Dental Plans —
Retirees
Information for:
Eligible Members of the State Health Benets Program (SHBP)
and the School Employees’ Health Benets Program (SEHBP)
Page 1 October 2023 Fact Sheet #73
The Retiree Dental Plans are oered to retirees eli-
gible to enroll in the State Health Benets Program
(SHBP) or the School Employees’ Health Benets
Program (SEHBP). Retirees and their eligible depen-
dents have a choice of two types of plans:
• A Dental Plan Organization (DPO); or
• The Retiree Dental Expense Plan.
ELIGIBILITY
The Retiree Dental Plans are available to the follow-
ing eligible retirees:
• Any retiree, including survivors, enrolled in a
medical plan oered under the Retired Group of
the SHBP or SEHBP at the time of retirement;
and
• Any retiree, including survivors of retirees, eli-
gible for enrollment in the Retired Group of the
SHBP or SEHBP but who elected to waive their
medical coverage because of other SHBP or
SEHBP coverage or coverage provided from an-
other employer. See the “Waiver of Enrollment in
Dental Coverage” section.
Note: Duplicate coverage within any New Jersey
State-administered dental plan is not permitted. An
individual may be covered as a retiree or as a de-
pendent, but not as both a retiree and a dependent.
Children may only be covered by one parent.
ENROLLMENT
A retiree or survivor eligible for the SHBP or SEHBP
will have one opportunity to enroll in a Retiree Dental
Plan when the individual retires or becomes eligible
for enrollment in the Retired Group. Medical plan
enrollment is generally oered within 30-60 days of
retirement or eligibility for benets under the Retired
Group.
Waiver of Enrollment in Dental Coverage
The one-time dental plan enrollment opportunity can
be deferred if you are eligible but have other group
dental coverage, either as a dependent of a spouse,
civil union partner, or same-sex domestic partner,
or through your own employment. The retiree or
survivor may elect to waive enrollment at the time
of retirement or rst oering and retain the right to
enroll at a later date. Coverage must be waived at
the time of enrollment in order to be eligible for later
enrollment if you lose the other coverage. You must
request enrollment within 60 days from the loss of
the other group dental coverage online through Ben-
etsolver by navigating to mynjbenetshub or via
your myNewJersey account. Proof of the other group
dental plan termination must be submitted in the form
of a HIPAA Certication of Coverage document or a
letter from the employer or dental administrator, in
addition to enrolling online through Benetsolver.
PREMIUM COSTS
Retirees will pay the full cost of the Retiree Dental
Plan. Coverage is oered with the understanding
that the State will bear no costs for the plan. Un-
der certain circumstances, a local public employ-
er that participates in the SHBP or SEHBP may
elect to share the cost of coverage for their retirees
through the adoption of P.L. 1999, c. 48 (Chap-
ter 48). The NJDPB will take the monthly premium
from the retirement allowance of the retiree. If the re-
tirement allowance is not sucient to cover the cost
of the premium, or if the retiree does not receive a
retirement allowance, then the NJDPB will bill the re-
tiree on a monthly basis.
For information on the monthly premiums for the Retir-
ee Dental Plans, see the rate chart that is available on
the NJDPB website: www.nj.gov/treasury/pensions
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 Retiree
Dental Expense 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.
Fact Sheet #73 October 2023 Page 2
Dental Plans — Retirees
This fact sheet is a summary and not intended to provide all information.
Although every attempt at accuracy is made, it cannot be guaranteed.
See the “Dental Plan Comparison” chart to compare
benet levels under each type of dental plan. If you
choose a DPO, you must select a dentist who partic-
ipates with that particular DPO and who can accept
you and your dependents as patients.
DENTAL TIERS
To protect the Plans and enrolled members against
the eect of retirees joining who have gone years
without any dental treatment, the Plans have three
benet tiers. If you enroll in a Retiree Dental Plan
within 60 days of leaving another group dental pro-
gram in which you were enrolled for a minimum of
12 months, you will be enrolled in the highest reim-
bursement tier, Tier 3. If you were not covered in a
group dental program within 60 days of enrolling in
a Retiree Dental Plan — or were enrolled in a group
dental program for less than 12 months — you will be
enrolled in Tier 1. After one year of coverage in Tier
1, you will move to Tier 2. After another year, you will
be moved to Tier 3. Once enrolled in Tier 3, the high-
est level of reimbursement, you will remain in that tier
for as long as you continue to be enrolled. See the
“Retiree Dental Expense Plan Reimbursement Tiers”
section.
PLAN SUMMARY — RETIREE DENTAL
PLAN ORGANIZATIONS (DPOs)
The DPOs are companies that contract with a net-
work of providers for dental services. There are sev-
eral DPOs participating in the Retiree Dental Plans
from which you may choose. Participating DPOs are
listed in the Retiree Dental Plans Member Guide-
book, available on our website.
In order to receive coverage, you must use provid-
ers who participate with the DPO that you select. Be
sure you conrm that the dentist or dental facility you
select is taking new patients and participates with
the SHBP/SEHBP Retiree Dental Plans, since DPOs
also service other organizations.
When you use a DPO dentist, diagnostic and pre-
ventive services are covered in full. Most other eligi-
ble expenses require a copayment. See the “Dental
Plan Comparison” chart. Orthodontic services are
not covered. If your dentist drops out of the DPO, you
must select another 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.
