Medical

Which Medical Plan is Right?

Our medical carrier is Aetna. Aetna’s Medical Hotline number is 1-855-223-8791

NBOE does not participate with the School Employees’ Health Benefits Program administered by the State of NJ.

If you were hired after July 1, 2020 you can only enroll in the NBOE NJ Educators Plan (NJEP), or NBOE Garden State Health Plan (GSHP), which includes prescription coverage, Freedom of Choice Dental, and/or Vision Plan.

If you were hired before July 1, 2020, you have the option to enroll into the Legacy medical plans, and the standalone prescription coverage, and the NJEP or GSHP plan. Also, you will have access to enroll into the Freedom of Choice Dental, and/or Vision Plan.

Note: since NBOE Garden State Health Plan has a limited network, please review the information below before considering the plan.

Click here for Aetna ID Card Instructions in English & Spanish

Garden State Health Plan

Your benefits choices can have a big impact on your health care experiences and expenses, so it is important that you consider your options carefully and find the benefits that are right for you and your family. Here are a few highlights of the Garden State Health Plan with Aetna and Express Scripts:

  • The GSHP offers the same level of benefit for both in and out of network services as the NJ Educators Plan (NJEP)
  • The co-pays mirror the rates for the NJEP
  • The GSHP plan design follows the NJEP for both Medical and Prescription Drug benefits
  • The GSHP uses the Aetna Whole Health℠ — New Jersey network of providers.
  • The GSHP offers a significantly smaller network in comparison to the other plans offered in the District
    • This includes only 35% of Hospitals and 60% of the Physicians in the Open Choice network
  • There is no coverage for out of state providers in the GSHP, except for a true emergency.
    • This includes facilities such as Memorial Sloan Kettering in NYC and CHOP in Philadelphia, which would now be considered out of network
How to Steps To find a Provider under GSHP
GSHP Aetna Whole Health - New Jersey network map

Medical Plan Comparison

If you were hired after July 1, 2020 you can only enroll in the NBOE NJ Educators Plan (NJEP), or NBOE Garden State Health Plan (GSHP), which includes prescription coverage, Freedom of Choice Dental, and/or Vision Plan.

NBOE 2025 Medical Benefit Grid Comparison

NJ Educators Plan (NJEP) and Garden State Health Plan (GSHP)

