STATE WORKER CONTRACT INFORMATION AND RESOURCES
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SUMMARY OF TENTATIVE AGREEMENT
CWA STATE OF NEW JERSEY
(JULY 1, 2019 – JUNE, 30 2023)
CWA PPO PLAN DOCUMENTS
- Q&A on Healthcare CWA PPO Plan w/ Member Contribution Comparison Chart
- CWA PPO Plan Design Chart – A direct comparison of your share of medical costs and prescription copays with CWA PPO & HMO vs. Tiered Network vs. High Deductible Plans
- Member Contribution Comparison Chart – A direct comparison of NJDirect vs. CWA PPO vs. Tiered Network Plan contribution rates that show the dollar amount in savings for members annually in employee contributions for single, member-spouse, parent-child, and family coverage effective July 1, 2019.
- Member Contribution Rate Charts – Your percentage of pay contribution and dollar amount in annual contributions for single, member-spouse, parent-child, and family coverage effective July 1, 2019.
1. Does my choice of in-network providers change from NJ Direct 15 to CWA PPO or from Aetna Freedom 15 to CWA PPO?
NO. NOT AT ALL. If your providers are in-network now, they will remain in-network. NJ Direct 15 uses the Horizon Managed Care Network which has 45,300 providers of whom 31,200 are primary care and specialist physicians. That network also includes nearly every NJ hospital. CWA PPO will use the SAME network.
The Aetna network for Freedom 15 will also remain the SAME for the Aetna version of CWA PPO.
2. Is there any change in benefits covered by CWA PPO compared to NJ Direct 15/Freedom 15?
NO change at all in covered benefits. Everything covered now will continue to be covered after the July 1st switch to CWA PPO.
3. Will Horizon and Aetna still be providing coverage through the CWA PPO?
YES. Our insurance carriers, Horizon and Aetna have not changed.
4. I’m in a course of treatment provided by in-network providers that will last past July 1. How will the switch to CWA PPO impact me?
Your coverage will remain THE SAME. We recommend that you double check that your providers are in-network.
5. If I travel or live out-of-state will I be able to find and use in-network providers with CWA PPO?
YES. For Horizon you will still be able to see providers across the country who are in-network for the local Blue Cross/Blue Shield affiliate (such as Independence Blue Cross or Empire Blue Cross) through the Blue Card program (that’s signified by the little suitcase on your Horizon card.) For Aetna, you will continue to be able to access their national network. CWA PPO is National No Referral.
6. These were negotiations, what did the state get?
A change in out-of-network payments to providers that will provide very significant savings to the state. Many out-of-network providers will receive lower payments while some such as out-of-network mental health providers will receive more. It will be more important to choose in-network providers for expensive services. There are also a few increased copays such as those for emergency room visits and prescription drugs through the savings from lower paycheck health contributions will greatly exceed any new costs.
7. I’m currently in an HMO plan; how will this tentative agreement impact my coverage?
You can remain in your current HMO without any change; however, your health contribution (payroll deduction) will continue to be determined by the current (Chapter 78) rate chart so you will likely pay more if you continue in the HMO. We recommend that you check this carefully during the April open enrollment.
8. Since we are staritng the CWA PPO plan year in July, will deductibles and out-of-pocket maximums reset as of that date? We started NJDirect15 in January and have already paid $200 towards a deductible or OOP max requirement. Do we lose that and start over with new deductibles and OOP max under CWA PPO? This would mean I am paying more than the required amount within a 12-month period.
NO. Deductibles, out-of-pocket max, etc. that have already been spent under NJD15 or Freedom will carry forward to the CWA PPO for the remainder of 2019 Plan Year.
9. Since we are starting CWA PPO in July, will there be a regular open enrollment in October, or will the next one be in July 2020? Are we doing a 6-month plan year for the remainder of 2019 and then start fresh in 2020 on the normal timetable?
We are doing 6 months for the remainder of 2019 and then we go back to the normal January 1 Plan Year.
10. For open enrollment in April 2019 – will a member automatically migrate from NJD15 to CWA PPO Horizon, and from Aetna PPO to CWA PPO Aetna? Or will they have to do an application to go from PPO to PPO?
Migration will be automatic from NJ Direct PPO plans/ Aetna Freedom PPO to CWA PPO based on your selected network, Horizon or Aetna. If you have Aetna Freedom you will convert to the CWA PPO in the Aetna network. Members would only have to affirmatively do an application if they are changing plans, such as going from HMO to CWA PPO or NJDirect to Tiered Network.
11. If I had pre-approval for the plan year for a healthcare service (bi-weekly injectibles, for example) will I need pre-approval again for the new plan or does my pre-approval carry through to the end of the December 2019 plan year?
Your pre-approval carries through the end of the December 2019 plan year. You would not need another pre-approval.
12. I attained 20 years of pension service credit by June 2011 (or 25 years prior to then) and am entitled to pay 1.5% (or 0%) of my pension income as a health contribution. Will CWA PPO change this? Does the CWA agreement disturb this with our new contribution grid?
NO. The amount you pay as a health contribution as a retiree is determined by the date you attained 20 or 25 years of pension service credit NOT by your retirement date. The CWA contribution grid will not disturb your 0% retiree rate. Congratulations on your retirement and you will still have no contribution. If you are locked in the 1.5% retiree contribution rate, the CWA contribution grid will NOT disturb your 1.5% of pension retiree rate.
RATIFICATION/CONTRACT VOTING INFORMATION
Click here for schedule: ratification-worksites-by-department-march-2019.xlsx
- Please join us at the CWA Local 1033 General Membership Meeting on March 7, 2019 at 4:30pm to 6:15pm at the War Memorial to go over details of the Tentative Contract