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Direct Access Plan for RWJBH BHealthy Care

The Direct Access Plan offers you the freedom of choosing from three levels of coverage: RWJBarnabas Health Inner Circle/Premier providers, Horizon Direct Access in-network, and out-of-network.

  1. RWJBarnabas Health Premier providers include RWJBH hospitals and labs, the Medical Group, and Joint Venture facility and physician groups of RWJBH. RWJBarnabas Health Inner Circle providers are healthcare providers that are affiliated with the RWJBH healthcare system. They are doctors that have admitting privileges and work closely with RWJBH, but are not employed by RWJBH. Using providers in the RWJBarnabas Health Premier/Inner Circle provides you with the lowest out-of-pocket costs.
  2. Horizon Direct Access covers services provided by physicians and facilities outside of the RWJBarnabas Health Inner Circle. These are providers that participate in the Horizon Direct Access Network (in NJ) or the national BlueCard® network (outside NJ).
  3. Out-of-network covers services provided by physicians and facilities that do not participate in the Horizon Direct Access network or the national BlueCard network.

Although not required, you are encouraged to select a Primary Care Physician (PCP) who assumes responsibility for coordinating your healthcare. It is recommended that you make an appointment to get your annual physical with your PCP — covered 100% in-network at no cost to you.

Plan benefits for out-of-network are based on an allowed amount fee schedule, not on provider billed charges, therefore, members using out-of-network providers may have additional out-of-pocket costs.