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This is an HTML version of an attachment to the Open Public Records Act request 'SHBP/SEHBP Active Employees - Town of Phillipsburg, Warren County'.

SYSTEM : S343 S T A T E O F N E W J E R S E Y RUN DATE : 01/23/18
PROGRAM NO: PN815AP2 DEPARTMENT OF THE TREASURY RUN TIME : 23:24:41
FREQUENCY : MONTHLY DIVISION OF PENSIONS AND BENEFITS REPORT NO: 815AP2-1
STATE HEALTH INFORMATION PROCESSING SYSTEM PAGE NO : 3273
MONTHLY ALPHA LIST FOR BILLING PERIOD 02/01/2018 - 02/28/2018 (201802)
LOCAL/ACTIVE/MONTHLY

0897-00 - PHILLIPSBURG TOWN

HEALTH---------- RX-------------- DENTAL---------- -HEALTH- ---RX--- -DENTAL-
--NAME---------------------- ---SSN--- --DOB--- SRV L EFF DATE SRV L EFF DATE SRV L EFF DATE --COST-- --COST-- --COST--

AMEY MATTHEW M *****6600 19810611 150 P 20150301 201 P 20150301 1350.06 351.55 0.00
ANDERSON THOMAS A *****8347 19600902 150 S 20110401 201 S 20110401 754.23 196.39 0.00
ANTHES KRISTI L *****7635 19821227 019 F 20160101 201 F 20160101 2064.43 547.94 0.00
ANTHES LAWRENCE E *****7578 19820820 ( SPOUSE INFO )
ANTHONY MICHAEL J *****8635 19790714 150 P 20170301 201 P 20170301 1350.06 351.55 0.00
BELCASTRO DOMINIC D *****2737 19820617 150 F 20121201 201 F 20121201 2104.28 547.94 0.00
BELCASTRO KRISTEN M *****2681 19820525 ( SPOUSE INFO )
BERRIGAN BRIAN N *****4259 19620213 150 F 20110401 201 F 20110401 2104.28 547.94 0.00
BERRIGAN DINA *****7986 19630528 ( SPOUSE INFO )
BESS MICHAEL D *****5160 19761102 050 F 20140402 201 F 20140402 2209.79 547.94 0.00
TAMPIER DANIELLE T *****5801 19820608 ( SPOUSE INFO )
BITTENMASTER CHRIS *****8226 19741115 150 F 20111008 201 F 20111008 2104.28 547.94 0.00
BITTENMASTER TANYA M *****5107 19720318 ( SPOUSE INFO )
BROTONS CRAIG R *****4528 19650821 150 F 20111101 201 F 20111101 2104.28 547.94 0.00
BROTONS LAURIE A *****8653 19661104 ( SPOUSE INFO )
BRUNETTI MAUREEN L *****6658 19500814 150 M 20140101 201 M 20140101 1508.45 392.79 0.00
BRUNETTI BRUCE W *****0360 19530518 ( SPOUSE INFO )
BURGER TIMOTHY L *****8845 19870505 050 F 20171028 201 F 20171028 4688.09 1162.45 0.00
BURGER DANA *****6609 19920212 ( SPOUSE INFO )
CALLERY SANDRA A *****1806 19560916 150 M 20110401 201 M 20110401 1508.45 392.79 0.00
CALLERY JOHN F *****5751 19550319 ( SPOUSE INFO )
CONNAUGHTON MICHAEL S *****8635 19810324 150 F 20121201 201 F 20121201 2104.28 547.94 0.00
CONNAUGHTON KELLI M *****8365 19850304 ( SPOUSE INFO )
CONNORS COREY M *****1681 19920804 150 P 20140225 201 P 20140225 1350.06 351.55 0.00
CROUSE LORI M *****5809 19661210 150 P 20150301 201 P 20150301 1350.06 351.55 0.00
DAVIS STEVEN A *****2207 19670826 150 F 20110401 201 F 20110401 2104.28 547.94 0.00
DAVIS ANNMARIE *****8902 19690808 ( SPOUSE INFO )
DUCKWORTH KRISTOPHER R *****0599 19900317 150 S 20130817 201 S 20130817 754.23 196.39 0.00
DUDDY KEVIN R *****4369 19531130 150 F 20110401 201 F 20110401 2104.28 547.94 0.00
DUDDY MARYELIZ *****1726 19580130 ( SPOUSE INFO )
DUGEY THOMAS *****9085 19550728 150 M 20110401 201 M 20110401 1508.45 392.79 0.00
DUGEY SHIRLEY *****1416 19590726 ( SPOUSE INFO )
FEY GINA I *****2193 19710716 150 F 20110401 201 F 20110401 2104.28 547.94 0.00
FEY BERNARD F *****9252 19690103 ( SPOUSE INFO )
GAL SANDOR *****6413 19800612 150 F 20110401 201 F 20110401 2104.28 547.94 0.00
CURTISS-GAL SHARON E *****0338 19750615 ( SPOUSE INFO )
HOADLEY ANGELA M *****3996 19700826 150 F 20110401 201 F 20110401 2104.28 547.94 0.00
HOADLEY JOHN *****6483 19640604 ( SPOUSE INFO )
HOYD ROBERT D *****3157 19760417 150 F 20110401 201 F 20110401 2104.28 547.94 0.00
HOYD BRANDY L *****4086 19800801 ( SPOUSE INFO )
HULL BRANDON E *****9193 19931029 150 S 20170825 201 S 20170825 754.23 196.39 0.00
HULSE KEVIN I *****0469 19761004 150 S 20150101 201 S 20110401 754.23 196.39 0.00
HUXTA PATRICIA M *****3229 19720504 150 M 20160101 201 M 20160101 1508.45 392.79 0.00
HUXTA CHRISTOPHE H *****2776 19710913 ( SPOUSE INFO )
JOHNSON KEVIN R *****6251 19780125 150 F 20161104 201 F 20161104 2104.28 547.94 0.00
JOHNSON STACIE L *****9723 19780325 ( SPOUSE INFO )
KISSELBACH BRAD M *****0215 19810926 150 F 20110401 201 F 20110401 2104.28 547.94 0.00

