Dental Plans —
Active Employees
Information for:
State Health Benets Program (SHBP)
School Employees’ Health Benets Program (SEHBP)
Page 1 October 2023 Fact Sheet #37
ELIGIBILITY
The Employee Dental Plans are available to full-time
State employees, full-time employees of a local em-
ployer (county, municipality, school board, etc.) that
elects by resolution to provide the Employee Dental
Plans to its employees and the eligible dependents
of these employees. For more information on dental
plans oered to retirees, see the Dental Plans — Re-
tirees Fact Sheet.
New eligible employees may enroll through Ben-
etsolver during the rst 60 days of employment.
Benetsolver can be accessed by navigating to
mynjbenetshub or via your myNewJersey account.
If you do not enroll when rst eligible, you have the
option to enroll during the annual SHBP/SEHBP
Open Enrollment period. Open Enrollment is normal-
ly held in the fall, with coverage eective the follow-
ing January.
If you do not enroll because of other dental coverage
and later lose that coverage, you can enroll by sub-
mitting a form within 60 days of the loss of coverage.
Once enrolled, you and your eligible dependents
must remain in the dental plan you elect for a min-
imum of 12 months before you can change plans or
drop coverage. In the event that you wish to change
dental plans, you will not be permitted to do so until the
Open Enrollment period following the 12-month period.
Note: Duplicate coverage within any New Jersey
State-administered dental plan is not permitted. An
individual may be covered as an employee or as a
dependent, but not as both an employee and a de-
pendent. Children may only be covered by one par-
ent.
DENTAL PLAN CHOICES
You have a choice between two types of dental plans:
• A Dental Plan Organization (DPO); or
• The Dental Expense Plan.
Dental Plan Organizations (DPOs)
The DPOs are companies that contract with a net-
work of providers for dental services. There are
several DPOs participating in the Employee Den-
tal Plans from which you may choose. Participat-
ing DPOs are listed in the Employee Dental Plans
Member Guidebook, available on the New Jersey
Division of Pensions & Benets (NJDPB) website at:
www.nj.gov/treasury/pensions
In order to receive coverage, you must use providers
who participate with the DPO that you select. Be sure
you conrm that the dentist or dental facility you se-
lect is taking new patients and participates with the
SHBP/SEHBP Employee Dental Plans, since DPOs
also service other organizations.
When you use a DPO dentist, diagnostic and preven-
tive services are covered in full. Most other eligible
expenses require a copayment. See the “Dental Plan
Comparison” chart later in this fact sheet. In addition,
orthodontic treatment is covered for both children
and adults, subject to a copayment.
If your dentist drops out of the DPO, you must select
another participating dentist from the DPO. If there
are none available within 30 miles of your home, or
if you move and your DPO cannot provide a dentist
within 30 miles of your home, you may change plans
immediately.
Dental Expense Plan
The Dental Expense Plan is a Preferred Provider Or-
ganization (PPO) plan administered by Aetna Dental.
The plan allows you to choose any licensed dentist
for your dental care; however, you will pay less if you
use an in-network provider. There is a deductible to
satisfy for some services, and some services are el-
igible only up to a limited amount. The annual plan
deductible is $50 per person/$100 per family in-net-
work, and $75 per person/$150 per family out-of-net-
work. The deductible does not apply to diagnostic,
preventive, and orthodontic services. After you satis-
fy the annual deductible, you are reimbursed a per-
centage of the reasonable and customary charges
or PPO-contracted allowance for services that are
covered under the plan.
The Dental Expense Plan provides for the following
benets:
• Diagnostic and Preventive Services are paid at
100 percent (in-network) of the PPO-contracted
allowance and 90 percent (out-of-network) of the
reasonable and customary allowance, with no
deductible;
Fact Sheet #37 October 2023 Page 2
Dental Plans — Active Employees
This fact sheet is a summary and not intended to provide all information.
Although every attempt at accuracy is made, it cannot be guaranteed.
• Basic Services such as llings and extractions
are paid at 80 percent (in-network) of the
PPO-contracted allowance and 70 percent (out-
of-network) of the reasonable and customary al-
lowance, after deductible;
• Major Restorative Services, such as crowns,
are paid at 65 percent (in-network) of the PPO-
contracted allowance and 55 percent (out-of-
network) of the reasonable and customary al-
lowance, after deductible;
• Prosthodontic Services for new or replacement
dentures are covered at 50 percent (in-network)
of the PPO-contracted allowance and 40 percent
(out-of-network) of the reasonable and custom-
ary allowance, after deductible. Repairs to exist-
ing dentures are covered at 80 percent (in-net-
work) of the PPO-contracted allowance and 70
percent (out-of-network) of the reasonable and
customary allowances, after deductible;
• Periodontics (treatment of gum disease) is
covered at 50 percent (in-network) of the
PPO-contracted allowance and 40 percent (out-
of-network) of the reasonable and customary al-
lowance, after deductible;
• Orthodontics are available after you have been
a full-time employee for 10 months (with no de-
ductible), but only for your children under the
age of 19. Orthodontic services are reimbursed
at 50 percent (in-network) of the PPO-contracted
allowance and 40 percent (out-of-network) of the
reasonable and customary allowance, and have
a separate $1,000 in-network and $750 out-of-
network individual lifetime reimbursement bene-
t maximum; and
• Benet Maximum per covered individual is
$3,000 annually in-network and $2,000 out-of-
network for a maximum of $3,000 combined in-
and out-of-network. This maximum applies to all
eligible services except orthodontic, which has a
separate $1,000/$750 individual lifetime benet
maximum.
