Members HealthPlan 2021 Updates and Materials

See Below 2021 Updates and Information from Members Health Plan
Please note the following 2 key changes effective 1/1/20:
  1. Husband/Wife groups are no longer eligible
  2. Pharmacy changing to Aetna

January 2021 Plan Changes and Updates

Pharmacy Program transitioning to Aetna effective 1/1/21
  • New ID Cards being Mailed to All current Members beginning the week of 12/14/20
  • Click Here for additional Program Information

Pharmacy Copay Changes

Maximum Out-of-Pocket (MOOP) Changes

Underwriting Guideline Changes:

  • Eligible Employer Revised: A group is eligible to participate in Members Health Plan NJ for coverage if they have at least two (2) Eligible Employees (one of which must be provided a W-2 and that W-2 employee must be enrolled in the health plan). Employer must be located in New Jersey.
  • Ineligible Employees Added: An individual and his or her legal spouse when the business is owned by the individual or by the individual and his or her legal spouse are not considered employees of the participating Employer for purposes of determining the groups eligibility with the Plan.
  • Tax Documentation Revised: Groups with 6-50 Eligible Employees no longer require tax documentation. The Plan requires a completed certification.
  • Click Here to review detailed Underwriting Guidelines

Click Here for a PowerPoint presentation of all Medical, Pharmacy and Underwriting Changes effective January 1st 2021

January 2021 Renewals Are Now Available

Small Group (2-50) and Large Group (51+) Renewals:

  • Employer Renewal Paperwork will be emailed to the Broker of Record the week of November 9th
  • Employers will receive a copy of their Renewal Paperwork the week of November 16th.
  • Renewal Documents will be available in MHPNJ Enrollment System effective November 13th.

Key Information:

  • Renewal Paperwork Needs to be returned no later than December 14th to avoid disruption to your clients medical, pharmacy and dental coverage.
  • Failure to submit renewal paperwork by January 31, 2021 may leave employees WITHOUT health coverage.
  • All renewal groups with a designated affiliation of Medical Professional or Medical Physician will now be required to join one of the plans sponsoring associations.
  • All renewal groups MUST renew with their current sponsor. A change of sponsor is NOT permitted as per the Plan Sponsors Board of Trustees.

Click Here to access the January Renewal Package. Please review the information carefully. Your client must complete and submit the appropriate paperwork in order to renew their health coverage.

January 2021 New Business Rates Are Now Available

  • New Business Rates are now available.
  • Click Here for a January 2021 New Business Packet
  • As a reminder, all NEW employer groups will be required to be a member of one of our sponsoring organizations.
    • Please remind your employers that payments to the below associations MUST be made by the employer, not a broker or other third party. If an employer is unable to make the payment, they will not be eligible for the Health Plan.
    • Membership is for one year and must be renewed annually.
    • Click Here for for a brief summary of Association Sponsors and eligibility criteria as each sponsoring association provides valuable resources and actively serves their employer members in various ways
    • Click Here for the Underwriting Guidelines to confirm your employer is eligible for MHPNJ.

Additional Benefit and Plan Information can be found by going to MHPNJ website