SYSTEM : S343 S T A T E O F N E W J E R S E Y RUN DATE : 01/23/18
PROGRAM NO: PN815AP2 DEPARTMENT OF THE TREASURY RUN TIME : 23:24:41
FREQUENCY : MONTHLY DIVISION OF PENSIONS AND BENEFITS REPORT NO: 815AP2-1
STATE HEALTH INFORMATION PROCESSING SYSTEM PAGE NO : 3274
MONTHLY ALPHA LIST FOR BILLING PERIOD 02/01/2018 - 02/28/2018 (201802)
LOCAL/ACTIVE/MONTHLY

0897-00 - PHILLIPSBURG TOWN

HEALTH---------- RX-------------- DENTAL---------- -HEALTH- ---RX--- -DENTAL-
--NAME---------------------- ---SSN--- --DOB--- SRV L EFF DATE SRV L EFF DATE SRV L EFF DATE --COST-- --COST-- --COST--

KISSELBACH JACQUELINE L *****9267 19780814 ( SPOUSE INFO )
KOELLER JUSTIN M *****1325 19850731 150 P 20170401 201 P 20170401 1350.06 351.55 0.00
LACEY BRADLEY S *****2088 19830426 150 F 20141108 201 F 20141108 2104.28 547.94 0.00
LACEY RACHAEL L *****7662 19831005 ( SPOUSE INFO )
LANCE WILLIAM J *****2293 19710131 150 F 20110401 201 F 20110401 2104.28 547.94 0.00
LANCE ANNMAR *****8989 19771005 ( SPOUSE INFO )
MACZKO JOHN M *****3882 19710205 150 F 20110401 201 F 20110401 2104.28 547.94 0.00
MACZKO STEPHANIE A *****1925 19721002 ( SPOUSE INFO )
MARINO BRETT M *****2967 19780131 150 F 20150327 201 F 20150327 2104.28 547.94 0.00
MARINO KARYSSA J *****3166 19830121 ( SPOUSE INFO )
MARINO LARRY L *****2819 19761007 150 P 20110401 201 P 20110401 1350.06 351.55 0.00
MARINO ROBERT A *****4617 19740430 150 S 20171101 201 S 20171101 754.23 196.39 0.00
MCDONALD JAMES *****9917 19801128 150 F 20160101 201 F 20160101 2104.28 547.94 0.00
MCDONALD KRISTEN L *****7404 19830516 ( SPOUSE INFO )
MCGINLEY CHAD *****3271 19640601 150 F 20110401 201 F 20110401 2104.28 547.94 0.00
MCGINLEY STEPHANIE *****3669 19640529 ( SPOUSE INFO )
MECCA CHRISTOPHE A *****9196 19810924 150 S 20140201 201 S 20140201 754.23 196.39 0.00
MECCA MARC A *****1205 19850307 150 S 20141101 201 S 20141101 754.23 196.39 0.00
MERLO ROBERT J *****2639 19640615 150 M 20110401 201 M 20110401 1508.45 392.79 0.00
MERLO PATRICIA M *****8555 19600612 ( SPOUSE INFO )
MESSINA DONNA *****3596 19540527 180 S 20170710 201 S 20170710 761.75 196.39 0.00
MESSLING DEBBIE L *****6060 19551010 150 M 20110401 201 M 20110401 1508.45 392.79 0.00
HERTZ RONALD W *****9419 19520315 ( SPOUSE INFO )
MONTILONE DEREK *****4761 19900207 150 P 20140825 201 P 20140825 1350.06 351.55 0.00