NBOE NJ Educators Plan
(Aetna/Express Scripts)* 		NBOE Garden State Health Plan (GSHP)
(Aetna/Express Scripts)*
There is no coverage for out of state providers in the GSHP (both in and out of network) except for true emergencies.
BENEFIT IN-NETWORK OUT-OF-NETWORK** IN-NETWORK OUT-OF-NETWORK**
Lifetime Maximum Unlimited Unlimited
Deductible
(Individual/Family)		 None $350 / $700 None $350 / $700
After deductible, plan pays 100% 70% 100% 70%
Maximum Out of Pocket Payment Limit
(Individual/Family)		 $500 / $1,000 $2,000 / $5,000 $500 / $1,000 $2,000 / $5,000
Primary Care Physician Selection Not Required Not Required
Preventive Care
Routine Adult Physician Exams / Immunizations 100% Not covered 100% Not covered
Routine Well Child Exams / Immunizations 100% Well Child Exams Not Covered;
Child Immunizations 70%, deductible waived		 100% Well Child Exams Not Covered;
Child Immunizations 70%, deductible waived
Routine Gynecological Care Exams (1 per year) 100% 70% after deductible 100% 70% after deductible
Routine Mammograms 100% 70% after deductible 100% 70% after deductible
Physician's Office Visits
Primary Care Services $10 copay 70% after deductible $10 copay 70% after deductible
CVS Minute Clinic $0 copay N/A $0 copay N/A
Specialist Services $15 copay A referral is not required to visit a specialist. 70% after deductible $15 copay 70% after deductible
A referral is not required to visit a specialist. A referral is not required to visit a specialist.
Maternity OB Visits $15 copay; first visit only 100% 70% after deductible $15 copay; first visit only 100% 70% after deductible
Allergy Testing and Treatment, OV copay may apply 100% 70% after deductible 100% 70% after deductible
Diagnostics Procedures
Laboratory* 100% in office or at Quest Diagnostics / LabCorp 70% after deductible 100% in office or at Quest Diagnostics / LabCorp 70% after deductible
Outpatient X-Ray/Radiology Services 100% 70% after deductible 100% 70% after deductible
Emergency Medical Care
Emergency Room 100% after $125 facility copay (Copay waived if admitted) 100% after $125 facility copay (Copay waived if admitted) #colspan#
Non-Emergency Care in an Emergency Room Not Covered Not Covered Not Covered Not Covered
Ambulance 90% 70% after deductible 90% 70% after deductible
Hospital Care
Inpatient coverage 100% 70% after deductible 100% 70% after deductible
Outpatient Surgery 100% 70% after deductible 100% 70% after deductible
Behavioral Health Services
Alcohol/Substance Abuse Services Same as any other illness; benefit depends on place of service Same as any other illness; benefit depends on place of service
Mental Health Services Same as any other illness; benefit depends on place of service Same as any other illness; benefit depends on place of service
Other Services
Skilled Nursing Facility 100% 70% after deductible 100% 70% after deductible
Limited to 120 days per benefit period Limited to 60 days per benefit period Limited to 120 days per benefit period Limited to 60 days per benefit period
Outpatient Rehabilitation Therapy (includes speech, physical, and occupational therapy) 100% after $15 copay 70% after deductible for speech & occupational therapy and lesser of $52 or 75% of in-network cost /visit for physical therapy 100% after $15 copay 70% after deductible for speech & occupational therapy and lesser of $52 or 75% of in-network cost /visit for physical therapy
Chiropractic Care 100% after $15 copay 70% after deductible to lesser of $35/visit or 75% of in-network cost 100% after $15 copay 70% after deductible to lesser of $35/visit or 75% of in-network cost
30 visit maximum per benefit period 30 visit maximum per benefit period
Notes- *Only plans available to employees hired or rehired on or after 07/01/2020.
**Out of Network UCR - 200% of Medicare, employee cost of coverage based on % of salary.
Quest Diagnostics and LabCorp are the Preferred Provider for Laboratory services.
“DISCLAIMER: The above is a summary of the carrier’s benefit offerings and may not reflect the plan’s finer details. Plan documents will prevail in the event of a discrepancy.”

Legacy Medical Plans

If you were hired before July 1, 2020, you have the option to enroll into the Legacy medical plans, and the standalone prescription coverage, and the NJEP or GSHP plan. Also, you will have access to enroll into the Freedom of Choice Dental, and/or Vision Plan.

Please see all three comparison charts below.

Choice POS II Plans (formerly known as PPO)