With the exception of emergency care, if your Dental
Expense Plan treatment includes charges that are
expected to cost more than $300, it is strongly rec-
ommended that your dentist le for predetermination
of benets with Aetna. With advance approval you
will know what services are covered and what pay-
ments will be made.
When you use an in-network dental provider, you
only pay the provider any applicable deductible and
the appropriate coinsurance based on the discount-
ed fee, thereby reducing your out-of-pocket cost. In
many cases the in-network dental provider will submit
the claims directly to Aetna, eliminating the necessity
to le claim forms. To nd an in-network provider, call
Aetna at 1-877-STATENJ (1-877-782-8365).
PREMIUM COSTS
For employees of the State, the premium cost for
dental plan coverage is shared between the State
and the employee. The amount of your payroll de-
duction is available from your human resources rep-
resentative or benets administrator. Dental rates
are also posted on our website.
State employee premiums can be paid on a pre-tax
basis through participation in the Premium Option
Plan (POP) of Tax$ave, a benet program available
under Section 125 of the federal Internal Revenue
Code (IRC). Participation in the POP is automatic
unless you le a form declining participation. The
Internal Revenue Service (IRS) strictly regulates en-
rollment in the POP and prohibits any benet chang-
es outside of an Open Enrollment period or unless a
qualifying life event occurs (e.g., loss of other cov-
erage, marriage, divorce, etc.). The Tax$ave Fact
Sheet explains the POP in more detail.
For employees of a participating local employer,
the premium cost for dental plan coverage will vary
based upon the policies of that employer, with regard
to health benet costs and any labor agreements
between the employer and the unions representing
the employee. Employees of a participating local em-
ployer should see their human resources represen-
tative or benets administrator for more information.
CHOOSING A DENTAL PLAN
Your choice of a dental plan is a personal decision. In
deciding whether to enroll and which plan to choose,
you should consider:
• The nature and amount of your anticipated den-
tal expenses for the next year;
• The covered services provided by the Dental Ex-
pense Plan or a DPO;
• The dierences in out-of-pocket costs for each
type of plan; and
• The degree of exibility that you may want in se-
lecting a dentist.
You can use the “Dental Plan Comparison” chart lat-
er in this fact sheet to compare benet levels under
each type of dental plan. If you choose a DPO, you
must select a dentist who participates with that par-
ticular DPO and who can accept you and your de-
pendents as patients.
The “Dental Plan Comparison” chart provides a
summary description of a variety of dental services
under the two types of dental plans oered by the
Employee Dental Plans. The chart is not complete
and does not describe all the benets, limitations,
or conditions associated with coverage under either
type of plan. Please refer to the Employee Dental
Plans Member Guidebook for additional details.
Page 3 October 2023 Fact Sheet #37
Dental Plans — Active Employees
This fact sheet is a summary and not intended to provide all information.
Although every attempt at accuracy is made, it cannot be guaranteed.
PARTICIPATING PLANS
• Cigna Dental Health, Inc.
w ww.cigna.com/sites/stateofnjdental
1-800-564-7642
Service Area: Nationwide except AK, ME, MT,
ND, NH, NM, PR, SD, VI, VT, and WY
• Horizon Dental Choice
w ww.horizonblue.com
1-800-433-6825
Service Area: NJ only
• Aetna DMO
w ww.aetna.com/statenj
1-877-STATENJ (1-877-782-8365)
Service Area: Nationwide except AK, AL, AR,
LA, ME, MS, MT, ND, NH, PR, SC, SD, VT, and
WY
• MetLife
w ww.metlife.com/dental
1-866-880-2984
Service Area: NJ, CA, FL, NY, and TX
• Dental Expense Plan
(PPO Administered by Aetna)
w ww.aetna.com/statenj
1-877-STATENJ (1-877-782-8365)
Service Area: Nationwide
Fact Sheet #37 October 2023 Page 4
Dental Plans — Active Employees
This fact sheet is a summary and not intended to provide all information.
Although every attempt at accuracy is made, it cannot be guaranteed.
