YOUR 2018 GUIDE TO CHOOSING AHealthPlan

NewemployeesmaymakeinitialelectionsforBenefitPlansinaccordancewiththeirEmployer’seligibilitypoliciesandcurrentCollectiveBargainingAgreements.Twiceeachyear,youhaveanopportunitytoreviewyourhealthplanchoiceduringtheFund’sOpenEnrollmentperiod.

IMPORTANTPOINTSTOREMEMBERCarefullyreviewalltheinformationinthisbooklet.

IfyouarechangingplansorhavechosentheHealthCareChoicePlanoroneoftheHMO’s,youmustselectaPrimaryCarePhysicianforyouandeachofyoureligibledependents.

CompleteallrequiredformsandreturnthemtotheHumanResourcesDepartmentbythedeadlinedates.Remember,anychangesyoumakewilltakeeffectonJanuary1orJuly1.

IfyouaresatisfiedwithyourcurrenthealthplanchoiceyoudonotneedtocompleteanyformsduringtheOpenEnrollmentPeriod.

MIDDLESEXCOUNTYJOINTHEALTHINSURANCEFUNDMIDDLESEXCOUNTYCOLLEGE

Remember,yourmedicalbenefitsareanimportantcomponentofyouroverallcompensationandbenefitspackage.Thisisyourannualopportunitytodecidewhichplanisbestforyouandyourfamily.Pleasereviewthisinformationcarefully.

HEALTHCARECHOICEPLAN

TRADITIONAL*

AETNA

CIGNA

CHOICESCHOICESCHOICESCHOICES

CHOICESCHOICESCHOICESCHOICES

CHOICES

CHOICES

CHOICES C

HOICES

CHOICES

CHOICES

YOUR 201 GUIDE TOCHOOSINGAHealth Plan

Once each year, you have an opportunity to review your healthplan choice during the Fund’s Open Enrollment period. If youchoose a new plan, it will become effective for use on January1st. New employees may make initial elections for BenefitPlans in accordance with their Employer’s eligibility policyand current Collective Bargaining Agreements.

IMPORTANT POINTS TO REMEMBERCarefully review all the information in this booklet.

If you are changing plans or have chosen the HealthCareChoice Plan or one of the HMO’s, you must select a PrimaryCare Physician for you and each of your eligible dependents.

Complete all required forms and return them to yourPersonnel Office no later than November 30, 2017.Remember, any changes you make will take effect on January 1,2018.

If you are satisfied with your current health plan choice youdo not need to complete any forms during this OpenEnrollment.

HEALTHCARE CHOICE PLAN

AETNA

CIGNA

OXFORD FREEDOMACCESS

TRADITIONAL PLAN(IF OFFERED BYYOUR EMPLOYER)

MIDDLESEX COUNTY JOINT HEALTH INSURANCE FUND

Remember, your medical benefits are an important component of your overall compensationand benefits package. This is your annual opportunity to decide which plan is best for you and your family.Please review this information carefully.

CHOICES CHOICES CHOICES CHOICES

CHOICES CHOICES CHOICES CHOICES

CHOICES

CHOICES

CHOICES

CHOICES

CHOICES

CHOICES

4782 (W101 )

OPEN ENROLLMENT CHOOSING YOUR HEALTH PLAN

HEALTH FUND INFORMATION FOR201 Open Enrollment

Each year, you have an opportunity to review your health planchoices during the Fund’s Open Enrollment period. This year’sOpen Enrollment period is November 1 through November 30,2017. Any changes you make will take effect January 1, 2018.Open Enrollment dates may vary slightly depending on youremployer’s schedule. Please check with your Personnel Officeto confirm the dates, and which plans are available.

You have several plans from which to choose. Each will haveadvantages as well as disadvantages. The more you learn aboutthe plans, the easier it will be for you to decide what plan bestfits your personal needs and budget.

What is mostimportant to me in a plan?

In choosing a plan, you have to decide what is most important toyou. Ask yourself these questions:

� How comprehensive do I want coverage of health care servicesto be?

� How do I feel about limits on my choice of doctors or hospitals?

