Explore your benefits
Learn more about your benefits, including prescription coverage. Visit the N.J. Division of Pensions & Benefits website.
Check with your employer to find out if all these plans are available to you.
All of our PPO plans include:
- Care in network or out of network in New Jersey, nationwide and abroad
- No need to select a Primary Care Physician (PCP)
- No referrals necessary to see a specialist
- Lower out-of-pocket costs when using the Horizon Managed Care Network or the BlueCard® PPO Network nationwide and Blue Cross Blue Shield Global® Core abroad
NJ DIRECT is available to employees hired prior to 7/1/2019. NJ DIRECT2019 is available to new hires on or after 7/1/2019.
NJ DIRECT HDLow and NJ DIRECT HDHigh are High Deductible Health Plans (HDHPs) that combine a high deductible health plan with a health savings account (HSA). Eligible preventive services are covered at 100% if in network and do not have a deductible. You are responsible for eligible medical and prescription expenses, up to the deductible. NJ DIRECT HDLow plan includes $300 Health Savings Account funding by employer.
Nationwide
No referral required
Deductible applies to all services that require a coinsurance.
| NJDIRECT | NJDIRECT2019 | NJDIRECT10 | NJDIRECT15 | NJDIRECT1525 | NJDIRECT2030 | NJDIRECT2035 | NJDIRECT HDLow | NJDIRECT HDHigh | |
|---|---|---|---|---|---|---|---|---|---|
| Individual | $0 | $100 | $0 | $0 | $0 | $0 | $200 | $1,600* | $4,100* |
| Family | $0 | n/a | $0 | $0 | $0 | $0 | $500 | $3,200* | $8,200* |
| NJDIRECT | NJDIRECT2019 | NJDIRECT10 | NJDIRECT15 | NJDIRECT1525 | NJDIRECT2030 | NJDIRECT2035 | NJDIRECT HDLow | NJDIRECT HDHigh | |
|---|---|---|---|---|---|---|---|---|---|
| 10%¹ | 10% after deductible¹ | 10%¹ | 10%¹ | 10%¹ | 10%¹ | 10% | 20% after deductible² | 20% after deductible² |
¹On select services (durable medical equipment, prosthetics, orthotics, oxygen, private duty nursing, ambulance).
²Includes eligible prescription cost share.
| NJDIRECT | NJDIRECT2019 | NJDIRECT10 | NJDIRECT15 | NJDIRECT1525 | NJDIRECT2030 | NJDIRECT2035 | NJDIRECT HDLow | NJDIRECT HDHigh | |
|---|---|---|---|---|---|---|---|---|---|
| Individual | $800 | $800 | $400 | $400 | $400 | $800 | $2,000 | $1,000 | $1,000 |
| Family | $2,000 | $2,000 | $1,000 | $1,000 | $1,000 | $2,000 | $5,000 | $2,000 | $2,000 |
| NJDIRECT | NJDIRECT2019 | NJDIRECT10 | NJDIRECT15 | NJDIRECT1525 | NJDIRECT2030 | NJDIRECT2035 | NJDIRECT HDLow | NJDIRECT HDHigh | |
|---|---|---|---|---|---|---|---|---|---|
| Individual | $7,560 | $7,560 | $400 | $7,560 | $7,560 | $7,560 | $7,560 | $2,600* | $5,100* |
| Family | $15,120 | $15,120 | $1,000 | $15,120 | $15,120 | $15,120 | $15,120 | $5,200* | $10,200* |
*Includes eligible prescription cost share.
| NJDIRECT | NJDIRECT2019 | NJDIRECT10 | NJDIRECT15 | NJDIRECT1525 | NJDIRECT2030 | NJDIRECT2035 | NJDIRECT HDLow | NJDIRECT HDHigh | |
|---|---|---|---|---|---|---|---|---|---|
| Primary Care Office Visit | $15 | $15 | $10 | $15 | $15 | $20 | $20 | 20% after deductible | 20% after deductible |
| Annual Routine Physical (In-Network Only) | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 |
| Direct Primary Care (DPC) | $0 | $0 | $0 | $0 | $0 | $0 | $0 | Not available | Not available |
| First Responders Docs (FRDOCS) | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 |
Cost share may apply
| NJDIRECT | NJDIRECT2019 | NJDIRECT10 | NJDIRECT15 | NJDIRECT1525 | NJDIRECT2030 | NJDIRECT2035 | NJDIRECT HDLow | NJDIRECT HDHigh | |
|---|---|---|---|---|---|---|---|---|---|
| Specialist Office Visit | $15 | $15 | $10 | $15 | $25 | $30/adult $20/child under age 26 | $35 | 20% after deductible | 20% after deductible |
| Annual Routine Vision (In-Network Only) | $15 | $15 | $10 | $15 | $25 | $30/adult $20/child under age 26 | $35 | 20% after deductible | 20% after deductible |
| Chiropractic | $15 | $15 | $10 | $15 | $25 | $30/adult $20/child under age 26 | $35 | 20% after deductible | 20% after deductible |
| Physical, Occupational, Speech Therapy | $15 | $15 | $10 | $15 | $25 | $30/adult $20/child under age 26 | $35 office visit 20% after deductible at an outpatient facility | 20% after deductible | 20% after deductible |
Laboratory services must be rendered by an in-network participating provider, with some exceptions based on medical policy.