Choice POS II Network Choice POS II Network Choice POS II Network
NBOE Choice POS II 10/15
(Aetna)
formerly known as PPO		 NBOE Choice POS II 20/35
(Aetna)
formerly known as PPO		 NBOE HD 1500
(Aetna)
BENEFIT IN-NETWORK OUT-OF-NETWORK IN-NETWORK OUT-OF-NETWORK IN-NETWORK OUT-OF-NETWORK
Lifetime Maximum Unlimited Unlimited Unlimited
Deductible
(Individual/Family)		 None $200 / $500 $200 / $400 $800 / $2,000 $1,500 / $3,000 $1,500 / $3,000
After deductible, plan pays 100% 70% 80% 60% 80% 60%
Maximum Out of Pocket Payment Limit
(Individual/Family)		 $800 / $1,600 $5,000 / $12,500 $2,000 / $4,000 $5,000 / $12,500 $2,500 / $5,000 $3,500 / $7,000
Primary Care Physician Selection Not Required Not Required Not Required
Preventive Care
Routine Adult Physician Exams / Immunizations 100% 70% After deductible 100% 60% After Deductible 100% 60% After Deductible
Routine Well Child Exams / Immunizations 100% 70% After Deductible;
deductible waived for child immunizations		 100% 60% After Deductible;
deductible waived for child immunizations		 100% 60% After Deductible;
deductible waived for child immunizations
Routine Gynecological Care Exams (1 per year) 100% 70% After deductible 100% 60% After deductible 100% 60% After deductible
Routine Mammograms 100% 70% After deductible 100% 60% After deductible 100% 60% After deductible
Physician's Office Visits
Primary Care Services $10 copay 70% after deductible $20 copay 60% after deductible 80% after deductible 60% after deductible
CVS Minute Clinic $0 copay N/A $0 copay N/A $0 Copay after deductible N/A
Specialist Services $15 copay 70% after deductible $35 copay 60% after deductible 80% after deductible 60% after deductible
A referral is not required to visit a specialist. A referral is not required to visit a specialist. A referral is not required to visit a specialist.
Maternity OB Visits $15 copay; first visit only 100% 70% after deductible $35 copay;
first visit only

100%		 60% after deductible 100%
(no deductible, no copay)		 60% after deductible
Allergy Testing and Treatment, OV copay may apply 100% 70% after deductible 80% after deductible 60% after deductible 80% after deductible 60% after deductible
Diagnostics Procedures
Laboratory* 100% in office or at Quest Diagnostics / LabCorp 70% after deductible 80% after deductible
Quest Diagnostics / LabCorp		 60% after deductible 80% after deductible
Quest Diagnostics / LabCorp		 60% after deductible
Outpatient X-Ray/Radiology Services 100% 70% after deductible 80% after deductible 60% after deductible 80% after deductible 60% after deductible
Emergency Medical Care
Emergency Room #colspan# #colspan# 100% after $100 facility copay
(Copay waived if admitted)		 80% after deductible 60% after deductible
Non-Emergency Care in an Emergency Room Not Covered Not Covered Not Covered Not Covered Not Covered Not Covered
Ambulance
(emergency only)		 100% no deductible after $100 copay 100% no deductible after $100 copay 80% per trip,
no deductible applies		 Paid same as in-network 80% per trip after deductible Paid same as in-network
Hospital Care
Inpatient coverage 100% 70% after deductible 80% after deductible 60% after deductible 80% after deductible 60% after deductible
Outpatient Surgery 100% 70% after deductible 80% after deductible 60% after deductible 80% after deductible 60% after deductible
Behavioral Health Services
Alcohol/Substance Abuse Services Same as any other illness; benefit depends on place of service Same as any other illness;
benefit depends on place of service		 Same as any other illness;
benefit depends on place of service
Mental Health Services Same as any other illness; benefit depends on place of service Same as any other illness;
benefit depends on place of service		 Same as any other illness;
benefit depends on place of service
Other Services
Skilled Nursing Facility 100% 70% after deductible 80% after deductible 60% after deductible 80% after deductible
Limited to 120 days
per benefit period		 60% after deductible
Limited to 120 days
per benefit period
Limited to 120 days per benefit period Limited to 120 days
per benefit period.		 The overall maximum per benefit period is 120 days combined In & Out-of-Network
Outpatient Rehabilitation Therapy
(includes speech, physical, and occupational therapy)		 100% after $15 copay 70% after deductible 100% after $20 copay 60% after deductible 80% after deductible 60% after deductible
Chiropractic Care 100% after $15 copay 70% after deductible 100% after $20 copay 60% after deductible 80% after deductible 60% after deductible
30 visit maximum per benefit period 30 visit maximum per benefit period 30 visit maximum per benefit period
**Out of Network UCR - 200% of Medicare, employee cost of coverage based on % of salary
Quest Diagnostics and LabCorp are the Preferred Provider for Laboratory Services.
DISCLAIMER: The above is a summary of the carrier’s benefit offerings and may not reflect the plan’s finer details. Plan documents will prevail in the event of a discrepancy.

Legacy Medical Plans - continued

Aetna Select Plans (Formerly HMO) - continues below

NBOE Select 10 (Aetna)
formerly known as HMO		 NBOE Select 15/25 (Aetna)
formerly known as HMO
IN-NETWORK OUT-OF-NETWORK IN-NETWORK OUT-OF-NETWORK
Lifetime Maximum Unlimited Unlimited
Deductible
(Individual/Family)		 None N/A None N/A
After deductible, plan pays 100% N/A 100% N/A
Maximum Out of Pocket Payment Limit
(Individual/Family)		 $5,480 / $10,960 N/A $5,480 / $10,960 N/A
Primary Care Physician Selection Required Required
Preventive Care
Routine Adult Physician Exams / Immunizations 100% Not Covered 100% Not Covered
Routine Well Child Exams / Immunizations 100% Not Covered 100% Not Covered
Routine Gynecological Care Exams (1 per year) 100% Not Covered 100% Not Covered
Routine Mammograms 100% Not Covered 100% Not Covered
Physician's Office Visits
Primary Care Services $10 copay Not Covered $15 copay Not Covered
CVS Minute Clinic $0 copay Not Covered $0 copay Not Covered
Specialist Services $10 copay Not Covered $25 copay Not Covered
A referral is required to visit a specialist. A referral is required to visit a specialist.
Maternity OB Visits 100% Not Covered 100% Not Covered
Allergy Testing and Treatment, OV copay may apply 100% Not Covered 100% Not Covered
Diagnostics Procedures
Laboratory* 100% in office or at
Quest Diagnostics / LabCorp		 Not Covered 100% in office or at
Quest Diagnostics / LabCorp		 Not Covered
Outpatient X-Ray/Radiology Services 100% Not Covered 100% Not Covered
Emergency Medical Care
Emergency Room 100% after $35 facility copay
(Copay waived if admitted)		 100% after $75 facility copay
(Copay waived if admitted)
Non-Emergency Care in an Emergency Room Not Covered Not Covered Not Covered Not Covered
Ambulance 100% 100%
Hospital Care
Inpatient coverage 100% Not Covered 100% Not Covered
Outpatient Surgery 100% Not Covered 100% Not Covered
Behavioral Health Services
Alcohol/Substance Abuse Services Same as any other illness;
benefit depends on place of service		 Same as any other illness;
benefit depends on place of service
Mental Health Services Same as any other illness;
benefit depends on place of service		 Same as any other illness;
benefit depends on place of service
Other Services
Skilled Nursing Facility 100%
Limited to 120 days
per benefit period		 Not Covered 100%
Limited to 120 days
per benefit period		 Not Covered
Outpatient Rehabilitation Therapy
(includes speech, physical, and occupational therapy)		 100% after $10 copay Not Covered 100% after $10 copay Not Covered
Chiropractic Care 100% after office copay Not Covered 100% after $25 copay Not Covered
20 visit maximum per benefit period 20 visit maximum per benefit period
Note: Quest Diagnostics and LabCorp are the Preferred Provider for Laboratory services
DISCLAIMER: The above is a summary of the carrier’s benefit offerings and may not reflect the plan’s finer details. Plan documents will prevail in the event of a discrepancy.

