12/16/2023 0 Comments Horizon direct 10 vs horizon direct 15![]() ![]() 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. Out-of-network benefits for emergency care.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.This plan also has access to wellness and discount programs. Horizon Advantage Exclusive Provider Organization (EPO) health plans offer members the freedom to use any of the thousands of participating physicians, hospitals and other health care professionals in the Horizon Managed Care Network without referrals. Prescription: 30% Coinsurance After Deductible.Copay(primary care/specialist) : $30/ 30% after deductible.Members can also access other hospital in the Horizon Hospital Network but will have higher out of pocket costs. For non-emergency care, Horizon Advance EPO members can choose to maximize their benefits by using Preferred Tier 1 hospitals. ![]() Members must select a Primary Care Physician to coordinate care and provide referrals to specialists who participate with the Horizon Advance EPO product. These plans provide integrated medical and pharmacy benefits, including wellness and emergency care. Our Horizon Advance EPO plans provide access to a variety of doctors, specialists and hospitals. Income requirements for subsidy on the exchange: You must meet the income requirements below.You must not be eligible for group coverage( or if you are, it must be considered unaffordable) Unaffordable means it will cost you more than 9% of your annual income.I’m just listing some basic information on who may qualify for a subsidy. If you think this may be you, please visit and go through the process. Getting a better deal on your individual coverageĬertain individuals will qualify for a premium subsidy if they purchase their coverage from the exchange. Otherwise, its probably best to just go through your broker. The benefits of going on the exchange are that you may qualify for a premium subsidy. Either all of these plans or just a few will also be offered on the exchange. All the information below was taken directly from These plans listed below are being offered off the exchange. ![]() We’ve been waiting patiently to see what the new products will be for 2014 and there they are. Horizon Blue Cross Blue Shield New Jersey Individual Exchange Products ![]()
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