![]() ![]() Under the Patient Protection and Affordable Care Act (PPACA) and the Health Care and Education Reconciliation (HCR) Acts, certain preventive care, such as immunizations (age and population restrictions may apply), certain screenings (blood pressure, cholesterol, depression, newborn, etc.), FDA-approved contraceptive methods, and well-baby care, will be covered by all of the SHBP medical plans without member cost sharing.Īs a result, primary care well visits (annual exams) will no longer require a copayment or coinsurance by the member for certain wellness services provided by an in-network provider. Preventive Services, Immunizations and Certain Screenings $300 employer funded Health Savings Account.$1,000 In-Network Individual Out-of-Pocket Maximum ($2000 Family).$3000 In-Network deductible Employee + 1 or more dependents.$1,000 In-Network Individual Out-of-Pocket Maximum.20% coinsurance after deductible is satisfied.$8000 In-Network deductible Employee + 1 or more dependents.*The Horizon HMO plan has a limited service area of New Jersey, Delaware, New York and bordering counties in Pennsylvania. $30 Specialist Care copay ($20 copay for children up to the 26th birthday).Members hired after July 1, 2019, will be enrolled in NJ DIRECT 2019. *Members hired before July 1, 2019, will be enrolled in NJ DIRECT.$150 Emergency Care copay* (*$50 for adults referred to the emergency room by their primary care physician and for pediatric).Access to contribute to optional Health Savings Account (HSA)Īvailable Plans: NJ Direct/NJ Direct 2019*.Prescription is integrated with the plan and subject to deductible and coinsurance.Out-of-network Coinsurance after deductible for non-preferred providers.In-network Coinsurance after deductible for preferred providers.Must pay all costs up to the deductible amount before plan pays for covered services preventative care covered at no cost (In-network only).Other copayment required, deductible only required for Tier 2 provider services.Lower cost sharing when using Tier 1 In-network providers when compared to Tier 2 In-network providers.Managed care network no Out-of-network coverage.Unique network of physicians and facilities.Standard copayments required for services.The PCP will issue a referral if you need to see a network specialist as part of your treatment.Select a Primary Care Physician (PCP) to coordinate your health care.Both HMO plans have a unique nationwide directory of participating providers.HMOs cover a wide range of services for preventative and diagnostic care.Separate HMO plans administered by Horizon.A nationwide network of providers is available.Certain preventative care such as annual exams, well-baby care, and certain screenings will be covered with no cost sharing.Members are not required to choose a primary care physician and do not need to obtain referrals. ![]() After deductibles are met, covered claims are paid of the “reasonable and customary” allowance for most services
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