NJ Plus BCBS changing to NJ Direct (April 1)

My work has been pretty good about giving us information for this but I just wanted to post in case anyone was unaware. This is if you are a state worker, you will be losing both the traditional and NJ Plus plan and switching to NJ Direct. It looks like this will be the better plan but I would just double check that your authorization works if this change over happens right when you should have surgery. Hope this helps someone!

Special Open Enrollment

As a result of recent labor agreements and the passage of Chapter 103, P.L. 2007, the New Jersey State Health Benefits Program (SHBP) will provide active members with new medical plans effective April 1, 2008. There will be a Special Open Enrollment from January 28, 2008 through February 15, 2008. Employees will be able to make a choice between the new Preferred Provider Organization (PPO) and two Health Maintenance Organizations (HMOs). The new Preferred Provider Organization (PPO) will be NJ DIRECT15. NJ DIRECT15 will replace the Traditional Plan and the New Jersey Plus Plan.  NJ DIRECT15 is administered by Horizon Blue Cross Blue Shield of New Jersey. In addition to NJ DIRECT15, the Aetna HMO and the Cigna HMO will continue to be available.

NJ DIRECT15

The NJ DIRECT15 Plan is similar in design to the current NJ Plus Plan in that it will provide in-network care and out-of-network care. The doctors that are in-network participants with NJ Plus will be in-network participants with NJ DIRECT15. The biggest difference between the two plans is that: 1) In-network providers will be available nationwide through NJ DIRECT15;  2) You will not have to select a primary care physician; and 3) You do not need a referral to see a specialist.

In-Network Services NJ DIRECT15

If a doctor participates in the Horizon BCBSNJ Managed Care Network, members will only pay the usual copayment for eligible services. Members who live outside of New Jersey can utilize doctors who participate in the national Blue Cross Blue Shield network. To find out if a doctor is part of the Managed Care Network, go to the Unified Provider Directory which can be found at www.state.nj.us/treasury/pensions/shbp.htm. You can also go directly to the website at www.horizonblue.com/shbp to check your doctor’s participation.

Out of Network Services NJ DIRECT15

If the doctor does not participate in the aforementioned networks, the services will be considered out-of-network. Out-of-network care is subject to an annual deductible and then the claim will be paid at 70% of the reasonable and customary charges. Please review the table that follows for out of pocket costs.

              Out of Pocket Expenses for Out of Network Care

Deductible (individual)	$100.00 per calendar year
Deductible (Family Maximum)	$250.00 per calendar year
Hospital Inpatient	$200.00 per hospital stay
Maximum Out of Pocket (Individual)	$2,000.00 per calendar year (coinsurance only)
Maximum Out of Pocket (Family)	$5,000.00 per calendar year (coinsurance only)

Once the out of pocket costs for coinsurance totals $2,000.00 per individual or $5,000.00 per family, covered benefits are paid at 100 percent of the “reasonable and customary” allowance through the remainder of the calendar year. Only pre-certified treatment counts toward the maximum out of pocket expense level.

Health Maintenance Organizations (HMOs)

The two HMO plans that will be available to active employees are Aetna and Cigna Healthcare. The way in which these plans work will not change.  You will select a Primary Care Provider (PCP) when you enroll in the HMO, referrals will be necessary in order to access specialist services, and there will be no out-of-network coverage. The PCP will coordinate your health care and provide you with electronic referrals when needed.  Both HMO plans are now providing services nationwide. HMOs have no deductibles or claim forms to file. You will pay the usual copayment for an office visit to your PCP or referred specialist.

You must you receive care from a doctor that participates with the HMO. To find out if a doctor is part of the Aetna HMO or the Cigna HMO, go to the Unified Provider Directory which can be found at www.state.nj.us/treasury/pensions/shbp.htm.

Plan Costs

 Most State employees pay a health contribution of 1.5% of salary for SHBP medical plan and/or prescription drug plan coverage regardless of the plan or selected level of coverage. The contribution will remain in effect.

How to Enroll

I. AFT, CWA, IFPTE, Non-Unit, and Grant Employees
	New Health Benefits Selection
Current Health Benefits Selection	NJ DIRECT15	CIGNA	AETNA
NJ Plus or Traditional Plans	No Action Needed.  Employees will be automatically transferred.	Employees must complete enrollment application during open enrollment.	Employees must complete enrollment application during open enrollment.
Oxford Health Plan/HealthNet/Amerihealth	No Action Needed.  Employees will be automatically transferred.	Employees must complete enrollment application during open enrollment.	Employees must complete enrollment application during open enrollment.
CIGNA	Employees must complete enrollment application during open enrollment.	No Action Required. Employee will remain in the plan.	Employees must complete enrollment application during open enrollment.
AETNA	Employees must complete enrollment application during open enrollment.	Employees must complete enrollment application during open enrollment.	No Action Required. Employee will remain in the plan.
II. Law Enforcement Employees
	New Health Benefits Selection
Current Health Benefits Selection	NJ Plus	Traditional	CIGNA/AETNA
NJ Plus	No Action Needed.  Employees will remain covered by plan.	N/A.  This plan does not accept new enrollments.	Employees must complete enrollment application during open enrollment.
Traditional	N/A No law enforcement employees are in the Traditional plan.	N/A No law enforcement employees are currently in the Traditional plan.	N/A No law enforcement employees are in the Traditional plan.
Oxford Health Plans/HealthNet/AmeriHealth	No Action Needed.  Employees will be automatically transferred.	N/A.  This plan does not accept new enrollments.	Employees must complete enrollment application during open enrollment.
AETNA/CIGNA	Employees must complete enrollment application during open enrollment.	N/A.  This plan does not accept new enrollments.	No Action Required if employee chooses to remain in current plan.  Employee will remain in the plan.

 

Be sure to submit your health insurance application to the Office of Human Resources, Administrative Services Building, Room 101. The State has advised us that the new insurance application will be available on January 28, 2008. To obtain an application, call the Office of Human Resources at 2283 or 3306. Please note that the Special Open Enrollment will be for medical plan changes only. Employees will not be allowed to add dependents to coverage, change coverage levels or make changes to dental or prescription drug plans.

For More Information

Information can be obtained at the website for each of the available medical plans. You may also call the medical plans for more information.

NJ DIRECT 15	www.horizonblue.com/shbp	1-800-414-7427
Aetna HMO	www.aetna.com/statenj	1-877-782-8365
Cigna Healthcare	www.cigna.com	1-800-564-7642

You may also visit the Division of Pensions and Benefits website at www.state.nj.us/treasury/pensions/shbp.htm or contact the Office of Human Resources at extension 3306 or extension 2283.

hi dr noyan was my surgeon too?? how are you doing.  i loved him jacki

I feel so lucky to have found him. He just took out my gall bladder on friday and I just think he is the kindest doctor I have ever met. The fact that insurance covered him is a bonus!

This happened to me over a year ago. I'm a librarian, and my town opted out of the NJ Plus & Traditional plans and gave us Horizon Direct Access. I like Direct better than NJ Plus because I don't need referrals. I was on the traditional plan back when I had my gastric bypass and BCBS was great about covering everything.

I think there is now the ability on the Horizon Blue website to do a physician's search for the new plans. I looked up a couple of doctors and they were there. Makes me wonder why this plan saves the state money. That was their motivation in changing, I believe.