Frequently Asked Questions
Shamong Township Schools
What health plans are available to me as an eligible Board of Education employee?
The District medical benefits are offered through Aetna and Horizon OMNIA and administered by the SHIF (Schools Health Insurance Fund). Our prescription benefits are provided through BeneCard PBF, while our dental plans are placed with Delta Dental. We also offer a vision benefit.
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Medical: Aetna / Horizon OMNIA
Prescription: BeneCard PBF
Dental: Delta Dental
What is the "health waiver" option?
The health waiver option offers flexibility in creating a personalized package of benefits. This option is an alternative to selecting health care coverage through the District, but is available only to employees with other health coverage. For example, if you have coverage through your spouse's employer, you can choose to receive cash instead of the District's health coverage. If you lose your other coverage, you can immediately enroll in the District plan by completing an enrollment form and providing documentation of coverage loss.
If you have questions about this option, please email the Business Office for instructions. Visit the Waiver Option page for details.
When can I make changes to my plan?You can make changes to your plan at Open Enrollment (Spring of each year). However, if your family experiences a life change (such as marriage, adoption, birth, or death), you may be eligible to change your plan at that time. It is important to notify the Business Office immediately when such an event occurs to update your plans within the specified window. See the next question for more information on adding a dependent to your plan.
How can I add new dependents to my plan?
When an important event occurs in your life, such as marriage, adoption, or birth of a child, you have a specified window of time to make changes to your health plans. It is important to enroll your new dependent within the given window or you may need to wait until the next Open Enrollment period.
Newborn children are automatically covered for 60 days from date of birth. To continue beyond the initial 60 days, you must actively enroll your child in the District plans. All other dependents must be enrolled within 31 days of eligibility. To make a smooth and timely change within the given window, complete the appropriate enrollment forms and forward to the Business Office immediately after the event.
What are the rules for dependents who "age out"?
Eligible dependents are your spouse, civil union partner, eligible same-sex domestic partner, or your eligible children (this can include natural children under age 26 regardless of marital, student, or financial dependency status, stepchildren, foster children and those in a guardian-ward relationship). Supporting documention is required for enrollment.
The Affordable Care Act (ACA) provides for medical and prescription coverage through the Shamong Township Board of Education for your eligible dependent through age 26. Coverage ends at the end of the year in which he/she turns age 26.
Dental coverage for your dependent child typically ends upon the end of the month in which he/she turns age 19; however, full-time students are eligible for coverage under your plan though the end of the month in which he/she turns age 23. You must notify the District when your dependent is no longer eligible for coverage or he/she could forfeit rights to continuing coverage options. Children no longer covered by your plan may be eligible to continue coverage under COBRA or the New Jersey Chapter 375 (<31 Dependent) plan (see below).
What is the "Chapter 375" plan?
The New Jersey Chapter 375 plan gives eligible adults to age 31 the choice to elect health and/or prescription coverage under a parent's group health plan. Go to the New Jersey Chapter 375 page for more information.
Where can I find a list of providers that participate in my plan?
Our carriers provide helpful search tools to help you locate primary doctors, specialists, facilities, and others that participate in your plan, see below. To view or search the BeneCard PBF pharmacy network, sign in / register online at benecardpbf.com.
Aetna
Horizon OMNIA
Delta Dental
Where can I get help if I have questions about claims or benefits?If you have questions about your plans, visit the Get Help page for help reaching the carriers through toll-free phone numbers, websites, or e-mail. You can find help with questions about your benefits, providers, claims, and more. When you contact either carrier, be sure to have your ID card and birth dates handy.
How can I find out about mail-order pharmacy?
BeneCard PBF manages our prescription plans. BeneCard PBF can help you begin a new mail-order prescription or have renewals delivered to your home. Just call BeneCard PBF at (877) 723-6005 and speak with an associate or mail your prescription with the Mail Service Patient Information and Order Form to get started.
Once your prescription is on record with BeneCard PBF, you can order refills by mailing a completed Order Form or online when you sign in / register for services at benecardpbf.com.
How can I find out about COBRA benefits?
If any of the below qualifying events occurs, you and your enrolled dependents may be eligible to continue benefits under COBRA (Consolidated Omnibus Budget Reconciliation Act of 1985):
* Your death
* Your hours of employment are reduced or your employment is terminated
* Your divorce or legal separation
* Your entitlement to Medicare
* Your child no longer qualifies as a dependent
* A proceeding under the United States Bankruptcy Code involving the employer from which you have retiredYou must notify the Business Office within 60 days of a divorce, legal separation or when a child no longer qualifies as a dependent. You are responsible for paying the required amount to continue coverage for a maximum of 18 or 36 months, depending on circumstances. Additionally, an extension of up to 29 months may be granted to qualified disabled beneficiaries.
For more details on COBRA, visit the Continuing Coverage page or your plan materials.