1. Sussex Wantage Regional School District
Plan Options effective
July 1, 2017 – June 30, 2018

2. Chapter 78 Legislation Chapter 78 was passed on June 28, 2011
Requires contributions based on actual cost of coverage and tiered by salary level
The School Employees’ Health Benefits Program (SEHBP) and State Health Benefits Program (SHBP) must implement at least three plan options, AND a High Deductible/Health Savings Account (HSA)
Employers with plans that are outside the SHBP/SEHBP are not required to implement at least three plan options or an HSA
All Employers must offer a Section 125 Premium Only Plan (POP) and a Health Flexible Spending Account (FSA)

3. Salary Range Year 1 Year 2 Year 3 Year 4
Employee pays below or 1.5% of salary, whichever is greater
Salary Range
Year 1
Year 2
Year 3
Year 4
less than 20,000
1.13%
2.25%
3.38%
4.50%
20,000-24,999.99
1.38%
2.75%
4.13%
5.50%
25,000-29,999.99
1.88%
3.75%
5.63%
7.50%
30,000-34,999.99
2.50%
5.00%
10.00%
35,000-39,999.99
8.25%
11.00%
40,000-44,999.99
3.00%
6.00%
9.00%
12.00%
45,000-49,999.99
3.50%
7.00%
10.50%
14.00%
50,000-54,999.99
15.00%
20.00%
55,000-59,999.99
5.75%
11.50%
17.25%
23.00%
60,000-64,999.99
6.75%
13.50%
20.25%
27.00%
65,000-69,999.99
7.25%
14.50%
21.75%
29.00%
70,000-74,999.99
8.00%
16.00%
24.00%
32.00%
75,000-79,999.99
16.50%
24.75%
33.00%
80,000-94,999.99
8.50%
17.00%
25.50%
34.00%
95,000 and over
8.75%
17.50%
26.25%
35.00%

4. Member / Spouse or Parent Child(ren)
Employee pays below or 1.5% of salary, whichever is greater
Salary Range
Year 1
Year 2
Year 3
Year 4
less than 25,000
0.88%
1.75%
2.63%
3.50%
25,000-29,999.99
1.13%
2.25%
3.38%
4.50%
30,000-34,999.99
1.50%
3.00%
6.00%
35,000-39,999.99
5.25%
7.00%
40,000-44,999.99
2.00%
4.00%
8.00%
45,000-49,999.99
2.50%
5.00%
7.50%
10.00%
50,000-54,999.99
3.75%
11.25%
15.00%
55,000-59,999.99
4.25%
8.50%
12.75%
17.00%
60,000-64,999.99
10.50%
15.75%
21.00%
65,000-69,999.99
5.75%
11.50%
17.25%
23.00%
70,000-74,999.99
6.50%
13.00%
19.50%
26.00%
75,000-79,999.99
6.75%
13.50%
20.25%
27.00%
80,000-84,999.99
14.00%
28.00%
85,000-99,999.99
22.50%
30.00%
100,000 and over
8.75%
17.50%
26.25%
35.00%

5. Salary Range Year 1 Year 2 Year 3 Year 4
Employee pays below or 1.5% of salary, whichever is greater
Salary Range
Year 1
Year 2
Year 3
Year 4
less than 25,000
0.75%
1.50%
2.25%
3.00%
25,000-29,999.99
1.00%
2.00%
4.00%
30,000-34,999.99
1.25%
2.50%
3.75%
5.00%
35,000-39,999.99
4.50%
6.00%
40,000-44,999.99
1.75%
3.50%
5.25%
7.00%
45,000-49,999.99
6.75%
9.00%
50,000-54,999.99
12.00%
55,000-59,999.99
10.50%
14.00%
60,000-64,999.99
4.25%
8.50%
12.75%
17.00%
65,000-69,999.99
4.75%
9.50%
14.25%
19.00%
70,000-74,999.99
5.50%
11.00%
16.50%
22.00%
75,000-79,999.99
5.75%
11.50%
17.25%
23.00%
80,000-84,999.99
18.00%
24.00%
85,000-89,999.99
6.50%
13.00%
19.50%
26.00%
90,000-94,999.99
21.00%
28.00%
95,000-99,999.99
7.25%
14.50%
21.75%
29.00%
100, ,999.99
8.00%
16.00%
32.00%
110,000 and over
8.75%
17.50%
26.25%
35.00%

7. Sussex Wantage Plan Options
The Sussex Wantage Board of Education continues to offer three medical plan options and two prescription plan options for employees:
Existing PPO
Existing Direct Access
Existing EPO
Existing $15 Generic/$25 Preferred Brand/$40 Non Preferred Brand Prescription Plan (RX # 2)
Existing $10 Generic/$20 Preferred Brand/$40 Non-Preferred Brand Prescription Plan (RX # 1)

8. Medical Plan Comparison
PPO
Direct Access
EPO
NJ Network
Horizon PPO Network
Horizon Managed Network
National Network
Bluecard
Primary Care Copay
$10
$20
Specialist Copay
$40
Annual Physical/Well Visits
No copay 8 8

9. Medical Plan Comparison
PPO
Direct Access
EPO
Hospital Network
Identical for all three plans
Inpatient Coverage
100% In-Network
80% after deductible
Out of Network
No Out of Network coverage outside of emergency
Inpatient Copay
None
$250/day
Up to 5 Days
ER Copay
$25
$100
Appropriate emergency care at the ER is considered in-network regardless of network status

10. Medical Plan Rate Comparison
Rates
PPO
Direct Access
EPO
Single
$843.50
$799.71
$691.68
2 Adults
$1,593.60
$1,510.85
$1,306.75
Family
$2,151.19
$2,039.53
$1,763.99
Parent & Child(ren)
$1,444.72
$1,369.68
$1,184.66

11. DA & EPO: Key Features
Horizon Managed network in NJ. Same hospital & national Bluecard networks as PPO.
No PCP selection and no referrals required.
Lower out of pocket costs compared to PPO.
No day/visit limits for mental health/substance abuse care.
Continues to provide members with Horizon’s full suite of resources including case management, chronic care management, wellness discounts and My Health Manager.

12. Prescription Plan Comparison
RX #2
Prescription
RX #1
Type of Plan
3 Tier Copayment
Generic vs. Brand vs. Non-Preferred
Retail Copayments
$15 Generic
$25 Brand
$40 Non-Preferred
$10 Generic
$20 Brand
Mail Order Copayments
(90 Day Supply)
$30 Generic
$50 Brand
$80 Non-Preferred
$5 Generic
$10 Brand
$20 Non-Preferred 12 12

13. Prescription Plan Rate Comparison
Rates
Rx Plan # 2
($15/$25/$40 Copay)
Rx Plan #1 ($10/$20/$40 Copay)
Single
$240.72
$280.04
2 Adults
$365.14
$424.78
Family
$493.10
$573.64
Parent & Child(ren)
$275.42
$320.41 13 13