The Division of Health Benefits administers Health Insurance coverage for Active and Retired employees of Middlesex County. Benefits include:

• Medical Plan
• Dental Plan
• Prescription Plan
• Vision Plan

The Division also administers federally mandated programs such as Family Medical Leave Act and Federal Leave Act.

DIVISION OF HEALTH BENEFITS

Middlesex County offers health benefits to all eligible employees working a regular schedule of 20 hours or more per week, excluding temporary and seasonal employees.

The Middlesex County Joint Health Insurance Fund (MCJHIF) sponsors the medical insurance plans available, through a self-insured arrangement with several other autonomous public entities throughout the county.

MEDICAL INSURANCE PLAN OPTIONS

Middlesex County employees are offered a choice of two types of medical insurance plans: Point-of-Service (POS) and Health Maintenance Organizations (HMO). Those considering HMO coverage are able to choose one of the three carriers with the highest enrollment of MCJHIF members; i.e., AetnaUSHealthCare, Cigna and Healthnet.

Point of Service (POS)Plan

A Point-of-Service (POS) plan is a ‘hybrid’ plan that provides a combination of features combining some of the best elements of Traditional medical plans (i.e., plans that allow complete freedom in the choice of medical service providers, but where the patient is responsible for a much greater share of expenses) and HMO plans.

Middlesex County currently offers a POS plan called ‘HealthCare Choice’. This plan uses the Horizon Blue Cross Blue Shield network of service providers (doctors, hospitals, laboratories, radiology groups, etc.).

Simply put, the HealthCare Choice plan offers members “the best of both worlds.” Co-payments are $5 for a doctor’s office visit and $25 for an Emergency Room (ER) visit, (see note regarding ER coverage), when members obtain medically necessary services through “in-network” providers, in the same way they would use an HMO. However, if members find they’d rather obtain medically necessary services from a provider who is NOT in the Horizon Blue Cross Blue Shield network, they are welcome to do so, and expenses are covered the same way a Traditional plan pays (that is, at 80% - after the member pays the first $100 annual deductable).

NOTE: Coverage for emergency room expenses is limited to severe and/or life-threatening conditions. Members must contact their Primary care Physician in all other cases. (A good ‘rule of thumb’ is: If you can use the telephone – do so! It could save you paying out of pocket for emergency room expenses later.) Members should check with their plan to determine what conditions apply.

Health Maintenance Organizations (HMO's)

Each HMO plan uses a network of participating service providers (doctors, hospitals, labs, x-ray groups, etc.). Members select a Primary Care Physician (PCP) and ALL medically necessary care is obtained by contacting the chosen PCP, who is responsible for determining whether specialty care is in order. A nominal co-payment (which varies according to the individual HMO) is required at the time services are rendered.

NOTE: As in the HealthCare Choice Plan, the coverage for emergency room expenses is limited to severe and/or life-threatening conditions. Members must contact their PCP in all other cases. (A good ‘rule of thumb’ is: If you can use the telephone – do so! It could save you paying out of pocket for emergency room expenses later.)
Members should check with the individual HMO to determine what conditions apply.

 

DENTAL PLANS

Middlesex County offers two types of dental plans, a Traditional Plan and a Managed Care Plan (DHMO).

Traditional Dental

Similar to a traditional medical plan, Middlesex County’s traditional dental insurance through Delta Dental allows members to obtain medically necessary services from the dentist of their choice. Also known as ‘an indemnity plan’, patients are usually responsible for payment in full for all services rendered and then qualify for reimbursement based on a schedule of predetermined amounts for each of the types of dental services available. Although this type of dental plan may not provide the richest benefit, many members feel that having the freedom to go to the dentist of their choice, more than makes up for any reimbursement limitation.

Dental Health Maintenance Organization (DHMO)

A DHMO plan operates much like a medical HMO, with members required to pre-select (from a panel of participating service providers), a location from which they and their dependents obtain all medically necessary care.

The DHMO plan is administered by Dental Services Organization, Inc., (DSO), where most of the providers are conveniently located throughout Middlesex County. By far, the most attractive feature of DHMO coverage is cost-effectiveness – members and their dependents pay NOTHING for services other than orthodontia or general anesthesia.

PRESCRIPTION PLAN

Perhaps Middlesex County’s most generous form of health insurance, this separate cardholder plan is offered through contract with Express Scripts, Inc., one of the nation’s most widely recognized carriers.

Coverage includes all FDA approved medications requiring a physician’s prescription by State and Federal regulation. Medications are dispensed upon presentation of a doctor’s prescription and a nominal co-payment ($3 for name brand drugs - $0 for generics)

VISION CARE PLAN

An “in house” Vision Care voucher reimbursement program is available for active employees only. (There is no dependent or retiree coverage available under this benefit.)

An employee is entitled to one reimbursement every two years, of up to $50 for examination and $90 for eyewear.

 

Middlesex County Joint Health Insurance Fund
Aetna/USHealthcare
Cigna Healthcare
Healthnet (formerly PHS)
Horizon Blue Cross Blue Shield

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