Eligibility to Enroll in the State Health Benefits Program

Eligibility for Dependents

  • Legal spouse
  • Same-sex domestic partner or civil union partner
  • Eligible children under age 26 (including stepchildren, foster children, adopted children or children an employee is legally required to support)

When Coverage Begins

  • Academic year 10-month employees with September 1 hire date = September 1 effective date
  • All other employees, effective after 2 months of continuous employment; i.e., August 15 hire date = October 15 effective date

Program Overview

  • Administered by OptumRx
  • Access to thousands of retail locations
  • Most pharmacies in New Jersey participate
  • Prescription copayments determined by the health plan selected

NJ Direct/NJ Direct 2019*

Retail Prescription Copayments

  • $7.00 Generic Copayment
  • $16.00 Brand Name Copayment (No generic available)
  • Member pays difference between Brand Name and Generic when Generic is available.

Mail Order Prescription Copayments

  • $0.00 Generic Copayment
  • $15.00 Brand Name Copayment (No generic available)
  • Member pays difference between Brand Name and Generic when Generic is available.
  • *Members hired before July 1, 2019, will be enrolled in NJ DIRECT.  Members hired after July 1, 2019, will be enrolled in NJ DIRECT 2019

NJ Direct 15,  Horizon HMO

Retail Prescription Copayments

  • $3.00 Generic Copayment
  • $10.00 Brand Name Copayment (No generic available)
  • Member pays difference between Brand Name and Generic when Generic is available.

Mail Order Prescription Copayments

  • $0.00 Generic Copayment
  • $15.00 Brand Name Copayment (No generic available)
  • Member pays difference between Brand Name and Generic when Generic is available.

NJ Direct 1525, Horizon OMNIA

Retail Prescription Copayments

  • $7.00 Generic Copayment
  • $16.00 Brand Name Copayment (No generic available)
  • Member pays difference between Brand Name and Generic when Generic is available.

Mail Order Prescription Copayments

  • $0.00 Generic Copayment
  • $40.00 Brand Name Copayment (No generic available)
  • Member pays difference between Brand Name and Generic when Generic is available.

NJ Direct 2030

Retail Prescription Copayments

  • $3.00 Generic Copayment
  • $18.00 Brand Name Copayment (No generic available)
  • Member pays difference between Brand Name and Generic when Generic is available.

Mail Order Prescription Copayments

  • $0.00 Generic Copayment
  • $36.00 Brand Name Copayment (No generic available)
  • Member pays difference between Brand Name and Generic when Generic is available.

NJ Direct 2035

Retail Prescription Copayments

  • $7.00 Generic Copayment
  • $21.00 Brand Name Copayment (No generic available)
  • Member pays difference between Brand Name and Generic when Generic is available.

Mail Order Prescription Copayments

  • $0.00 Generic Copayment
  • $52.00 Brand Name Copayment (No generic available)
  • Member pays difference between Brand Name and Generic when Generic is available.
  • For maintenance prescription drugs, mail order is mandatory under NJ DIRECT 2035

NJ Direct HD 4000

  • Prescription is integrated with the medical plan and subject to deductible and coinsurance

NJ Direct HD 1500

  • Prescription is integrated with the medical plan and subject to deductible and coinsurance