Aetna Select Plans (Formerly HMO) - continued

NBOE Select 20/20 (Aetna)
formerly known as HMO		 NBOE Select 20/35 (Aetna)
formerly known as HMO
BENEFIT IN-NETWORK OUT-OF-NETWORK IN-NETWORK OUT-OF-NETWORK
Lifetime Maximum Unlimited Unlimited
Deductible
(Individual/Family)		 None N/A $200 / $400 N/A
After deductible, plan pays 100% N/A 80% N/A
Maximum Out of Pocket Payment Limit
(Individual/Family)		 $5,480 / $10,960 N/A $2,000 / $4,000 N/A
Primary Care Physician Selection Required Required
Preventive Care
Routine Adult Physician Exams / Immunizations 100% Not Covered 100% Not Covered
Routine Well Child Exams / Immunizations 100% Not Covered 100% Not Covered
Routine Gynecological Care Exams (1 per year) 100% Not Covered 100% Not Covered
Routine Mammograms 100% Not Covered 100% Not Covered
Physician's Office Visits
Primary Care Services $20 copay Not Covered $20 copay Not Covered
CVS Minute Clinic $0 copay Not Covered $0 copay Not Covered
Specialist Services $20 copay Not Covered $35 copay Not Covered
A referral is required to visit a specialist. A referral is required to visit a specialist.
Maternity OB Visits 100% Not Covered 100% Not Covered
Allergy Testing and Treatment 100% Not Covered 100% Not Covered
Diagnostics Procedures
Laboratory* 100% in office or at
Quest Diagnostics / LabCorp		 Not Covered 100% in office or at
Quest Diagnostics / LabCorp		 Not Covered
Outpatient X-Ray/Radiology Services 100% Not Covered 100% Not Covered
Emergency Medical Care
Emergency Room 100% after $100 facility copay
(Copay waived if admitted)		 100% after $100 facility copay
(Copay waived if admitted)
Non-Emergency Care in an Emergency Room Not Covered Not Covered Not Covered Not Covered
Ambulance 100% 100% after $100 copay
Hospital Care
Inpatient coverage 100% Not Covered 100% Not Covered
Outpatient Surgery 100% Not Covered 100% Not Covered
Behavioral Health Services
Alcohol/Substance Abuse Services Same as any other illness;
benefit depends on place of service		 Same as any other illness;
benefit depends on place of service
Mental Health Services Same as any other illness;
benefit depends on place of service		 Same as any other illness;
benefit depends on place of service
Other Services
Skilled Nursing Facility 100%
Limited to 120 days
per benefit period		 Not Covered 80% after deductible
Limited to 120 days
per benefit period		 Not Covered
Outpatient Rehabilitation Therapy 100% after $20 copay Not Covered 100% after $20 copay Not Covered
(includes speech, physical, and occupational therapy) 60 visit maximum per benefit period
combined In and Out-of-Network		 100% after $20 copay Not Covered
Chiropractic Care 100% after office $20 copay Not Covered 100% after $25 copay Not Covered
20 visit maximum per benefit period 20 visit maximum per benefit period
Note: Quest Diagnostics and LabCorp are the Preferred Provider for Laboratory services
DISCLAIMER: The above is a summary of the carrier’s benefit offerings and may not reflect the plan’s finer details. Plan documents will prevail in the event of a discrepancy.

Newark Board of Education
DocFind Instructions

Step 1:  Visit Aetna’s website at www.aetna.com/docfind

Step 2:  On the right side of the page, under “Continue as a Guest” enter the Zip code or City, State you would like to “find a Provider”.  You may adjust the distance from zero to 100 miles.  Click “SEARCH”

Step 3:  Select your plan:  you may type the name of your plan (i.e.: “Aetna Choice POS II (Open Access)”. 

Plan Name:

NBOE Choice POS II 

Aetna Open Access Managed Choice/PPO

DocFind Plan selection is…

Category = Aetna Open Access Plans

Plan Name = Aetna Choice POS II (Open Access)

Step 4:  Enter name of your provider in the “what do you want to search for…?” box or “select category” box (then narrow your search further (ie: All Primary Care Physicians, Hospitals, Urgent Care, etc.)

Step 5:  Review your results (select either:  List view or Map View) 

Aetna Whole Health New Jersey Network Coverage Area
DocFind Instructions
Aetna Garden State Health Plan

Video: Preventative Care

Video: Primary Care vs Urgent Care vs ER

Next Page -->