MOORE TIMOTHY *****8006 19780726 150 F 20110401 201 F 20110401 2104.28 547.94 0.00
MOORE LAUREN A *****6398 19811209 ( SPOUSE INFO )
OLOUGHLIN SANDRA J *****0735 19590810 150 P 20110401 201 P 20110401 1350.06 351.55 0.00
PAPOVICH BRENDA J *****0486 19690712 150 S 20110401 201 S 20110401 754.23 196.39 0.00
PATTI VALERIE *****3749 19530505 150 S 20171001 201 S 20171001 754.23 196.39 0.00
PETERS WILLIAMS G *****3207 19680628 150 P 20110401 201 P 20110401 1350.06 351.55 0.00
PFLUGH ERICH J *****6531 19900417 050 S 20170722 201 S 20170722 792.04 196.39 0.00
PURSELL PAUL E *****6960 19531103 150 M 20160101 201 M 20160101 1508.45 392.79 0.00
PURSELL BRENDA M *****5498 19621130 ( SPOUSE INFO )
QUICK SHANNON *****6605 19830729 150 S 20170724 201 S 20170724 754.23 196.39 0.00
RATH-TICKLE STEPHANIE *****2207 19821130 051 F 20160311 205 F 20160311 2041.24 496.96 0.00
TICKLE GLEN P *****0602 19830427 ( SPOUSE INFO )
REED CHRISTOPHE H *****0713 19640404 150 M 20110401 201 M 20110401 1508.45 392.79 0.00
REED CYNDEE S *****6770 19610324 ( SPOUSE INFO )
REPPERT RALPH A *****1327 19670227 150 F 20110401 201 F 20110401 2104.28 547.94 0.00
REPPERT JANICE L *****1892 19720310 ( SPOUSE INFO )
RICKER GARY A *****2215 19800101 050 S 20170101 201 S 20170101 792.04 196.39 0.00
SERRANO THEODORE K *****9737 19660617 150 P 20170701 201 P 20170701 1350.06 351.55 0.00
SLATON BARBARA J *****0861 19560215 150 M 20110401 201 M 20110401 1508.45 392.79 0.00
SLATON JON C *****4488 19560725 ( SPOUSE INFO )
SLIFER JOSHUA M *****0733 19740907 150 P 20140823 201 P 20140823 1350.06 351.55 0.00
SMITH PAUL R *****2903 19530623 150 M 20150101 201 M 20150101 1508.45 392.79 0.00
SMITH PHYLLIS A *****3997 19530209 ( SPOUSE INFO )

SYSTEM : S343 S T A T E O F N E W J E R S E Y RUN DATE : 01/23/18
PROGRAM NO: PN815AP2 DEPARTMENT OF THE TREASURY RUN TIME : 23:24:41
FREQUENCY : MONTHLY DIVISION OF PENSIONS AND BENEFITS REPORT NO: 815AP2-1
STATE HEALTH INFORMATION PROCESSING SYSTEM PAGE NO : 3275
MONTHLY ALPHA LIST FOR BILLING PERIOD 02/01/2018 - 02/28/2018 (201802)
LOCAL/ACTIVE/MONTHLY

0897-00 - PHILLIPSBURG TOWN

HEALTH---------- RX-------------- DENTAL---------- -HEALTH- ---RX--- -DENTAL-
--NAME---------------------- ---SSN--- --DOB--- SRV L EFF DATE SRV L EFF DATE SRV L EFF DATE --COST-- --COST-- --COST--

