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Medical Plans
As an eligible employee, you can choose medical coverage from a selection of plans in two categories:
- NJ DIRECT 15 (administered by Horizon Blue Cross Blue Shield of New Jersey)
- One of two Health Maintenance Organizations (HMOs)
NJ DIRECT 15 (PPO)
- Benefits fall into two categories: services from preferred providers and those provided by non-preferred providers
- Preferred provider benefits are paid after $15 office visit or $50 emergency care copay
- Non-preferred provider benefits require members to meet an annual deductible. After deductibles are met, covered claims are paid at 70% of the “reasonable and customary” allowance for most services
- Members are not required to choose a primary care physician and do not need to obtain referrals
- A nationwide network of providers is available
Health Maintenance Organizations (HMO)
- Separate HMO plans administered by Aetna and CIGNA
- HMOs cover a wide range of services for preventative and diagnostic care
- Both HMO plans have a unique nationwide directory of participating providers
- Select a Primary Care Physician (PCP) to coordinate your health care
- The PCP will issue a referral if you need to see a network specialist as part of your treatment
- No deductibles or claim forms
- Standard copayments required for services
- $15 copay for visits to primary care physician and specialists
- Up to $50 copay for emergency care
| Provider Phone Numbers | |
| NJ DIRECT 15 (PPO) | 800-414-7427 |
| Aetna (HMO) | 877-STATE NJ |
| CIGNA Healthcare (HMO) | 800-564-7642 |
| Resources To Help You | |
| Benefits Specialist | 732-932-3020, ext. 4077 |
| 2008 Medical Rates | |
| Medical Plan FAQs | |
| Postdoc Fellow Health Insurance FAQs | |
| State Health Benefits Program Unified Provider Directory | |
| State Health Benefits Comparison Summary | |
| NJ DIRECT Member Handbook | |
| Aetna HMO Member Handbook | |
| CIGNA HMO Member Handbook |
