Plans

NJ DIRECT HDHP

NJ DIRECT HD1500 and NJ DIRECT HD4000 combine a high-deductible health plan with a health savings account (HSA).

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NJ DIRECT High Deductible Health Plans (HDHPs)

Eligible preventive services are covered at 100 percent if received in network and do not have a deductible. Members are responsible for all other eligible medical and prescription expenses, up to the deductible.

After the deductible is met, the member is responsible for 20% coinsurance in network and 40% coinsurance out of network as well the difference between the allowance and the amount charged by an out-of-network provider, until the out-of-pocket maximum is reached.

Once the out-of-pocket maximum is reached, eligible services will be covered at 100 percent of the allowance, subject to all plan provisions.

Expenses for ineligible services, charges in excess of the allowance, and services not authorized and determined to be ineligible do not count toward the out-of-pocket maximum.

Other features include:

  • No need to select a PCP.
  • No referral needed to see a specialist
  • Certain services require prior authorization.
  • No claims to file when accessing care in network.
  • BlueCard®, giving you access to more than 1.3 million doctors, hospitals, facilities and other health care professionals in the U.S.
  • Blue Cross Blue Shield Global Core, which covers you and your covered dependents for eligible services when abroad.
  • Dedicated nurses for additional support in managing a condition or an episode of care.
  • Precious Additions®, a prenatal education and information program.
  • Online services to securely manage your personal benefit and claim information.
  • Horizon Blue app connecting you to care and support 24/7.
  • My Health Manager, powered by WebMD®, for a range of health and wellness tools and resources online, including NJWELL, the state’s wellness program.

2020 Plan Guides
SHBP/SEHBP Overview
State and State College/University Employee Plans
SHBP State and State College/University Employees Plans for CWA Members
SHBP Local Government Employee Plans
SEHBP Local Education Employee Plans

2019 Plan Guides
SHBP Health Plan Guide
2019 State Health Benefits Program (SHBP) Plans for State Employee CWA Members
2019 SEHBP Health Plan Guide

Read more information on HSAs.

 

SEHBP Plan Comparison Chart 2019

2019 State Health Benefits Program (SHBP) Plans for State Employee CWA Members *NEW

SHBP Plan Comparison Chart 2019

SHBP Plan Comparison Chart 2018

SEHBP Plan Comparison Chart 2018

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Application to change health benefits plan

NJ DIRECT HDHP Member Guidebook

For benefit information, visit the New Jersey Division of Pensions and Benefits website.

  • Online services to securely manage your personal benefit and claim information.
  • Horizon Blue app connecting you to care and support 24/7.
  • My Health Manager, powered by WebMD®, for a range of health and wellness tools and resources online, including NJWELL, the state’s wellness program.
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