Wednesday’s votes mark the latest attempt to shore up New Jersey’s beleaguered public worker health plans, which have faced years of escalating premiums. (Dana DiFilippo | New Jersey Monitor)
A state committee approved a series of changes to the State Health Benefits Program on Wednesday that will raise some member costs in a bid to reduce New Jersey’s spending on employee benefits by $150 million in 2026.
The resolutions approved at the State Health Benefit Program’s Wednesday plan design committee meeting will raise copays, deductibles, and out-of-pocket maximums, particularly for out-of-network services.
Other changes will increase members’ share of costs for prescription drugs and impose a 50% coinsurance rate on certain procedures — like endoscopies, knee replacements, and colonoscopies, among some others — done by out-of-network providers.
Wednesday’s votes mark the latest attempt to shore up New Jersey’s beleaguered public worker health plans, which have faced years of escalating premiums that threaten a full collapse of some parts of the state plan.
Spokespeople for Gov. Phil Murphy declined to comment, and a spokesperson for the Communications Workers of America, the state’s largest public-sector union, did not return a request for comment.
Resolutions increasing medical and prescription copays and requiring coinsurance for some out-of-network procedures will apply only to active state workers, not retirees enrolled in the State Health Benefits Program.
The resolutions will increase copays on all classes of prescription drugs, with larger raw increases for higher-cost, brand-name medications. That includes higher copays for GLP-1 weight loss drugs like Wegovy.
Members will be required to pay a $45 copay for a 30-day supply of GLP-1 medications if they are engaged in a lifestyle management program, or $125 if they are not.
The plan design changes were spurred by language in the state’s annual budget that requires officials to identify and implement $100 million in savings within the State Health Benefits Program in the current July-to-June fiscal year. Those savings were meant to total $200 million over the course of 2026.
The state’s actuaries rejected nearly every savings proposal submitted by unions, saying they could not weigh the cost savings they promised.
Aon, the actuary, greenlit a range of proposals made by administration officials, many of which focused on reducing the state’s share of health care costs.
That share, called an actuarial value, sits between 93% and 98% in New Jersey’s existing state plans, though most members are enrolled in plans at the higher end of that range, according to a Treasury report released in May.
Administration and labor officials reached a separate agreement earlier in September that reduced the level of cuts and offered more conservative increases to member costs than were originally proposed by the administration.
“This entire environment was greatly disrupted by the budget bill,” said Micahel Zanyor, a committee member who represents the New Jersey State Troopers Fraternal Association. “It created a situation where tough choices had to be made to protect as many people as we could from rate increases, and I believe these five resolutions we’re voting on accomplish that.”
Staff from the state’s pension and benefits division said the changes approved at Wednesday’s meeting would not be in place when the new plan year begins on Jan. 1 and would not affect the plan’s regular open enrollment period, which runs the entire month of October.
Earlier in September, the State Health Benefits Commission approved a 20% premium increase for state workers’ plan and a 37% increase for local government plans administered by the state.
Local government workers’ plan faces a death spiral as municipal governments flee the State Health Benefits Program for options in the private market, according to a March report from the Treasury. Those departures push premiums higher, spurring more towns and counties to drop state plans.
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