CWA and Union Negotiated Members
Check with your employer to find out which plans are available to you.
All of our PPO plans include:
- Care in network or out of network in New Jersey, nationwide and abroad
- No need to select a Primary Care Physician (PCP)
- No referrals necessary to see a specialist
- Lower out-of-pocket costs when using the Horizon Managed Care Network or the BlueCard® PPO Network nationwide and Blue Cross Blue Shield Global® Core abroad
NJ DIRECT HD1500 and NJ DIRECT HD4000 are High Deductible Health Plans (HDHPs) that combine a high deductible health plan with a health savings account (HSA). Eligible preventive services are covered at 100% if in network and do not have a deductible. You are responsible for eligible medical and prescription expenses, up to the deductible. NJ DIRECT HD1500 plan includes $300 Health Savings Account funding by employer.
IN-NETWORK (IN)
| CWA UNITY DIRECT NJ DIRECT |
CWA UNITY DIRECT2019 NJ DIRECT2019 |
NJ DIRECT HD1500 | NJ DIRECT HD4000 | |
|---|---|---|---|---|
| Service Area Available | Nationwide | Nationwide | Nationwide | Nationwide |
| Specialist Referral | No referral required | No referral required | No referral required | No referral required |
| Deductible Deductible applies to all services that require a coinsurance. |
||||
| $0 | $100 | $1,5001 | $4,0001 | |
| $0 | Not applicable | $3,0001 | $8,0001 | |
| Coinsurance | 10%2 | 10% after deductible2 | 20% after deductible1 | 20% after deductible1 |
| Coinsurance Out-of-Pocket Maximum | ||||
| $800 | $800 | $1,000 | $1,000 | |
| $2,000 | $2,000 | $2,000 | $2,000 | |
| Total Out-of-Pocket Maximum (Copay+Deductible+Coinsurance) | ||||
| $6,840 | $6,840 | $2,5001 | $5,0001 | |
| $13,680 | $13,680 | $5,0001 | $10,0001 | |
HEALTH CARE SERVICES
| CWA UNITY DIRECT NJ DIRECT |
CWA UNITY DIRECT2019 NJ DIRECT2019 |
NJ DIRECT HD1500 | NJ DIRECT HD4000 | |
|---|---|---|---|---|
| Primary Care Office Visit | $15 | $15 | 20% after deductible | 20% after deductible |
| Annual Routine Physical (In-Network Only) | $0 | $0 | $0 | $0 |
| Direct Primary Care Medical Home (DPCMH) | $0 | $0 | Not available | Not available |
| Horizon CareOnline (Telemedicine) | Cost share may apply | Cost share may apply | Cost share may apply | Cost share may apply |
| Specialist Office Visit | $15 | $15 | 20% after deductible | 20% after deductible |
| Annual Routine Vision (In-Network Only) | $15 | $15 | 20% after deductible | 20% after deductible |
| Chiropractic 30 visits per calendar year |
$15 | $15 | 20% after deductible | 20% after deductible |
| Physical/Occupational/Speech Therapy Based on medical necessity |
$15 | $15 | 20% after deductible | 20% after deductible |
DIAGNOSTIC LABORATORY/RADIOLOGY/ADVANCED IMAGING
Laboratory services must be rendered by an in-network participating provider, with some exceptions based on medical policy.
| CWA UNITY DIRECT NJ DIRECT |
CWA UNITY DIRECT2019 NJ DIRECT2019 |
NJ DIRECT HD1500 | NJ DIRECT HD4000 | |
|---|---|---|---|---|
| Outpatient Laboratory/Radiology/Advanced Imaging | $0 | $0 | 20% after deductible | 20% after deductible |
| Freestanding Laboratory/Radiology/Advanced Imaging | $0 | $0 | 20% after deductible | 20% after deductible |
EMERGENCY/URGENT MEDICAL SERVICES
| CWA UNITY DIRECT NJ DIRECT |
CWA UNITY DIRECT2019 NJ DIRECT2019 |
NJ DIRECT HD1500 | NJ DIRECT HD4000 | |
|---|---|---|---|---|
| Urgent Care Center | $15 | $15 | 20% after deductible | 20% after deductible |
| Emergency Room | $150* | $150* | 20% after deductible | 20% after deductible |
| Ambulance | 10% | 10% after deductible | 20% after deductible | 20% after deductible |
OTHER SERVICES
| CWA UNITY DIRECT NJ DIRECT |
CWA UNITY DIRECT2019 NJ DIRECT2019 |
NJ DIRECT HD1500 | NJ DIRECT HD4000 | |
|---|---|---|---|---|
| Inpatient Facility | $0 | $0 | 20% after deductible | 20% after deductible |
| Outpatient Facility | $0 | $0 | 20% after deductible | 20% after deductible |
| Outpatient Behavioral Health | $15 | $15 | 20% after deductible | 20% after deductible |
| Durable Medical Equipment (DME) | 10% | 10% after deductible | 20% after deductible | 20% after deductible |
OUT-OF-NETWORK (OON)
| CWA UNITY DIRECT NJ DIRECT |
CWA UNITY DIRECT2019 NJ DIRECT2019 |
NJ DIRECT HD1500 | NJ DIRECT HD4000 | |
|---|---|---|---|---|
| Deductible | ||||
| $400 | $400 | See in-network deductible Out-of-network deductible is combined with in-network deductible |
See in-network deductible Out-of-network deductible is combined with in-network deductible |
|
| $1,000 | $1,000 | See in-network deductible Out-of-network deductible is combined with in-network deductible |
See in-network deductible Out-of-network deductible is combined with in-network deductible |
|
| Coinsurance after Deductible | 30% | 30% | 40% | 40% |
| Out-of-Pocket Coinsurance Maximum | ||||
| $2,000 | $2,000 | $3,500 | $6,000 | |
| $5,000 | $5,000 | $7,000 | $12,000 | |
| Inpatient Hospital Deductible | $500/stay | $500/stay | Not applicable | Not applicable |
Out-of-network cost basis:
- CWA Unity DIRECT, CWA Unity DIRECT2019, NJ DIRECT and NJ DIRECT2019: 175% of CMS (Centers for Medicare & Medicaid Services) fee schedule. After out-of-pocket maximum is reached annually, behavioral health is reimbursed at 195% CMS fee schedule. This policy applies through 7/1/21.
- NJ DIRECT HD plans: 90th percentile of FAIR Health national benchmark. All plans with an out-of-network benefit also have specified dollar limits for out-of-network chiropractic ($35), physical therapy ($52) and acupuncture ($60).
This document is for informational purposes only and does not constitute a binding agreement. The information provided by this document is not intended to replace or modify the terms, conditions, limitations and exclusions contained within health, dental or vision benefit plans issued or administered by Horizon BCBSNJ. In the event of a conflict between the information contained in this document and your plan documents, your plan documents shall control.
Retirees: Please visit state.nj.us/treasury/pensions for information regarding available retiree plans.
This is not a complete list of all covered services. Exclusions and limitations apply to some services. Visit state.nj.us/treasury/pensions/member-guidebooks.shtml for more information.
