverva.dmas.virginia.gov/learn/premium-assistance/ health-insurance-premium-payment-hipp-programs
Phone: 1-800-432-5924
WASHINGTON – Medicaid
Website: https://www.hca.wa.gov/ Phone: 1-800-562-3022
WEST VIRGINIA – Medicaid and CHIP
Website: http://mywvhipp.com/ and https://dhhr.wv.gov/ bms/
Medicaid Phone: 304-558-1700
CHIP Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447)
WISCONSIN – Medicaid and CHIP
Website: https://www.dhs.wisconsin.gov/ badgercareplus/p-10095.htm Phone: 1-800-362-3002
WYOMING – Medicaid
Website: https://health.wyo.gov/healthcarefin/medicaid/ programs-and-eligibility/ Phone: 800-251-1269
To see if any other states have added a premium assistance program since July 31, 2024, or for more information on special enrollment rights, contact either:
U.S. Department of Labor Employee Benefits Security Administration www.dol.gov/agencies/ebsa 1-866-444-EBSA (3272)
U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services www.cms.hhs.gov 1-877-267-2323, Menu Option 4, Ext. 61565
Mercer County Special Services reserves the right to modify, amend, suspend or terminate any plan, in whole or in part, at any time. The information in this Enrollment Guide is presented for illustrative purposes and is based on information provided by the employer. The text contained in this Guide was taken from various summary plan descriptions and benefit information. While every effort was taken to accurately report your benefits, discrepancies, or errors are always possible. In case of discrepancy between the Guide and the actual plan documents, the actual plan documents will prevail.