2024 NJ SHBP State and State College/University Employees
Plans for CWA and Union Negotiated Members
Plans effective 7/1/2024 (effective 6/29/2024 for biweekly employees)
HorizonBlue.com/shbp 1-800-414-SHBP (7427)
PPO Plans
High Deductible PPO Plan
CWA UNITY DIRECT
NJ DIRECT
(employees hired prior to 7/1/19)
CWA UNITY DIRECT2019
NJ DIRECT2019
(new hires on or after 7/1/19)
NJ DIRECT HDLow
1
IN-NETWORK (IN)
Service Area Available Nationwide Nationwide Nationwide
Specialist Referral No referral required No referral required No referral required
Deductible
2
Individual $0 $100
$1,600
3
Family $0 Not applicable $3,200
3
Coinsurance 10%
4
10%
after deductible
4
20% after deductible
3
Coinsurance Out-of-Pocket Maximum
Individual $800 $800 $1,000
Family $2,000 $2,000 $2,000
Total Out-of-Pocket Maximum (Copay+Deductible+Coinsurance)
Individual $7,560 $7,560 $2,600
3
Family $15,120 $15,120 $5,200
3
HEALTH CARE SERVICES
Primary Care Ofce Visit $15 $15 20% after deductible
Annual Routine Physical (In-Network Only) $0 $0 $0
Direct Primary Care (DPC) Doctors Ofce $0 $0 Not available
First Responders Doctors Ofce (FRDOCS) $0 $0 $0
Horizon CareOnline (Telemedicine) Cost share may apply Cost share may apply Cost share may apply
Specialist Ofce Visit $30 $30 20% after deductible
Annual Routine Vision (In-Network Only) $30 $30 20% after deductible
Chiropractic
5
$30 $30 20% after deductible
Physical/Occupational/Speech Therapy
6
$30 $30 20% after deductible
DIAGNOSTIC LABORATORY
7
/RADIOLOGY/ADVANCED IMAGING
Outpatient Laboratory/Radiology/Advanced Imaging $0 $0 20% after deductible
Freestanding Laboratory/Radiology/Advanced Imaging $0 $0 20% after deductible
EMERGENCY/URGENT MEDICAL SERVICES
Urgent Care Center $45 $45 20% after deductible
Emergency Room $150
8
$150
8
20% after deductible
Ambulance 10% 10% after deductible 20% after deductible
OTHER SERVICES
Inpatient Facility $0 $0 20% after deductible
Outpatient Facility $0 $0 20% after deductible
Outpatient Behavioral Health $30 $30 20% after deductible
Durable Medical Equipment (DME) 10% 10% after deductible 20% after deductible
OUT-OF-NETWORK (OON)
10
Deductible - Individual $400 $400
See in-network deductible
11
Deductible - Family $1,000 $1,000
See in-network deductible
11
Coinsurance after Deductible 30% 30% 40%
Out-of-Pocket Coinsurance Maximum - Individual $2,000 $2,000
$3,600
Out-of-Pocket Coinsurance Maximum - Family $5,000 $5,000 $7,200
Inpatient Hospital Deductible $500/stay $500/stay Not applicable
10. 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. NJ DIRECT HD plans: 90th percentile of FAIR
Health national benchmark. All plans with an out-of-network benet also have specied dollar limits for out-of-network chiropractic ($35), physical therapy ($52) and acupuncture ($60).
11. Out-of-network deductible is combined with in-network deductible.
This is not a complete list of all covered services. Exclusions and limitations apply to some services. Visit nj.gov/treasury/pensions/member-guidebooks.shtml for more information.
You can reference HorizonBlue.com/shbp to determine your premium contribution.
Horizon Dental Choice plan available. Please visit HorizonBlue.com/shbp.
Retirees: Please visit nj.gov/treasury/pensions for information regarding available retiree plans.
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 plans issued or administered by Horizon. In the event of a conict between the information contained in this document and your plan documents, your plan documents shall control.