DPO Plan Reimbursement Tiers
The types of services covered are based on the den-
tal tier in which you are currently enrolled:
• Tier 1 - Diagnostic and Preventive Services Only
• Tier 2 - Includes Tier 1 Services Plus Restorative
Services
• Tier 3 - Includes Full Retiree DPO Plan Design
Once enrolled in Tier 3, you will remain in that tier for
as long as you continue to be enrolled.
PLAN SUMMARY —
RETIREE DENTAL EXPENSE PLAN
The Retiree Dental Expense Plan is a traditional in-
demnity, fee-for-service plan. 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 $50 per person annual deduct-
ible, and a maximum aggregate deductible of $150
per family, which must be met before reimburse-
ments are made. The Retiree Dental Expense Plan
reimburses covered services provided at a percent-
age of the reasonable and customary charges. The
Plan is self-insured by the State and is administered
by Aetna Dental.
The Retiree Dental Expense Plan covers preventive,
basic, and major restorative services at dierent lev-
els. The deductible is waived for preventive services.
The Plan does not reimburse for any orthodontic ser-
vices.
Network Dentists
The Retiree Dental Expense Plan has a network of
dentists who have agreed to accept a discounted
fee for services. If a member uses a network pro-
vider, the fee for the service will generally be lower
than that charged by an out-of-network dentist so the
member’s costs will be lower.
Retiree Dental Expense Plan
Reimbursement Tiers
The percentage of reimbursement you receive for
covered services is based on the dental tier in which
you are currently enrolled:
TIER
RETIREE DENTAL
EXPENSE PLAN
COINSURANCE
TIER 1
80% – Preventive Care
50% – Basic Restorative
30% – Major Resorative
TIER 2
90% – Preventive Care
60% – Basic Restorative
40% – Major Restorative
TIER 3
100% – Preventive Care
70% – Basic Restorative
50% – Major Restorative
PLAN COMPARISON
The following chart provides a summary description
of a variety of dental services under the two types of
dental plans oered by the Retiree 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 Retiree Dental Plans Member Guidebook for ad-
ditional details.
Page 3 October 2023 Fact Sheet #73
Dental Plans — Retirees
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)
Deductible $50 per person, but not more than $150 total; waived for
Preventive Care
None
Coinsurance See “Retiree Dental Expense Plan Reimbursement Tiers” Plan pays 100% (less copayment) 100% Diagnostic and
Preventive
Copayments None Varies depending on service
Benets Maximum $1,500 per person No limit
Provider Limitations Can use any licensed provider, must use dentist who partici-
pates in the Dental Expense Plan
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 are covered subject to co-
payments as shown below
Examinations Oral evaluations limited to twice per calendar year; Plan pays
100%**
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 100%
Cleanings (Oral Prophylaxis) Two cleanings per calendar year; Plan pays 100%** Two cleanings per calendar year; Plan pays 100%
Fluoride 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 100%
Tooth Sealants Covered for children under age 19 (with restrictions); Plan
pays 100%**
Covered only for children under age 19; No copayment (with
limitations)
Routine Fillings Plan pays 70%** Covered copayments may apply; $15–$70
Simple Extraction Plan pays 70%** Covered after copayment of $35
Crowns Plan pays at 50%** Covered after copayment of $225–$340
Root Canal (Endodontics) Plan pays 70%** Endodontic Therapy covered after copayment of $150–$265
Dentures Repair of existing dentures covered at 70%;** New or replace-
ment dentures covered at 50%
Covered after copayment of $55–$455 (with limitations)
Oral Surgery for Removal
of Impacted Tooth
Plan pays 70%;** Considered under the medical plan rst
then dental will consider
Covered under copayment of $80–$100
Periodontics Plan pays 50%** (with limitations) Covered after copayment of: $90 for gingivectomy (one to
three teeth), $70 for root planing (per quadrant) $150–$265
*In the Dental Expense Plan, you are responsible for the amount the dentist charges above the reasonable and customary allowances when using out-of-network providers.
**Coinsurance listed is for Tier 3.
Fact Sheet #73 October 2023 Page 4
Dental Plans — Retirees
This fact sheet is a summary and not intended to provide all information.
Although every attempt at accuracy is made, it cannot be guaranteed.
COVERAGE EFFECTIVE DATES
Generally, the eective date for your Retiree Dental
Plan coverage will coincide with your Retired Group
medical plan enrollment date.
Coverage will end when:
• Your medical plan coverage is terminated unless
medical coverage was waived for other cover-
age through a public employer. See the “Eligibil-
ity” section;
• You voluntarily request health or dental plan ter-
mination in writing, or you elect to terminate cov-
erage online through Benetsolver;
• Your medical and/or dental premiums are not
paid; or
• Your medical coverage ends due to the fact that
your former employer withdraws from the SHBP
or SEHBP. This does not apply to retirees who
qualied for State-paid medical coverage; i.e.,
former employees of local school districts or
county colleges, and municipal police and re-
ghters who qualify under the provisions of P.L.
1997, c. 330 (Chapter 330).
MORE INFORMATION ABOUT THE PLANS
For more information about the plan design or to lo-
cate dentists who are part of the Plans’ provider net-
work, contact your plan (see the “Participating Plans”
section). For information about enrollment eligibility,
contact the NJDPB Oce of Client Services at (609)
292-7524, or view information about the Retiree
Dental Plans on our website.
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
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
