Current through Register Vol. 54, No. 7, April 4, 2022
Cost-effectiveness shall be determined by comparing the cost of the
beneficiary/employee and all eligible family members' participation in the NJ
FamilyCare program against the total cost to the State of reimbursing the
beneficiary/employee for the employee share of the cost of family coverage less
a monthly premium contribution amount for the family purchasing the employer
plan. The amounts used for the calculations in this section shall be derived
from actuarial tables used by the NJ FamilyCare program and actual costs
reported by the employee/employer during the processing of the Premium Support
Program (PSP) application.
the State to provide benefits under NJ FamilyCare, an actuarially valid total
cost per family per month will be determined, using current data from NJ
FamilyCare (NJFC), Managed Care participant rates.
The cost of the employer-sponsored plan
shall be determined by totaling the costs to the State to participate in the
1. The monthly amount
of the employee premium plus the actuarial value of all excess cost-sharing
expenditures (co-payments, deductible and coinsurance), less the NJ
FamilyCare/Premium Support Program monthly premium amount, plus the cost of
"wraparound" services, if applicable, will constitute the total cost to the
State to purchase the employer plan.
(d) As a condition of PSP approval, the
result of the cost-effectiveness test shall indicate a cost savings difference
of, at a minimum, five percent between what the State would pay for the
employee's participation in the employer-sponsored health plan and what the
State would pay for the employee's participation in the NJ FamilyCare
(e) If the
employer-sponsored plan is determined by the Division to be cost-effective in
accordance with (d) above, the applicant shall participate in the Premium
Support Program. If the employer-sponsored plan is determined not
cost-effective, in accordance with (d) above, the beneficiary will continue to
participate in the NJ FamilyCare program.