Medical

PLANS

Choice Plan

(formerly the Select Plans)

Options PPO Plan

(formerly the Traditional Plan)

Aetna Patriot V Plan

The Patriot V QPOS Plan offered by the Fund provides you with in-network (referred) services coordinated by your participating Primary Care Physician (PCP). The Plan offers participants the options of going directly to out-of-network (self-referred) providers or facilities without a referral.

When you self-refer, you will be subject to the applicable self-referred deductible and coinsurance benefits levels and maximums.

The Patriot V Plan covers routine Wellness and Preventive Care provided by your PCP.

You may also obtain pediatric dental services and gynecological exams from participating providers without a referral from your PCP. If you choose to access care without a referral, you must obtain authorization prior to receiving self-referred care for certain services. Failure to precertify may result in a reduction of benefits

*Links to external websites are provided for your convenience only. The North Jersey Municipal Employee Benefit Fund is not responsible or liable for the content, accuracy or privacy practices of linked sites, or for services described on those sites.

Networks


UnitedHealthcare

111 Wood Ave South Suite 2
Iselin, NJ 08830
UnitedHealthCare (UHC) is the medical Third Party Administrator "TPA" for the North Jersey Municipal Employee Benefits Funds Choice Plus and Options PPO Plans.

For more than two decades, UnitedHealthCare has strived to improve the health care experience, help individuals take a more active role in their own health and well-being and to make health care services more accessible for all Americans.

Members of the NJMEBF have access to myuhc.com. You can find information about your medical benefits, locate a physician* in your network using UHCs customized online hospital and physician directory, check eligbility information and more. Other great features include:
  • View the approximate cost for a specific procedure in your area with the help from UHCs Treatment Cost Estimator
  • Compare hospitals based on criteria important to you
  • Check the status of your claims
  • Research a wide variety of health content
  • Participate in live, online chats with medical experts

Aetna

55 Lane Rd
Fairfield, NJ 07004
The Aetna Navigator contains information geared towards the participant. Research medications, change your Aetna PCP and more, all Online.

Aetna Links:

Medicare

The Medicare website contains information on Medicare parts A & B. You can easily see if you are eligible, find out what the premiums are, find out what is covered, inquire about how to file a claim and more.

DELTA DENTAL

New Jersey's largest dental health carrier

Delta Dental of New Jersey, Inc.
Delta Dental Plaza
1639 Route 10
Parsippany, NJ 07054

Delta Dental's Benefits Connection is a free 24 hour service allowing subscribers and their dentists to obtain instant, detailed information about their specific Delta Dental benefits online.

  • See what services your plan allows.
  • Review the percentages that Delta Dental Will Cover.
  • Is there a deductible or waiting period involved?
  • Check the status of your claim
Delta Dental links
  • This email address is being protected from spambots. You need JavaScript enabled to view it.

Prescriptions

The NJMEBF offers prescription benefits through Express Scripts, Inc.
1 Express Way St. Louis, MO 63131 - Mailstop: STLP
Express Scripts Resources
  • Participating pharmacy locator
  • Online drug store
  • Printable Claim Forms/COB Forms and more.
  • ¬© 2003 - 2018 North Jeresey Municipal Municipal Employee Benefits Fund