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ON-This section must be filled out completely. Please print or type. . Social Security Number 3. PRESCRIPTION DRUG COVERAGE 2. MEDICAL COVERAGE 2a. EMPLOYEE SELECTION (Choose only one plan) - - Effective Dates: 3a. EMPLOYEE SELECTION AETNA HORIZON I wish to be covered by the Employee Prescription Drug Plan. Street Address (Include Apartment #) City State NJ DIRECT1525 Aetna Freedom1525 NJ DIRECT2030 Aetna Freedom2030 Aetna HMO Aetna HMO1525 Member and Domestic Partner (see instr.

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The recommended Plan Year 2023 premium rate changes are as follows: a 19.2% increase for Active Employees, a 12.7% increase for Early Retirees, and a 2.9% decrease for Medicare Retirees.

The New Jersey State Health Benefits Program (SHBP) and School Employees' Health Benefits Program (SEHBP) offer employees and their covered dependents the opportunity to join a Direct Primary Care doctor's office at no additional cost.

The Retired Group of the State Health Benefits Pro- gram (SHBP) or School Employees' Health Benefits Program (SEHBP) offers medical, prescription, and dental coverage to certain retiring members and their eligible dependents.

The recommended Plan Year 2023 premium rate changes are as follows: a 21.6% increase for Active Employees, a 13.0% increase for Early Retirees and a 0.7% increase for Medicare Retirees.

In New Jersey, an employee's pension contribution to the state plan is tax-deferred for federal purposes, said Steven Gallo, a certified public accountant and personal financial specialist with U.S. Financial Services in Fairfield.

For those districts who have their Health Benefit Coverage through the School Employees Health Benefit Plan (SEHBP), you will see premiums rise 15.1% beginning January 1, 2023. The increase is 15.6% for Medical and 10.8% for RX for a combined increase (total) of 15.1%.

School Employees' Health Benefits Program Active Group Eligibility. Eligibility for Active Group coverage is determined by the School Employees' Health Benefits Program (SEHBP). All enrollments, changes to coverage, terminations, etc. must go through your employer. Full-time Employees.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232