NJ DIRECT HDHP


NJ DIRECT HDHP is a high deductible health plan combined with a Health Savings Account (HSA) to help you pay for care. Eligible preventive services received in network are covered at 100% — there’s no deductible. For all other eligible medical and prescription expenses, you are responsible for costs, up to the deductible.

After the deductible is met, you pay 20% coinsurance in network and 40% coinsurance out of network as well the difference between the allowance and the amount charged by an out-of-network provider, until the out-of-pocket maximum limit is reached.

Once the out-of-pocket maximum is reached, eligible services are covered at 100% of the allowance, subject to all plan provisions.

Expenses for ineligible services, charges in excess of the allowance, and services not authorized and determined to be ineligible, do not count toward the out-of-pocket maximum limit.

You have access to one of the largest doctor and hospital networks in New Jersey and 1.3 million providers nationwide through the BlueCard® PPO Network.1 You also have coverage worldwide through Blue Cross Blue Shield Global Core. That makes it easy to find an in-network doctor or hospital. You can choose to go out of network, too, but pay more for your care.

Remember, your out-of-pocket costs are lower when using in-network doctors and facilities.

All plans include:

  • Well Care and Preventive Care: Services such as annual physical and gynecological exams, well baby/child medical care, immunizations and annual vision exams are covered 100% when using an in-network doctor.
  • Behavioral Health and Substance Use Disorder: Counseling services are covered for mental/nervous conditions and alcohol/substance use disorder.
  • Horizon Health Guides: Your Horizon Health Guide can help with all your health care needs: answering questions, making medical appointments, solving issues, helping with claims, finding care, even making health and wellness benefit suggestions tailored to you. And we’ll help you manage a chronic health condition. Coming in February!
  • Telemedicine: Talk to a doctor 24/7/365 using Horizon CareOnline℠.
  • Health Programs: Registered nurses help you manage a chronic or complex health condition.
  • Precious Additions®: A prenatal education program supported by My Health Manager®, powered by WebMD®, gives you access to online tools and resources.

Your health plan may also include care outside of NJ through these options: