Employee Dental Plans — Member Guidebook January 2024 Page 4
State Health Benets Program School Employees’ Health Benets Program
INTRODUCTION
The State Health Benets Program (SHBP) was es-
tablished in 1961. It oers medical, prescription drug,
and dental coverage to qualied State and local gov-
ernment public employees, retirees, and eligible de-
pendents. Local employers must adopt a resolution to
participate in the SHBP.
The State Health Benets Commission (SHBC) is
the executive organization responsible for overseeing
the SHBP.
The State Health Benets Program Act is found in the
New Jersey Statutes Annotated, Title 52, Article 14-
17.25 et seq. Rules governing the operation and admin-
istration of the program are found in Title 17, Chapter 9
of the New Jersey Administrative Code.
The School Employees’ Health Benets Program
(SEHBP) was established in 2007. It oers medical,
prescription drug, and dental coverage to qualied lo-
cal education public employees, retirees, and eligible
dependents. Local education employers must adopt a
resolution to participate in the SEHBP.
The School Employees’ Health Benets Commis-
sion (SEHBC) is the executive organization responsi-
ble for overseeing the SEHBP.
The School Employees’ Health Benets Program Act is
found in the New Jersey Statutes Annotated, Title 52,
Article 14-17.46 et seq. Rules governing the operation
and administration of the program are found in Title 17,
Chapter 9 of the New Jersey Administrative Code.
The New Jersey Division of Pensions and Benets
(NJDPB), specically the Health Benets Bureau and
the Bureau of Policy and Planning, are responsible for
the daily administrative activities of the SHBP and the
SEHBP.
The Employee Dental Plans consist of the Dental
Plan Organizations (DPOs) and the Dental Expense
Plan (DEP). The Employee Dental Plans are available
to full-time employees of the State of New Jersey, State
colleges and universities, certain independent State
agencies, and adopting local government and local
education employers. Before making any enrollment
decision, you should carefully review the standards
of eligibility and the conditions, limitations, and exclu-
sions of the benet coverage oered under each plan.
The complete terms of Employee Dental Plans cover-
age are described in the DPO and DEP contracts with
amendments.
Every eort has been made to ensure the accuracy
of the Employee Dental Plans Member Guidebook.
However, State law and the New Jersey Administrative
Code govern the SHBP and SEHBP. If there are dis-
crepancies between the information presented in this
guidebook and/or plan documents and the law, regula-
tions, or contracts, the law, regulations, and contracts
will govern. Furthermore, if you are unsure whether a
dental service or procedure is covered, contact your
dental plan before you receive services to avoid any
denial of coverage issues that could result.
If, after reading this guidebook, you have any questions,
comments, or suggestions regarding the information
presented, please write to the New Jersey Division of
Pensions & Benets, P.O. Box 295, Trenton, NJ 08625-
0295, call us at (609) 292-7524, or send email to:
pensions.nj@treas.nj.gov
EMPLOYEE DENTAL PLANS ELIGIBILITY
Eligibility for coverage is determined under the provi-
sions of the SHBP. Enrollments, terminations, chang-
es to coverage, etc. must be presented through your
employer to the Health Benets Bureau of the NJDPB.
If you have any questions concerning eligibility pro-
visions, you should see your employer’s benets ad-
ministrator. You can also contact the NJDPB Oce
of Client Services at (609) 292-7524 or by email at:
pensions.nj@treas.nj.gov
State Employees
To be eligible for State Employee coverage, you must
work full-time for the State of New Jersey or be an ap-
pointed or an elected ocial of the State of New Jersey
(this includes employees of a State agency or authori-
ty and employees of a State college or university). For
State employees, full-time requires 35 hours per week
or more if required by contract or resolution.
State part-time employees covered under P.L. 2003,
c. 172 (Chapter 172), and State intermittent employees
covered by negotiated agreements between the State
of New Jersey and the Communications Workers of
America (CWA) are not eligible for coverage under the
Employee Dental Plans.
Local Employees
To be eligible for Employee Dental Plans local employ-
er coverage, you must be a full-time employee or an
appointed or elected ocial receiving a salary from a
local government/education employer (county, munic-
ipality, county or municipal authority, board of educa-
tion, etc.) that participates in the SHBP or the SEHBP
and has adopted a resolution to provide dental benets
under the Employee Dental Plans.
Each participating local employer denes, in its reso-
lution, the minimum hours required to be considered a
full-time employee, but it can be no less than 25 hours
per week or more if required by contract. Employment
must also be for 12 months per year except for employ-
ees whose usual work schedule is 10 months per year
(the standard school year).
Local part-time employees covered under Chapter 172
are not eligible for coverage under the Employee Den-
tal Plans.