� How do I feel about a primary care doctor referring me tospecialists for additional care?

� How convenient does my care need to be?

� How important is the cost of services?

� How do I feel about keeping receipts and filing claims?

You might also want to think about whether the services a planoffers meet your needs. Call the plan for details about coverageif you have questions. When making your choice considerthe following:

� Lifestyle changes you may be thinking about, such as startinga family or retiring.

� Chronic health conditions or disabilities that you or familymembers have.

� Care for family members who travel a lot, attend college, orspend time at two homes.

SOURCES OFADDITIONAL INFORMATION ABOUT HEALTHPLANS AND HEALTH ISSUES

America’s Health Insurance Plans - Consumer Guide to Health Planshttp://www.ahip.org

NJ Department of Health and Social Serviceshttp://www.nj.gov/health

NJ Department of Health and Senior Services - NJ HMO Consumer Rights & Complaint Procedureshttp://www.state.nj.us/health/hmo/rights.htm

US Department of Health and Human Services - Gateway to general information on health issueshttp://www.healthfinder.gov/

What are myhealth plan choices?Choosing the right health plan for you and your dependentsmay not seem as easy as it once was. Plans may differ in howmuch you have to pay and the ease at which you obtain certainservices. Although no plan will pay for all the costs associatedwith your medical care, some plans will pay for a greaterpercentage of the cost than others.

Our Fund offers a variety of plans including: Traditional,HealthCare Choice and HMOs. This Open Enrollment guideincludes highlights of each. For all the details of a particularplan, see the Summary Plan Document for that plan.

Not all plans are available to all employees in the Fund. Pleasecheck with your Personnel Office to confirm which options areavailable to you.

� � � � � Further information will be available on the Fund’s web-site at www.mcjhif.com

MIDDLESEX COUNTY JOINT HEALTH INSURANCE FUND http://www.mcjhif.com

MIDDLESEX COUNTY JOINT HEALTH INSURANCE FUND

IMPORTANTANNOUNCEMENTS FOR 201

� Summary of CHAPTER 78Chapter 78 was signed into law on June 28, 2011 byGovernor Christie. Among other requirements,Chapter 78 established a new contribution arrangementthat requires public employees and certain retirees tocontribute more towards the cost of their employersponsored health insurance.The amount of any required contribution and when thecontributions will begin is based upon many factorsincluding salary and bargaining unit representation.Please refer to “TheMedical Contribution Estimator”on the MCJHIF Web Site in order to determine yourestimated required contribution for 2018.Further detail on Chapter 78 is found on the back page.

� New Jersey Chapter 375 over-age DependentChildren up to 30 law and DU31 Coverage untilAge 31This regulation only applies to fully insured programsthroughout New Jersey. Currently the Fund onlymaintains one program that is fully-insured fallingwithin the Chapter 375 parameters; the OxfordFreedom program. Under these provisions certainqualified over age children may elect coverage underthe fully insured plan offered by the Fund (OxfordFreedom) from the time their dependent coverageeligibility would normally end until their 31st birthday.The covered person/dependent is responsible for thefull cost of this extended coverage and will be billeddirectly on a monthly basis.It is important to note that any/all dependent childrencurrently covered under the provisions of Chapter 375,P.L. 2005, will need to complete a new application toenroll as a dependent child under age 26 under PatientProtection and Affordable Care Act (PPACA).

� Federal Health Coverage Law - Patient Protectionand Affordable Care ActProvisions of the federal Patient Protection andAffordable Care Act (PPACA) include the coverageof children until age 26.Eligibility• A “child” is defined as an enrollee’s child until age26, regardless of the child’s marital, student, orfinancial dependency status — even if the youngadult no longer lives with his or her parents.

• Medical and prescription drug coverage will beextended to eligible children through December31 of the year they turn age 26.

Women’s HealthEffective with prescriptions filled on or after January1, 2013, the generic hormonal birth control pills andcertain barrier contraceptive devices will be coveredat 100%.VerificationA photocopy of the dependent child's birth certificatethat includes the covered parent’s name must besubmitted along with the application.A photocopy of the dependent child’s birth certificateshowing the spouse/partner’s name as a parent and aphotocopy of marriage/partnership certificate showingthe names of the employee and spouse/partner.For a legal guardianship, grandchild, or foster childprovide a photocopy of Affidavits of Dependency anda Final Court Order with the presiding judge’s signatureand seal attesting to the legal guardianship of thecovered employee.

