Horizon Medicare Advantage NJ DIRECT (PPO) Plans

Horizon BCBSNJ offers Medicare-eligible retired State Health Benefits Program (SHBP) members Medicare Advantage (MA) PPO plans.

With the Horizon Medicare Advantage NJ DIRECT (PPO) plans, eligible SHBP retirees have access to physicians and other health care professionals who participate in our Medicare Managed Care Network and the Medicare Advantage PPO network of other Blue Cross and/or Blue Shield Plans, as well as all physicians and other health care professionals who are eligible to receive Medicare payments and provide health care services to a Horizon Medicare Advantage NJ DIRECT (PPO) member.

The following plans are be offered to Medicare-eligible SHBP retirees:

Current SHBP Retiree Coverage Corresponding Horizon Medicare Advantage NJ DIRECT (PPO) plan
NJ DIRECT10 Horizon Medicare Advantage NJ DIRECT10 (PPO)
NJ DIRECT15 Horizon Medicare Advantage NJ DIRECT15 (PPO)

When SHBP retirees become Medicare-eligible, the SHBP automatically transfers the retirees currently enrolled with Horizon BCBSNJ’s NJ DIRECT10 and NJ DIRECT15 plans into the Horizon Medicare Advantage NJ DIRECT (PPO) plan that corresponds to their current coverage.

The SHBP and Horizon BCBSNJ have developed the Horizon Medicare Advantage NJ DIRECT (PPO) plans to be consistent with what is covered under the current SHBP retiree plans and provide both in- and out-of-state coverage.

However, Medicare-eligible SHBP retirees in these plans can choose to enroll into a Horizon Medicare Advantage NJ DIRECT (PPO) plan.

Your patients do not need referrals for specialty care with the Horizon Medicare Advantage NJ DIRECT (PPO) plans. However, physicians may need to get prior authorization for certain member services.

Members’ plan benefits include:

  • Access to in- and out-of-state coverage
  • All Medicare Part A and Part B benefits, and additional supplemental benefits
  • No referrals required for physicians or specialists (prior authorization required where necessary)
  • Free preventive care, including annual screenings, immunizations and nutritional counseling

Dependent coverage for SHBP Medicare-eligible retirees

The Horizon Medicare Advantage NJ DIRECT (PPO) plans are single coverage plans. For that reason, when your patients move to the Horizon Medicare Advantage NJ DIRECT (PPO) plan, their dependents who are not Medicare eligible will remain active in the current coverage. Dependents may have their own member ID cards and unique member ID numbers.

Pharmacy coverage

SHBP retiree prescription drug benefits are not offered through Horizon BCBSNJ. If you need help with verifying prescription drug benefits, please call the pharmacy benefits manager phone number listed on the member’s prescription drug ID card.

Submitting your claims

Under the Horizon Medicare Advantage NJ DIRECT (PPO) plans, medical claims should be sent to Horizon BCBSNJ as the primary insurer. Out-of-state providers should submit claims through their local Blue Cross and/or Blue Shield (BCBS) Plans.