A Negotiated Benefit Through Our CWA-State of NJ Contract
The Healthcare Ombudsperson Program is a joint venture between CWA and the State of New Jersey to provide education and counseling to employees, to resolve employee issues effectively and efficiently, and to work collaboratively to create better healthcare outcomes.
If you have a healthcare question or assistance with your benefits, please reach out to your branch president or other representative, and they will get you in contact with the CWA Local 1031 Healthcare Ombudsperson.
Special Open Enrollment 2026
There will be a special open enrollment during the month of April for all NJ State Workers. Plan changes will go into effect for most members on July 1, 2026 (Employees on Centralized Payroll will see changes effective June 27th)
During this period, members may:
- Select a different health plan
Members may not:
- Select a different dental plan
- Add or Remove Dependents
- Sign up for Flexible Spending Account (FSA) Program
Open Enrollment is optional, and if you do not choose to make any changes, you do not need to do anything- you will automatically keep your existing plan with the new name. FSA enrollment must be done annually and does not automatically renew, and can only be done during the October Open Enrollment period.
- Horizon Blue Cross Blue Shield – Open Enrollment 2026 Web Page
- Horizon Webinars
- Cost Calculator
- Find a Provider
- Aetna – Open Enrollment 2026 Web Page
- Webinars
- Find a Provider
Health Benefits Changes Are Coming
This information applies to CWA contract full-time employees working under the CWA contract with the State of NJ, enrolled in Union Negotiated Rate health plans. For employees at Rutgers & University Hospital, see below for more information.
List of Changes to NJ State Health Benefits Program for 2026
These changes were negotiated in Summer of 2025 to stave off increases in premiums for 2026, and will begin taking effect July 1, 2026 for most CWA 1031 employees, some employees that are on centralized payroll will see these changes June 27th, the start of the pay period.
All plan names will be changing, there will now be a “26” before the names of all plans going forward, ie: CWA Unity Direct will become 26 CWA Unity Direct; NJ Direct15 will be 26 NJ Direct 15. If you do nothing during Open Enrollment, you will automatically be moved from your current plan to the new “26” plan that matches your existing plan. You will receive new subscriber cards from Horizon or Aetna, and can access updated cards in your apps after the changeover occurs.
MEDICAL PLAN CHANGES
What’s NOT Changing:
- Copays for Office Visits, Specialists, Urgent Care, and Emergency Room remain the same
- Premiums for CWA Unity Direct/CWA Unity Direct 2019 & OMNIA will remain the same.
CWA Unity Plans (and Legacy NJ Direct PPO Plans (Direct 10, Direct 15 at Rutgers & UH) – New Deductibles and Maximums:
- In-Network Deductible: $110 (individual) / $220 (family)
- Out-of-Network Deductible: $750 (individual) / $1,500 (family)
- Out-of-Network Out-of-Pocket Maximum: $2,500 (individual) / $6,000 (family)
- Out-of-Network Physical Therapy: Limited to 20 visits per year
CWA Unity AND Tiered-Network Plans – New Copays and Requirements:
- Imaging Services: $50 copay per visit (not per image) for outpatient or freestanding facilities
- Does NOT apply to preventative or pregnancy-related imaging
- Ambulatory Surgical Centers (ASC)
- Members are incentivized to use ASCs for routine procedures instead of hospitals. Procedures performed in hospitals will incur a 50% coinsurance charge.