DENTAL PLAN COMPARISON
DENTAL EXPENSE PLAN DENTAL PLAN ORGANIZATION
(DPO)
IN-NETWORK OUT-OF-NETWORK
Deductible $50 per person per calendar year/
$100 per family; None for diagnostic,
preventive, and orthodontic services
$75 per person per calendar year/
$150 per family; None for diagnostic,
preventive, and orthodontic services
None
Coinsurance Plan pays: 100% Diagnostic and Pre-
ventive; 80% Basic Restorative; 65%
Major Restorative; 50% Periodontics
and Prosthodontics*
Plan pays: 90% Diagnostic and Pre-
ventive; 70% Basic Restorative; 55%
Major Restorative; 40% Periodontics
and Prosthodontics*
Plan pays 100% (less copayment);
100% Diagnostic and Preventive
Copayments None None Varies depending on service
Benets Maximum $3,000 (Maximum of $3,000 com-
bined in- and out-of-network) per
member annually (excluding ortho-
dontics); $1,000 (lifetime) per child for
orthodontics
$2,000 (Maximum of $3,000 com-
bined in- and out-of-network) per
member annually (excluding ortho-
dontics); $750 (lifetime) per child for
orthodontics
Unlimited
Provider Limitations Must use participating dentist Any licensed dentist Must use DPO-participating dentist
Selected Services Some services listed below may be
covered subject to deductibles and
coinsurance as shown above
Some services listed below may be
covered subject to deductibles and
coinsurance as shown above
Services listed below are covered
in full subject to copayments
Examinations Oral evaluations limited to twice per
calendar year; Plan pays 100%*
Oral evaluations limited to twice per
calendar year; Plan pays 90%*
Oral evaluations limited to twice per
calendar year; Plan pays 100%
X-Rays Covered subject to limitations; Plan
pays 100%*
Covered subject to limitations; Plan
pays 90%*
Covered subject to limitations; Plan
pays 100%
Cleanings (Oral Prophylaxis) Two cleanings per calendar year; Plan
pays 100%*
Two cleanings per calendar year; Plan
pays 90%*
Two cleanings per calendar year; Plan
pays 100%
Fluoride Applications Covered only for children under age
19; Twice per calendar year; Plan
pays 100%*
Covered only for children under age
19; Twice per calendar year; Plan
pays 90%*
Covered only for children under age
19; Twice per calendar year; Plan
pays 100%
* In the Dental Expense Plan, you are responsible for the amount the dentist charges above the reasonable and customary allowances.
Page 5 October 2023 Fact Sheet #37
Dental Plans — Active Employees
This fact sheet is a summary and not intended to provide all information.
Although every attempt at accuracy is made, it cannot be guaranteed.
DENTAL PLAN COMPARISON
DENTAL EXPENSE PLAN DENTAL PLAN ORGANIZATION
(DPO)
IN-NETWORK OUT-OF-NETWORK
Tooth Sealants Covered for children under age 19
(with restrictions); Plan pays 100%*
Covered for children under age 19
(with restrictions); Plan pays 90%*
Covered only for children under age
19; No copayment (limitations apply)
Routine Fillings Plan pays 80%* Plan pays 70%* Covered; Copayments may apply**
Simple Extraction Plan pays 80%* Plan pays 70%* Covered after copayment of $20
Crowns Plan pays 65%* Plan pays 55%* Covered after copayment of $150–
$225**
Root Canal (Endodontics) Plan pays 80%* Plan pays 70%* Endodontic Therapy covered after
copayment of $100–$175**
Dentures Repair of existing dentures covered at
80%;* New or replacement dentures
covered at 50%*
Repair of existing dentures covered at
70%;* New or replacement dentures
covered at 40%*
Covered after copayment (with limita-
tions)**
Oral Surgery for Removal of Im-
pacted Tooth
Plan pays 80%;* May be covered un-
der the medical plan rst, then dental
will consider
Plan pays 70%;* May be covered un-
der the medical plan rst, then dental
will consider
Covered after copayment of $65
Periodontics Plan pays 50% (with limitations) Plan pays 40% (with limitations) Covered after copayment of: $30 for
gingivectomy (one to three teeth);
$55 for root planing (per quadrant);
$100–$175** for osseous surgery
Orthodontic After you have been an employee for
10 months, eligible services covered
at a 50% coinsurance level, up to a
$1,000 lifetime maximum per child;
Covered only for those who start treat-
ment before age 19 (See Employee
Dental Plans Member Guidebook for
specics)
After you have been an employee for
10 months, eligible services covered
at a 40% coinsurance level, up to a
$750 lifetime maximum (maximum
of $1,000 combined in- and out-of-
network) per child; Covered only for
those who start treatment before age
19 (See Employee Dental Plans Mem-
ber Guidebook for specics)
Maximum treatment is 24 months;
Copayment as follows:
Patient under age 18: $1,000 or 50%
of reasonable and customary charges,
whichever is less;
Patient age 18 or over: $1,750 or 50%
of reasonable and customary charges,
whichever is less
* In the Dental Expense Plan, you are responsible for the amount the dentist charges above the reasonable and customary allowances.
** See the Employee Dental Plans Member Guidebook for DPO copayment amounts.
Fact Sheet #37 October 2023 Page 6
Dental Plans — Active Employees
This fact sheet is a summary and not intended to provide all information.
Although every attempt at accuracy is made, it cannot be guaranteed.
This fact sheet has been produced and distributed by:
New Jersey Division of Pensions & Benets
P.O. Box 295, Trenton, NJ 08625-0295
(609) 292-7524
For the hearing impaired: TRS 711 (609) 292-6683
www.nj.gov/treasury/pensions
