Centers of Excellence
Available in Plan Year 2027
The State Health Benefits Program (SHBP) will implement a Centers of Excellence (COE) Pilot Program* in 2027 Plan Year administered by Carrum Health which will apply to all members enrolled in a PPO plan**.
Individuals who choose Carrum Health experience high-quality results and feel fully supported every step of the way. Your benefit includes:
- Consistent high-quality care - The surgeons and specialists in Carrum Health’s network are among the best in the country - achieving high-quality outcomes with higher patient satisfaction.
- No surprise bills - All costs are covered, so you won’t get a bill.
- Dedicated support - You’ll have a dedicated care navigator to support you every step of the way - from answering your questions to gathering medical records and coordinating your care.
The non-emergency COE Covered Procedures include:
- Knee and hip replacements
- Bariatric weight loss surgery
- Diagnostic colonoscopies***
- Spinal surgery
- Heart surgery
You must consult with a Carrum Health care team member prior to scheduling a procedure which is covered within the COE program. If you proceed with one of the covered procedures through your medical carrier (Aetna or Horizon), you may be subject to an additional copay and member cost share.
After speaking with Carrum Health, a member will have three options:
- You can have the procedure performed by a provider in the COE Network and have no cost share.
- You can go to a provider on your medical carrier's (i.e. Aetna or Horizon) network and pay a $300 copay.
- You can go to an out-of-network provider and be subject to all applicable member cost sharing as well as possible billing by the provider for costs not covered by the plan's reimbursement (this is known as balance billing).
If you do not wish to participate in the COE Pilot Program, then you can enroll in an HMO, HDHP, or Tiered-Network plan during Open Enrollment for the Plan Year 2027. See your plan's Summary of Benefits and Coverage for more information.
*In accordance with State Health Benefits Program Plan Design Committee (SHBP PDC) Resolution 2024-7, as amended by Resolution 2025-13
**Eligible PPO plans include: 26 Aetna CWA Unity Freedom and 26 Horizon CWA Unity DIRECT; 26 Aetna Freedom and 26 Horizon NJ DIRECT; 26 Aetna Freedom 15 and 26 Horizon NJ DIRECT15; 26 Aetna Freedom 1525 and 26 Horizon NJ DIRECT1525; 26 Aetna Freedom 2030 and 26 Horizon NJ DIRECT2030; 26 Aetna Freedom 2035 and 26 Horizon NJ DIRECT2035.
***Please note that diagnostic colonoscopies will continue to be an Ambulatory Surgical Center Covered Procedure until the COE program starts.
Patient Testimonial
Centers of Excellence
Available in Plan Year 2027
The State Health Benefits Program (SHBP) will implement a Centers of Excellence (COE) Pilot Program* in 2027 Plan Year administered by Carrum Health which will apply to all members enrolled in a PPO plan**.
Individuals who choose Carrum Health experience high-quality results and feel fully supported every step of the way. Your benefit includes:
- Consistent high-quality care - The surgeons and specialists in Carrum Health’s network are among the best in the country - achieving high-quality outcomes with higher patient satisfaction.
- No surprise bills - All costs are covered, so you won’t get a bill.
- Dedicated support - You’ll have a dedicated care navigator to support you every step of the way - from answering your questions to gathering medical records and coordinating your care.
The non-emergency COE Covered Procedures include:
- Knee and hip replacements
- Bariatric weight loss surgery
- Diagnostic colonoscopies***
- Spinal surgery
- Heart surgery
You must consult with a Carrum Health care team member prior to scheduling a procedure which is covered within the COE program. If you proceed with one of the covered procedures through your medical carrier (Aetna or Horizon), you may be subject to an additional copay and member cost share.
After speaking with Carrum Health, a member will have three options:
- You can have the procedure performed by a provider in the COE Network and have no cost share.
- You can go to a provider on your medical carrier's (i.e. Aetna or Horizon) network and pay a $300 copay.
- You can go to an out-of-network provider and be subject to all applicable member cost sharing as well as possible billing by the provider for costs not covered by the plan's reimbursement (this is known as balance billing).
If you do not wish to participate in the COE Pilot Program, then you can enroll in an HMO, HDHP, or Tiered-Network plan during Open Enrollment for the Plan Year 2027. See your plan's Summary of Benefits and Coverage for more information.
*In accordance with State Health Benefits Program Plan Design Committee (SHBP PDC) Resolution 2024-7, as amended by Resolution 2025-13
**Eligible PPO plans include: Aetna Freedom 10 and Horizon NJ DIRECT10; Aetna Freedom 15 and NJ DIRECT15; Aetna Freedom 1525 and Horizon NJ DIRECT1525; Aetna Freedom 2030 and Horizon NJ DIRECT2030; Aetna Freedom 2035 and Horizon NJ DIRECT 20235; Aetna CWA Unity Freedom and Horizon CWA Unity DIRECT; Aetna CWA Unity Freedom 2019 and Horizon CWA Unity DIRECT2019; Aetna Freedom and Horizon NJ DIRECT; Aetna Freedom 2019 and Horizon NJ DIRECT2019; 26 Aetna CWA Unity Freedom and 26 Horizon CWA Unity DIRECT; 26 Aetna Freedom and 26 Horizon NJ DIRECT; 26 Aetna Freedom 15 and 26 Horizon NJ DIRECT15; 26 Aetna Freedom 1525 and 26 Horizon NJ DIRECT1525; 26 Aetna Freedom 2030 and 26 Horizon NJ DIRECT2030; 26 Aetna Freedom 2035 and 26 Horizon NJ DIRECT2035.
***Please note that diagnostic colonoscopies will continue to be an Ambulatory Surgical Center Covered Procedure until the COE program starts.
While this site is a tool to answer most of your questions, full details of the plan are contained in the Summary Plan Descriptions (SPDs), which govern each plan’s operation. Whenever an interpretation of a plan benefit is necessary, the actual plan document will be used.