NJ DIRECT 10/15

NJ DIRECT members do not need to select a Primary Care Physician, and referrals are not needed to access specialty care. Members can access an NJ DIRECT 10/15 network doctor or hospital at any time and enjoy the in-network level of benefits. NJ DIRECT members also have access to more than 600,000 BlueCard PPO network doctors and 6,000 network hospitals nationally outside of New Jersey to receive their in-network level of benefits.

The in-network benefits of NJ DIRECT provide you with many well care and preventive services such as annual physicals, well baby/child medical care, immunizations, annual vision exams and annual gynecological exams. Your in-network outpatient services are generally considered at 100% after an applicable copayment. Most in-network hospital admissions are covered at 100%.

The out-of-network benefits allow you to obtain services from eligible physicians, hospitals and health care professionals who do not participate in the NJ DIRECT 10/15 network in New Jersey or the BlueCard PPO network outside of New Jersey. Keep in mind that you will have out-of-pocket expenses when you use your out-of-network benefit. Most out-of-network care is reimbursed at a percentage of the reasonable and customary allowance after your annual deductible is met.

NJ DIRECT covers you for emergencies when traveling. You are covered at the in-network level of benefits. If you receive non-emergency care, you have coverage at the out-of network level for eligible and medically necessary services.

NJ DIRECT also provides the following health and wellness and value-added programs:

• Health and Wellness Education Programs for the following: Asthma, Chronic Obstructive Pulmonary Disease, Coronary Artery Disease, Heart Failure, Chronic Kidney Disease, Diabetes, Multiple Sclerosis, Hepatitis C, and Weight Management.
• PRECIOUS ADDITIONS prenatal education and information program which provides expectant mothers with information to enjoy a healthy pregnancy.
• CareWise^® – The CareWise Web site combines a reliable health information site with a 24-hour nurse phoneline, so if there's something on the site you don't understand, a CareWise nurse is just a phone call away to answer your questions.
• My Health Manager – A secure, online, personalized health guide featuring many resources to help you manage your health, including a Health Assessment Tool, Symptom Checker, Personal Health Record, Hospital Quality Comparison Tool, electronic health newsletters, and more.
• Horizon Discount Program – Discounts on products and services such as: eyeglasses, laser correction services, health club memberships, hearing aids, alternative therapy, weight management, and more
• Behavioral Health Services – General behavioral health information on issues our members most often research. You can also take a self-assessment or use one of our investment tools or fitness calculators, or check out information on child and elder care regulations, links to volunteer opportunities, and much more.

Please Note:
An active employee whose employer does not offer a separate prescription drug plan has prescription drug coverage through the Employee Prescription Drug Reimbursement Plan. By presenting a discount prescription drug card to the pharmacist, members are charged a reduced fee up front and the claim is electronically submitted to Horizon BCBSNJ for consideration under NJ DIRECT (when using a participating pharmacy). A mail order service is also available through Caremark. Members may obtain maintenance prescriptions by mail or online. If you use a non-participating pharmacy, you will need to submit a completed claim for reimbursement.

NJ Division of Pensions and Benefits - State Health Benefits Program