Frequently Asked Questions
Burlington Township School District
What health plans are available to me as an eligible Board of Education employee?
The District currently offers medical and dental plans through Aetna and Delta Dental respectively. Both are administered by the School Health Insurance Fund (SHIF). Our prescription plans are placed with BeneCardPBF. Visit the Plan Options page to find plan overviews and summaries detailing available plans.
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What is the "health waiver" option?
The health waiver, sometimes called a "cash-in-lieu-of-benefits" option, offers flexibility in creating a personalized package of benefits. This option is an alternative to selecting health care coverage through the District, but is available only to employees with other health coverage. For example, if you have coverage through your spouse's employer, you may be eligible to receive cash instead of the District's health coverage. If you lose your other coverage, you can immediately enroll in the District plan by completing an enrollment form and providing documentation of eligibility.
When can I make changes to my plan?
You can make changes to your plan at Open Enrollment (Spring of each year). However, if your family experiences a life change (such as marriage, adoption, birth, or death), you can make adjustments to your plans at that time. It is important to notify the HR Department within 30 days (60 days for the birth of a child) when such an event occurs.
How can I add new dependents to my plan?
When an important event occurs in your life, such as marriage, adoption, or birth of a child, you have a specified window of time to update your health plans. It is important to enroll your new dependent within the given window or you may need to wait until the next Open Enrollment period.
Newborn children are automatically covered for 60 days from date of birth. To continue coverage beyond the initial 60 days, you must actively enroll your child in the District plans. All other new dependents must be enrolled within 30 days of eligibility. To make a smooth and timely change, complete the appropriate enrollment forms and forward to the HR Department immediately after the event.
The Affordable Care Act (ACA) provides for medical and prescription coverage through the Burlington Township Board of Education for your eligible dependent through the end of the month in which he/she turns to age 26. Dental coverage for your dependent child typically ends at the end of the year of his/her 19th birthday (or 23rd birthday if attending an accredited school, college, or university as a full-time student).
You must notify the District when your dependent is no longer eligible for coverage or he/she could forfeit rights to continuing coverage options. Children no longer covered by your plan may be eligible to continue coverage under COBRA, the ACA Health Insurance Marketplace, or the New Jersey Chapter 375 (<31 Dependent) plan (see below).
Refer to the Eligibility page for more details.What is the "Chapter 375" or <31 Dependent plan?
The New Jersey Chapter 375 (Dependent <31) plan gives eligible adults to age 31 the choice to elect health and/or prescription coverage under a parent's group health plan. Click on the Continuing Coverage section of this website for more information.
Where can I find a list of providers that participate in my plan?
Our carriers provide helpful search tools to help you locate primary doctors, specialists, facilities, and others that participate in your plan:
BeneCardPBF
Delta Dental
Do I need to choose a Primary Care Physician?
If you are enrolled in the Aetna Citizen QPOS plan, you are required to choose a Primary Care Physician (PCP). To have services paid at the in-network level, you must seek care through your PCP; your PCP will coordinate your care and provide referrals to specialists as needed. You can change your PCP at any time. However, certain in-network services are covered with no referral required. You also have the option to visit out-of-network providers subject to deductible, coinsurance, and higher out-of-pocket costs. Learn more about your QPOS plan here and review your plan overviews for details.
Where can I find help if I have questions about claims or benefits?
When you have questions about your plans, visit the Get Help page for help reaching our carriers via toll-free phone numbers, online services, or e-mail. You can find help with questions about your benefits, providers, claims, and more. Be sure to have your ID card and birth dates handy.
Each carrier offers access to your plan information online. View your claims, benefits, order an ID card, and much more. If you are not yet registered, do so today!
BenecardPBF Online Services
Delta Dental Online Services
Which copays are eligible for reimbursement from Aetna?
If you are enrolled in the Patriot V or Patriot X medical plan, Aetna will reimburse a portion of eligible copays. Just submit copied receipts with the reimbursement cover sheet directly to Aetna. Once your plan deductible is met, Aetna will reimburse 70% (Patriot V) or 80% (Patriot X) of your copay amount. Learn more here.
Does my plan include a vision benefit?
The Patriot V, Patriot X, and Citizen QPOS medical plans include a vision benefit when you visit participating Aetna eye care providers (out-of-network services are not covered) as follows:
1) Patriot V plan covers exams with a $10 in-network copay and eyewear up to $100 per 24 months
2) Patriot X plan covers exams with a $15 in-network copay and eyewear up to $70 per 24 months
3) Citizen QPOS (Patriot V Flex) plan covers exams with a $5 copay **Members age 1 through 18 who wear glasses or contacts are covered for one exam per 12-month period
**Members age 19 and over who wear glasses or contacts are covered for one exam per 24-month period
**Members who do not wear glasses or contacts are covered for one exam per 24-month period
Refer to your benefit overviews for coverage details. Aetna also offers a separate Vision Discount Program; see brochure for information.
When do services need precertification?
Certain services, such as hospitalization or outpatient surgery, require precertification from Aetna. In-nework providers are responsible for obtaining precertification prior to treatment. If you are enrolled in a plan that offers an out-of-network benefit and you are obtaining services from an out-of-network provider, you are responsible for contacting Aetna directly for precertification.
Am I covered for care when traveling overseas?
Your Aetna plan typically covers emergency services when traveling overseas. Routine care, however, is not a covered benefit when traveling outside the United States. Refer to your plan overview or contact Aetna directly for details.
How can I find out about mail-order pharmacy?
BenecardPBF manages our prescription plans. BenecardPBF can help you begin a new mail-order prescription or have renewals delivered to your home. Just call BenecardPBF at (877) 723-6005 and speak with an associate or mail your prescription with the Mail Service Patient Information and Order Form to get started. Once your prescription is on record, you can order refills by mailing a completed Order Form or online when you sign in / register for services at www.benecardpbf.com.
How can I find out about COBRA benefits?
If a qualifying event occurs, you and your enrolled dependents may be eligible to continue benefits under COBRA (Consolidated Omnibus Budget Reconciliation Act of 1985). You must notify the HR Department within 60 days of loss of coverage due to, for instance, a divorce, legal separation, or your child no longer qualifying as a dependent. For more details on COBRA, visit the Continuing Coverage page or refer to your plan overviews.