THE CHOICE IS YOURS� Review all the information in this Open Enrollment Guide.

� If you choose the HealthCare Choice Plan or one of the HMOs, you will have to pick a Personal/Primary Care Physician for you andeach of your eligible dependents.

� Complete any required forms and return them to your Personnel Office by November 30, 2017 (please confirm this date with yourPersonnel Office, as it may vary with local needs). Any changes you make will take effect on January 1, 2018.

� County employees should login to the Employee Self Service website and go to the Open Enrollment Section.

� If you are satisfied with your current Health Plan, you do not need to complete any forms during this Open Enrollment.

�New Jersey Pension and Health Benefits Reformunder Chapter 78, P.L. 2011Sections 39 to 44: Required Active and RetiredEmployee Contributions towards Health BenefitCoverageThis law requires all public employees and certainpublic retirees to contribute toward the cost of healthcare benefits coverage based upon a percentage of thecost of coverage. All active public employees will paya percentage of the cost of health care benefits coveragefor themselves and any dependents. Lower compensatedemployees will pay a smaller percentage and morehighly compensated employees will pay a higherpercentage. In addition, the applicable percentage willvary based upon whether the employee has family,individual, or member with child or spouse coverage.These rates will be phased in over several years foremployees employed on the contribution’s effectivedate who will pay 1/4, 1/2, and 3/4 of the amount of thecontribution rate during the first, second and thirdyears, respectively. The law establishes a “floor” foremployee contributions so that no employee will payan amount that is less than 1.5% of the employee’scompensation. The contribution commenced onJanuary 1, 2012 for certain public employees and uponthe expiration of a collective negotiation agreement forothers.Similar provisions in this law apply to retirees ofunits of local government. Retirees may be required tocontribute a percentage of the cost of health care benefitscoverage in retirement benefit. These provisions willnot apply to public employees who, on the effectivedate of the law, have 20 or more years of service in oneor more State or locally-administered retirement systems.A 1.5% “floor”, for those retirees to whom the 1.5%contribution in current law applies, will also be applicableto these retirees.Further information will be available on the Fund’sweb-site at www.mcjhif.com

Same as any other illness Same as any other illness

Same as any other illness Same as any other illness

Same as any other illness Same as any other illness

Same as any other illness Same as any other illness

Same as any other illness Same as any other illness

Same as any other illness Same as any other illness

Copay for exam/$70 every24 months for hardware

60% after deductible for exam/$70 every 24 months

for hardware

100% 60% after deductible

Not covered 2

(Except MosquitoCommission)

Not covered 2

(Except MosquitoCommission)

www.oxfordhealth.com

100%

100%

100% after copay

60% after deductible

60% after deductible

60% after deductible

60% after deductible - no limitCopay no limit

Copay for 1st prenatal visit,then 100%

60% after deductible

60% after deductible

60% after deductible

60% after deductible

60% after deductible

60% after deductible

100% 60% after deductible

210 day combined in and out of network limit

100% 60% after deductible

100%

100%

100%

100%

100%

Copay 60 visitsper calendar year

Deductible and coinsurance upto 60 visits per calendar year

Limited payment for bonyimpacted molars, mouthtumors, accidental injury,

if medically necessary

Limited payment for bonyimpacted molars, mouthtumors, accidental injury,

if medically necessary

100% 60% after deductible

100% up to 100 daysper calendar year

Deductible and coinsurance upto 60 days per calendar year

888-201-4133

100% after copaywaived if admitted

100% after copaywaived if admitted

100% after copaywaived if admitted

100% after copaywaived if admitted

$0 $2,000

$0 $6,000

$2,500 4 $7,200 4

$5,000 4 $21,600 4

OXFORD FREEDOM ACCESS

IN-NETWORK OUT-OF-NETWORK

100% 100%

100%

Not covered

100%, $100lens reimbursement

every 24 months

100% after copay for annualexam, $20 to $75 per year for

hardware at participating provider

100%

Not covered 2

(Except MosquitoCommission)

www.aetna.com www.cigna.com

100% 100% up to 60 daysper calendar year

100%

100%

100% after copay

100%

100%

100%

100%

100%

100%

100% after copay

100% after copay,max. of 20 visits per year

100% after copayfor initial visit

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100% over a 60 consecutiveday period per illness or injury