- Exceptions apply when the procedure:
- Is an emergency
- Is a medical necessity to be performed in a hospital setting
- No ASC within 50 miles of the member’s residence
- Ambulatory Surgical Centers FAQ & Instructions (PDF)
- Includes full list of applicable procedures
- Instructions on how to search for an in-network ASC in Aetna & Horizon plans
PRESCRIPTION DRUG CHANGES (All Plans)
New Copay Structure:
| 30 Days at Retail Pharmacies | 90 Days by Mail-Order | |
| Generic Drugs | $10 | $10 |
| Brand Name Drugs | $20 | $50 |
| Non-Preferred Brand Name Drugs | $75 | $150 |
| Specialty Drugs | $75 | $150 |
- Mandatory generic substitution when available
- Mandatory mail order for maintenance medications (90-day supply) when possible
- If the retail cost of a drug is less than the copay, members pay the retail cost
- Out of Pocket Maximum – $2120 (individual) / $4240 (family)
- Applies to all plans, including HMO
GLP-1 Drugs
- (Ozempic, Wegovy, etc.):
- For diabetes treatment: $20 (retail) / $50 (mail) (Standard Co-pay for name brand drugs)
- For other conditions (effective 1/1/2026): $45 per 30-day supply
- Future change: The State will launch a lifestyle management program for members using GLP-1s for non-diabetic conditions. Members who choose not to participate will pay $125 per 30-day supply. THIS PROGRAM HAS NOT YET BEEN IMPLEMENTED, DATE TBA.
State Health Benefits Plan Design Committee
The plan design committee (PDC) is responsible for formally implementing any changes to the health benefits for state workers. They met on September 24th to formally implement the changes negotiated with the governor for plan year 2026. Below is the full text of the changes adopted by the PDC.
- Original MOA to Healthplan Changes
- Resolution to Modify Copays, Deductibles, and Out-of-Pocket Maximums and Limit Out of Network Physical Therapy
- Resolution to Modify Prescription Drug Copays and Out-of-Pocket Maximums for Prescription Drug Benefits
- Resolution Regarding Ambulatory Surgical Centers
- Resolution to Modify Centers of Excellence Pilot Program
Special Considerations for Employees at Rutgers & University Hospital
RU & UH employees have access to the same plans CWA State employees have access to, at the same union negotiated rates. RU & UH staff also have access to several legacy health plans, at rates set by the formula set out under the state’s Chapter 78 Law. These legacy plans have seen substantial rate increases in the last few years and saw rate increases for 2026. CWA strongly recommends any members enrolled in a legacy plan to strongly consider switching to a plan with union negotiated rates, especially considering the new prescription copays, deductibles, out-of-pocket maximum increases, and new rules for ambulatory surgical centers applies to the legacy plans as well as the union negotiated rate plan.
To compare the cost of plans, you can use the Horizon Premium Calculator
- 2026 Premium Calculator – SHBP/SEHBP
- For “employee type” select Rutgers/UH/NJIT
- Select your level of coverage
| Chapter 78 Plans | Premiums Increased on 1/1/26 | |
| Horizon | Aetna | |
| NJ Direct 10 NJ Direct 15 NJ Direct 2030 NJ Direct 2035 Horizon HMO Horizon HDLow Horizon HDHigh |
Aetna Liberty 10 Aetna Liberty 15 Aetna Liberty 2030 Aetna Liberty 2030 Aetna HMO Aetna HDLow Aetna HDHigh |
|
| Union Negotiated Rate Plans | Premiums Did Not Change | |
| Horizon | Aetna | |
| NJ Direct NJ Direct 2019 OMNIA |
Freedom Freedom 2019 Liberty Plus |
Division of Pensions and Benefits
Our health plans are administered by the NJ Division of Pensions & Benefits, to go directly to their website use the links below.
- State of NJ – Department of the Treasury – NJDPB | SHBP for Active Members
- State of NJ – Department of the Treasury – NJDPB | SHBP for Retirees
Benefitsolver
All changes to your health insurance benefits are done through the Benefitsolver website.
Select programs for CWA members enrolled in the NJ State Health Benefits Programs (NJ SHBP)
NJ WELL – Earn $350
Your well-being matters. NJ Well provides inclusive and holistic experiences to meet members’ needs through activities and educational programming to support healthy lifestyles. Obtain 800 points and earn a reward.
Horizon bFit
Earn a $20 monthly reward for going to the gym or getting your steps in. Available to members and their dependents.