Plan Information
NJ DIRECT
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 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 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.
- 24/7 Nurse Line – The 24/7 Nurse Line is available 24 hours a day, seven days a week so that whenever you have a health care question, a nurse is just a phone call away. You can also chat with a nurse by clicking here.
- 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.
This section includes only a general description of the benefits available to members of the NJ State Health Benefits Program and School Employees' Health Benefits Program. The benefits described are subject to all of the terms, conditions, limitations and definitions included in the Plan documents. If there is a contradiction between the benefits described in this section and those provided in the Plan documents, the Plan documents will prevail.  NJ Division of Pensions and Benefits - State Health Benefits Program
Here you will find the SHBP Member Handbook.
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