100% after copay; max.60 visits per calendar year

100%

Bony impacted,wisdom teeth

Not covered

100% 100%

1-800-370-4526 1-800-CIGNA24

100%

100%

100%

100%

100% after copay,waived if admitted

100% after copay,waived if admitted

100% after copay,waived if admitted

100% after copay,waived if admitted

None

None

$1,500 4

$3,000 4

None

None

$2,500 4

$5,000 4

100%

100% 100% after copay

100%

100%

100% after $5 copay

AETNAHMO

(no coverage out-of-network)

CIGNAHMO

(no coverage out-of-network)

80% out of networkallowance after deductible

80% out of networkallowance after deductible

80% out of networkallowance after deductible

80% out of networkallowance after deductible

80% out of networkallowance after deductible

80% out of networkallowance after deductible

DRUG ABUSE (OUTPATIENT) 3

201 MIDDLESEX COUNTY JOINT HEALTH INSURANCE FUND

TRADITIONAL(If offered byyour employer)

CUSTOMER SERVICEHorizon Blue Cross

Blue Shield ofNew Jersey 800-355-2583

www.horizonblue.com

100% for 365 days

100%

100%

Basic benefit at 100% balanceat 80% after deductible

80% of network allowanceafter ductible

80% of network allowanceafter deductible

Basic benefit at 100% balanceat 80% of network allowance

after deductible

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

Basic benefit at 100%balance at 80% after

deductible

100%(case management required)

Basic benefit at 100%balance at 80% after

deductible

Basic benefit at 100%balance at 80% of networkallowance after deductible

100% for first 120 days,balance covered at

80% after deductible,maximum combined

hospital stay is 365 day

100%80% out of network

allowance after deductible

80% after deductible 2+5

Not covered

100%

80% after deductible 2+5

$50 per calendar yearincludes lenses, frames

80% after deductible

80% out of networkallowance after deductible

$50 per calendar yearincludes exam, lenses, frames

Horizon Blue Cross Blue Shield ofNew Jersey 800-355-2583

Horizon Blue Cross Blue Shield ofNew Jersey 800-355-2583

www.horizonblue.com www.horizonblue.com

100%

100% up to 100 daysin-network facilityper calendar year

80% out of network allowanceafter deductible max. up to60 days per calendar year

100%80% out of network

allowance after deductible

80% out of networkallowance after deductible

80% out of networkallowance after deductible

80% out of networkallowance after deductible

80% out of networkallowance after deductible

80% out of networkallowance after deductible

80% out of networkallowance after deductible

80% out of networkallowance after deductible

100%

100% after copay

100% after copay

100% after initial copay

100%

100%

100%

100% after copay

Limited payment for bonyimpacted molars, mouthtumors, accidental injury,

if medically necessary

Limited payment for bonyimpacted molars, mouthtumors, accidental injury,

if medically necessary

Limited payment for bonyimpacted molars, mouthtumors, accidental injury,

if medically necessary

Limited payment for bonyimpacted molars, mouthtumors, accidental injury,

if medically necessary

Limited payment for bonyimpacted molars, mouthtumors, accidental injury,

if medically necessary

80% out of networkallowance after deductible

100% after copayper admission

80% after deductibleper admission

100% after copayper admission

100%

100% after copay

80% after deductibleper admission

80% out of networkafter deductible

100% after copay

100% after copay 100% after copay

100% after copay 100% after copay

100% afterinitial copay

100% afterinitial copay

100%

100% after copay 100% after copay

100% after copay 100% after copay

100% after copay

Not covered 2

(Except MosquitoCommission)

Not Covered

Not covered 2

(Except MosquitoCommission)

