NJ DIRECT

STATE OF NEW JERSEY DEPARTMENT OF THE TREASURY DIVISION OF PENSIONS & BENEFITS NJ DIRECT HIGH DEDUCTIBLE HEALTH PLAN MEMBER GUIDEBOOK FOR EMPLOYEES AND RETIREES ENROLLED IN THE STATE HEALTH BENEFITS PROGRAM PLAN YEAR 2022 ADMINISTERED FOR THE DIVISION OF PENSIONS & BENEFITS BY HORIZON BLUE CROSS BLUE SHIELD OF NEW JERSEY NEW JERSEY DIVISION OF PENSIONS & BENEFITS TABLE OF CONTENTS INTRODUCTION ..4 Horizon BCBSNJ Member Online Services ..5 HORIZON HEALTH guide ..6 NJWELL Rewards Program ..7 NJ DIRECT HDHP ..8 HEALTH BENEFITS PROGRAM ACTIVE EMPLOYEE ELIGIBILITY ..9 ENROLLMENT .. 10 ELIGIBLE DEPENDENTS .. 11 AUDIT OF DEPENDENT COVERAGE .. 13 MULTIPLE COVERAGE UNDER THE SHBP/SEHBP IS PROHIBITED .. 13 MEDICARE COVERAGE WHILE EMPLOYED .. 14 RETIREE ELIGIBILITY .. 14 MEDICARE COVERAGE .. 17 GENERAL CONDITIONS OF THE PLAN .. 17 Medical Need and Appropriate Level of Care .. 17 Health Care Fraud .. 18 PRECERTIFICATION OF BENEFITS IN-NETWORK AND OUT-OF- NETWORK.

Your Health Guide can work with you and your physician(s) to make sure you get the most appropriate ... Answer a few simple questions and get information on potential causes and treatments to discuss with your physician; ... Health Savings Account (HSA) and may be referred to as a Consumer Driven Health Plan

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