SNYDER MARTIN *****9036 19900313 011 F 20170701 201 F 20170701 2043.77 547.94 0.00
SNYDER NATASHA L *****0976 19910515 ( SPOUSE INFO )
SOSNOVIK MATTHEW *****7482 19811121 150 S 20111101 201 S 20111101 754.23 196.39 0.00
STETTNER JAMES P *****1237 19770422 050 F 20140708 201 F 20140708 2209.79 547.94 0.00
VACCARO BETTINA C *****2684 19800819 ( SPOUSE INFO )
STIRES MICHAEL F *****2117 19820811 150 F 20150101 201 F 20150101 2104.28 547.94 0.00
STIRES TRICIA M *****2758 19780516 ( SPOUSE INFO )
SUTTON BRIAN S *****3423 19641214 150 M 20110401 201 M 20110401 1508.45 392.79 0.00
SUTTON LISA B *****2736 19650129 ( SPOUSE INFO )
THOMPSON RASHEEDAH M *****0962 19891203 150 F 20180101 201 F 20180101 3137.91 770.28 0.00
THOMPSON PRINCE A *****9059 19881218 ( SPOUSE INFO )
VAUGHN DONALD J *****4866 19580809 150 M 20160101 201 M 20160101 1508.45 392.79 0.00
VAUGHN LAURA *****7463 19620623 ( SPOUSE INFO )
VINE WILLIAM R *****6357 19681015 150 F 20110401 201 F 20110401 2104.28 547.94 0.00
VINE STEPHANIE A *****2460 19711109 ( SPOUSE INFO )
WARGO JEANNINE R *****5910 19760107 050 F 20110401 201 F 20110401 2209.79 547.94 0.00
WARGO ROBERT J *****1030 19750710 ( SPOUSE INFO )
WEIGAND KYLE M *****9730 19891015 150 M 20170902 201 M 20170902 1508.45 392.79 0.00
WEIGAND LINDSAY S *****3082 19910731 ( SPOUSE INFO )
WIDEMOND MARVIN *****3774 19810221 150 F 20160101 201 F 20160101 2104.28 547.94 0.00
PAUL SAMARIA *****1072 19810621 ( SPOUSE INFO )
ZECHMAN TRAVIS J *****7936 19770218 150 F 20110401 201 F 20110401 2104.28 547.94 0.00
ZECHMAN SHERRI A *****1061 19770317 ( SPOUSE INFO )


TOTAL EMPLOYEES - 71 TOTAL BILL - 148,905.35

TOTAL HEALTH ENROLLED - 71 TOTAL HEALTH COST - 118,314.68
TOTAL RX ENROLLED - 71 TOTAL RX COST - 30,590.67

SYSTEM : S343 S T A T E O F N E W J E R S E Y RUN DATE : 01/23/18
PROGRAM NO: PN815AP2 DEPARTMENT OF THE TREASURY RUN TIME : 23:24:41
FREQUENCY : MONTHLY DIVISION OF PENSIONS AND BENEFITS REPORT NO: 815AP2-1
STATE HEALTH INFORMATION PROCESSING SYSTEM PAGE NO : 3276
MONTHLY ALPHA LIST FOR BILLING PERIOD 02/01/2018 - 02/28/2018 (201802)
LOCAL/ACTIVE/MONTHLY

0897-00 - PHILLIPSBURG TOWN


HEALTH SERVICES
SRV **S** *M/S* *M/P* *F/S* *F/P* **P** *TOT* *TOT AMT**
--- ----- ----- ----- ----- ----- ----- ----- ----------
011 0 0 0 1 0 0 1 2043.77
019 0 0 0 1 0 0 1 2064.43
050 2 0 0 4 0 0 6 12901.54
051 0 0 0 1 0 0 1 2041.24
150 11 13 0 26 0 11 61 98501.95
180 1 0 0 0 0 0 1 761.75


RX SERVICES
SRV **S** *M/S* *M/P* *F/S* *F/P* **P** *TOT* *TOT AMT**
--- ----- ----- ----- ----- ----- ----- ----- ----------
201 14 13 0 32 0 11 70 30093.71
205 0 0 0 1 0 0 1 496.96

SYSTEM : S343 S T A T E O F N E W J E R S E Y RUN DATE : 01/23/18
PROGRAM NO: PN815AP2 DEPARTMENT OF THE TREASURY RUN TIME : 23:24:41
FREQUENCY : MONTHLY DIVISION OF PENSIONS AND BENEFITS REPORT NO: 815AP2-1
STATE HEALTH INFORMATION PROCESSING SYSTEM PAGE NO : 3277
MONTHLY ALPHA LIST FOR BILLING PERIOD 02/01/2018 - 02/28/2018 (201802)
LOCAL/ACTIVE/MONTHLY

0897-00 - PHILLIPSBURG TOWN

HEALTH SERVICES LOG
-------------------
011 - HORIZON HMO
019 - AETNA HMO
050 - NJ DIRECT10
051 - NJ DIRECT1525
150 - NJ DIRECT15
180 - AETNA FREEDOM15






























RX SERVICES LOG
---------------
201 - EMPLOYEE RX (LOCAL & EDUC-ACVP
205 - STATE 1525 PRESCRIPTION PLAN



HEALTH CONTRACT LEVEL LOG
-------------------------
**S** SINGLE
*M/S* MARRIED/SPOUSE *M/P* MARRIED/DOM PARTNER/CIVIL UNION PARTNER
*F/S* FAMILY/SPOUSE *F/P* FAMILY/DOM PARTNER/CIVIL UNION PARTNER
**P** PARENT/CHILD