Not Covered

80% after deductible

100% after copay 80% after deductible

100% after copay 80% after deductible

100% after copay 80% after deductible

100% after copay 80% after deductible

100% after copay 80% after deductible

100% after copay 80% after deductible

100% after copayCopay, then

80% after deductible

100% after copayCopay, then

80% after deductible

None $1,500

None $3,000

$2,500 $4.500

$5,000 $9,000

80% after deductible

100% 100%

100% 100%

100% 100%

100% 100%

100% 100%

100% 100%

WEBSITE

HOSPITAL STAY BENEFITSHOSPITAL INPATIENT

SKILLED NURSING FACILITY

HOSPITAL PREADMISSIONTESTING

PHYSICIAN (OFFICE VISITS)

PHYSICAL EXAMS

IMMUNIZATIONS

MAMMOGRAMS

PAP SMEAR

PROSTATE EXAM

CHIROPRACTIC

MATERNITY

WELL BABY

MISCELLANEOUS SERVICESRADIATION/CHEMOTHERAPY

OUTPATIENT

HOSPICE

PHYSICAL AND/ ORSPEECH THERAPY

DENTAL COVERAGEIN MEDICAL PLAN

X-RAYS/LAB TESTS

PRESCRIPTION DRUGSIN MEDICAL PLAN

VISION CARE INMEDICAL PLAN

MENTAL HEALTH ANDSUBSTANCE ABUSE

ALCOHOL ABUSE (INPATIENT)

ALCOHOL ABUSE 3

(OUTPATIENT)80% after deductible

100% for first 120 days,balance covered at

80% after deductible,maximum combined

hospital stay is 365 day

100% for first 120 days,balance covered at

80% after deductible,maximum combined

hospital stay is 365 day

80% after deductible

80% after deductible

100%

100%

100%

$200 (employee plus one)

$400 plus 5

$100 individual deductible

$400 per covered person 5

plus $200 family deductible

100%

100%

100% after $25 copay,copay waived if admitted

100% after $25 copay,copay waived if admitted

None

None

$300 5

$600 5

100% after $5 copay 80% out of networkallowance after deductible

80% out of networkallowance after deductible

80% out of networkallowance after deductible

80% out of networkallowance after deductible

$100

$200

$400 plus$100 individual deductible

$800 plus$200 family deductible

100% after copay

80% out of networkallowance after deductible

80% out of networkallowance after deductible

100% after copay80% out of network

allowance after deductible

DRUG ABUSE (INPATIENT) 3

MENTAL HEALTH 3

(INPATIENT)

MENTAL HEALTH 3

(OUTPATIENT)

EMERGENCY CAREEMERGENCY ROOM (ACCIDENTAL)

EMERGENCY ROOM (OTHER)

OUT-OF-POCKET EXPENSESDEDUCTIBLE (INDIVIDUAL)

DEDUCTIBLE (FAMILY MAX.)

MAX. OUT-OF-POCKET(INDIVIDUAL)

MAX. OUT-OF-POCKET(FAMILY)

MEDICAL SERVICESPHYSICIAN (SURGERY)

PREVENTIVE SERVICES1

HORIZONPOINT OF SERVICE (POS)IN-NETWORK OUT-OF-NETWORK

This chart provides you with an outline of covered benefits. Keep in mind that the benefits outlined in this chart highlight features of your health benefit program. These outlines do not constitute a contract. Some limitations and exclusions may apply. Payment of benefits is subject solely to the terms of the contract.1Preventive Service covered at 100% when coded as preventive care.2Mosquito Commission has prescription coverage under the CIGNA and Oxford plans.3All health plans cover Mental Health, Alcohol, and Substance Abuse as any other medical illness in accordance with the Federal Mental Health Parity and Addiction Equity Act of 2008.4The Out of Pocket Maximum Cost for in network medical and prescription expenses (combined) in the 201 plan year is limited to $6,550 per individual and $13,100 per family.5Copay/Coinsurance is only reimbursed if incurred due to a free standing drug plan.

4782 (W101 )

HORIZON OMNIA

Tier 1 Tier 2