NJ Direct 10 is only available for retirees and is the successor to the Traditional Plan. You may need pre certification for certain procedures like x-rays, MRIs, etc. ![]() There was an incorrectly worded sentence on the Guide to Choosing a SHBP Health Plan. Referrals are NOT needed in NJ DIRECT 15 either in or out of network. Co-pays do not go towards the out of pocket (same as old NJ Plus)įor out of network – the 30% payments for out of network and other items DO count towards out of pocket maximum.ĭeductibles and annual/lifetime maximums from Traditional & NJ Plus plans will carry over into NJ Direct Plans.Ĭhoosing a Primary Care Physician is always encouraged but there is no requirement to do so. When they move in Direct 15, they are advised to notify Horizon that they were already previously approved under the Traditional Plan to avoid any complicationsįor in network only, co-insurance (such as for durable medical goods) counts against the $400 in network out of pocket maximum. Members in the Traditional Plan who are undergoing special or other treatments that have already been approved (pre approval for pending treatment as well) will not be required to seek new approvals in NJ Direct 15. The above applies to all Active, Retired & Cobra members.ĭuring the term of the agreement, people who plan to retire outside of New Jersey in NJ Direct 10 (or NJ Direct 15 due to years of service per the agreement) will be covered under Blue Cross/Blue Shield Blue Card Network. Retirees in Traditional Plan will move to NJ Direct 10.īoth NJ Direct 15 & 10 are administered by Horizon Blue Cross Blue Shield But you should check with your provider to verify their plan participation.Įmployees in NJ Plus and Traditional Plan will automatically move to NJ Direct 15 UNLESS you want to change to either Aetna or Cigna HMOs.Įmployees in the Amerihealth, Healthnet or Oxford HMOs will be moved to NJ Direct 15 UNLESS they wish to choose Aetna or Cigna HMOs. There are no longer specific service areas in different states. Even though you’re paid bi-weekly – you are considered state monthly.Īll of the plans are available nationwide. The new health benefit plans will take effect on Apfor State monthly employees. Or for any members traveling - Choose "Guest" and input "NJX" for identification prefix - type of plan is PPO) NJ Direct 15- 1-80 (More FAQs directly from Horizon Direct 15 appear further below in this document) ![]() It would be wise to also check with your doctor(s) office to be sure they are in network of the plan you’ve chosen. This eliminates having to spell your doctor's or hospital name exactly as they are in the system in order for them to show up on the search. ![]() Please note that the best way to find your doctors or hospitals in these searches is to input your zip code and use within 5, 10 or 15 miles radius from your zip code to find a list of providers within your area. The new web sites for health care providers are operational and if you are changing plans you should use the 'Doc find' & ' Hospital Find' options on the providers' web sites to see if your doctors etc.
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