| NJDIRECT | NJDIRECT2019 | NJDIRECT10 | NJDIRECT15 | NJDIRECT1525 | NJDIRECT2030 | NJDIRECT2035 | NJDIRECT HDLow | NJDIRECT HDHigh | |
|---|---|---|---|---|---|---|---|---|---|
| Outpatient | $0 | $0 | $0 | $0 | $0 | $0 | 20% after deductible | 20% after deductible | 20% after deductible |
| Freestanding | $0 | $0 | $0 | $0 | $0 | $0 | 20% after deductible | 20% after deductible | 20% after deductible |
| NJDIRECT | NJDIRECT2019 | NJDIRECT10 | NJDIRECT15 | NJDIRECT1525 | NJDIRECT2030 | NJDIRECT2035 | NJDIRECT HDLow | NJDIRECT HDHigh | |
|---|---|---|---|---|---|---|---|---|---|
| Urgent Care Center | $15 | $15 | $10 | $15 | $25 | $30/adult 20/child under age 26 | $35 | 20% after deductible | 20% after deductible |
| Emergency Room | $150* | $150* | $75* | $100* | $100* | $125 | $300 | 20% after deductible | 20% after deductible |
| Ambulance | 10% | 10% after deductible | 10% | 10% | 10% | 10% | 20% after deductible | 20% after deductible | 20% after deductible |
Lower copayment applies to children under 19 and physician referrals.
| NJDIRECT | NJDIRECT2019 | NJDIRECT10 | NJDIRECT15 | NJDIRECT1525 | NJDIRECT2030 | NJDIRECT2035 | NJDIRECT HDLow | NJDIRECT HDHigh | |
|---|---|---|---|---|---|---|---|---|---|
| Inpatient Facility | $0 | $0 | $0 | $0 | $0 | $0 | 20% after deductible | 20% after deductible | 20% after deductible |
| Outpatient Facility | $0 | $0 | $0 | $0 | $0 | $0 | 20% after deductible | 20% after deductible | 20% after deductible |
| Outpatient Behavioral Health | $15 | $15 | $10 | $15 | $25 | $30/adult $20/child under age 26 | $35 office visit 20% after deductible at an outpatient facility | 20% after deductible | 20% after deductible |
| Durable Medical Equipment (DME) | 10% | 10% after deductible | 10% | 10% | 10% | 10% | 20% after deductible | 20% after deductible | 20% after deductible |
Out-of-network cost basis: NJ DIRECT and NJ DIRECT2019: 175% of CMS (Centers for Medicare & Medicaid Services) fee schedule. 90th percentile of FAIR Health national for all other health plans with an out-of-network benefit. All plans with an out-of-network benefit also have specified dollar limits for out-of-network chiropractic ($35), physical therapy ($52) and acupuncture ($60).
| NJDIRECT | NJDIRECT2019 | NJDIRECT10 | NJDIRECT15 | NJDIRECT1525 | NJDIRECT2030 | NJDIRECT2035 | NJDIRECT HDLow | NJDIRECT HDHigh | |
|---|---|---|---|---|---|---|---|---|---|
| Individual | $400 | $400 | $100 | $100 | $100 | $200 | $800 | Out-of-network deductible is combined with in-network deductible. | Out-of-network deductible is combined with in-network deductible. |
| Family | $1,000 | $1,000 | $250 | $250 | $250 | $500 | $2,000 | Out-of-network deductible is combined with in-network deductible. | Out-of-network deductible is combined with in-network deductible. |
| NJDIRECT | NJDIRECT2019 | NJDIRECT10 | NJDIRECT15 | NJDIRECT1525 | NJDIRECT2030 | NJDIRECT2035 | NJDIRECT HDLow | NJDIRECT HDHigh | |
|---|---|---|---|---|---|---|---|---|---|
| Individual | 30% | 30% | 20% | 30% | 30% | 30% | 40% | 40% | 40% |
| Out-of-Pocket Coinsurance Maximum - Individual | $2,000 | $2,000 | $2,000 | $2,000 | $2,000 | $5,000 | $6,500 | $3,600 | $6,100 |
| Out-of-Pocket Coinsurance Maximum - Family | $5,000 | $5,000 | $5,000 | $5,000 | $5,000 | $12,500 | $13,000 | $7,200 | $12,200 |
All 2024 SHBP/SEHBP medical plans include:
- Well Care and Preventive Care: Services such as annual physical and annual gynecological exams, well baby/child medical care and preventive care immunizations are covered 100% when using an in-network doctor.
- Behavioral Health and Substance Use Disorder: Counseling services are covered for mental/emotional health and alcohol/substance use disorder.
- Telemedicine: Talk to a doctor 24/7/365 usingHorizon CareOnline℠.
- Precious Additions®: A prenatal education program supported by My Health Manager®, powered by WebMD®, gives you access to online tools and resources.
Your health plan may also include care outside of NJ through these options:
- BlueCard®: For care in the U.S., Puerto Rico and U.S. Virgin Islands.
- Blue Cross Blue Shield Global Core: For care when you travel abroad.
- Away From Home Care: Access to care for Horizon HMO members who are away from home.
Need help?
Call Member Services at 1-800-414-SHBP (7427), weekdays, from 8 a.m. to 6 p.m., Eastern Time (ET), or sign in to chat or send an email. You can use the Horizon Blue app, too!
This document is for informational purposes only and does not constitute a binding agreement. The information provided by this document is not intended to replace or modify the terms, conditions, limitations and exclusions contained within health, dental or vision benefit plans issued or administered by Horizon BCBSNJ. In the event of a conflict between the information contained in this document and your plan documents, your plan documents shall control.
Retirees: Please visit state.nj.us/treasury/pensions for information regarding available retiree plans.
This is not a complete list of all covered services. Exclusions and limitations apply to some services. Visit state.nj.us/treasury/pensions/member-guidebooks.shtml for more information.
