HEALTH BENEFITS UPDATE
Landmark decision for copay compensation
KEVIN C.
LYONS
At the March 20 meeting of the State Health
Benefits Design Committee, the Committee
unanimously voted for a solution that finalized
the Superior Court decision that addressed the
unilateral indexing of retiree prescription
copays by the Division of Pensions and Benefits
in the years 2013, 2014 and 2015.
The Committee was presented with three
possible solutions to rectify the overpayment of
copays in the aforementioned years. Unfortunately, the monumental task of calculating payments to members
would have resulted in another year of delay in payments to our
retirees, and due to medicare regulations some members would
have actually owed money to the federal government.
This solution allows for compensation in that copays will be
reduced or eliminated depending on the classification of the drug
and the type of plan in which the member is enrolled for the period from July 1, 2015 through Dec. 31, 2015, and will return to 2012
rates as a baseline for negotiating new plans for 2016.
The decision in the superior court was a landmark one in that
it gives the Committee the authority on all levels to negotiate
plans going forward, which is especially important in this era of
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NEW JERSEY COPS
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JUNE 2015
escalating costs in the health care realm. The Committee, both
labor and management, have made a commitment to work
together to create plans that provide better healthcare for both
our retirees and active enrollees.
The terms of the retirees for the rest of 2015 are as follows:
For the period from now to June 30, copays will remain as they
are currently.
For the period from July 1 through Dec. 31, copays for $10 and
$15 copay plans will be:
Tier
Retail
Mail (3 months)
Generic
Name Brand
Non Preferred
$0
$3
$11
$0
$3
$11
For the $10 HMO plans:
Tier
Retail
Mail (3 months)
Generic
Name Brand
Non Preferred
$1
$6
$17
$1
$6
$17
The maximum out of pocket of $1,351 per person –
the 2012 rate – will apply for 2015.