Medical Plans

As an eligible employee, you can choose medical coverage from a selection of plans in two categories:

• NJ DIRECT 15 (administered by Horizon Blue Cross Blue Shield of New Jersey)
• One of two Health Maintenance Organizations (HMOs)

NJ DIRECT 15 (PPO)

• Benefits fall into two categories: services from preferred providers and those provided by non-preferred providers
• Preferred provider benefits are paid after $15 office visit or $50 emergency care copay
• Non-preferred provider benefits require members to meet an annual deductible. After deductibles are met, covered claims are paid at 70% of the “reasonable and customary” allowance for most services
• Members are not required to choose a primary care physician and do not need to obtain referrals
• A nationwide network of providers is available

Health Maintenance Organizations (HMO)

• Separate HMO plans administered by Aetna and CIGNA
• HMOs cover a wide range of services for preventative and diagnostic care
• Both HMO plans have a unique nationwide directory of participating providers
• Select a Primary Care Physician (PCP) to coordinate your health care
• The PCP will issue a referral if you need to see a network specialist as part of your treatment
• No deductibles or claim forms
• Standard copayments required for services
• $15 copay for visits to primary care physician and specialists
• Up to $50 copay for emergency care