is nj direct a ppo?
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.
Important Note: This is a passive open enrollment! This means that if you are satisfied with your elections, there is no action required with the exception of the FSA accounts.
Important Note: Employees who have already waived coverage do not need to elect to waive each open enrollment period.
Benefitsolver is a website portal for employees to review, enroll in their health benefits, make plan changes, add new dependents, and upload documentation.
» Learn how to access Benefitsolver (PDF)
» Visit the NJ State Health Benefits Program – Virtual Benefits Fair
» SHBP – Health Plan Webinars (PDF)
*Members hired prior to July 1, 2019, will be enrolled in NJ DIRECT. Members hired after July 1, 2019, will be enrolled in NJ DIRECT 2019. **For CWA members only. Members hired prior to July 1, 2019, will be enrolled in CWA Unity DIRECT. Members hired after July 1, 2019, will be enrolled in CWA Unity DIRECT 2019.
The NJ SHBP 2023 Plan Overviews are being finalized and posted soon. The plan overviews provided by Horizon contain a side-by-side view of the basic benefits, copayments, and other out-of-pocket costs for the SHBP medical and prescription drug plans.
2023 Rate Charts are updated.
The program offers a financial incentive of $1,000 to first-time enrollees who remain enrolled for one year for all coverage levels (i.e., Single, Member and Spouse, Parent and Child, or Family coverage). The incentive is paid by gift card no later than the end of the current tax year and is deemed reportable income for tax purposes. The incentive shall be forfeited and returned to the SHBP if the subscriber fails to remain enrolled in the Tiered-Network Plan for at least one plan year. This program does not extend to children over the age of 26 or COBRA members.
Dental coverage is offered to eligible employees through the Employee Dental Plans. Six different dental plans are offered based on one of two different plan designs — Dental Plan Organizations (DPO) and a Dental Expense Plan (DEP).
Five DPOs are available:
DPOs contract with a network of providers for dental services. When an employee or dependent uses a DPO dentist, diagnostic and preventive services are covered in full. Most other eligible expenses require a small copayment. Members must use a provider participating with the selected DPO to receive coverage. Be sure to confirm that the dentist or dental facility is taking new patients and participates with the SHBP Employee Dental Plans since DPOs also service other organizations.
One PPO is available:
2023 Rate Charts are updated.
The New Jersey State Health Benefits Program (NJ SHBP) offers employees and their covered dependents the opportunity to join a Direct Primary Care doctor’s office at no additional cost. Simply choose a Direct Primary Care Doctor from Everside Health (formerly Paladina Health and R-Health) or Sanitas Medical Center and get unlimited access to personalized care with no co-pays, when and where it’s convenient for you.
» Learn more about Direct Primary Care
A wellness rewards program is offered to active employees of the public sector who participate in the State Health Benefits Program (NJ SHBP) and their covered spouses/partners.
» Learn more about NJWELL
Allows eligible full-time employees to set aside before-tax dollars to pay for certain medical, dental, and dependent care expenses, thereby avoiding federal taxes and saving money. 2023 information will be finalized and updated as soon as information becomes available.
Important Note: Enrollment in the FSA does NOT carry over from the previous year. You must complete an enrollment form. The deadline to submit is October 31st. No exceptions!!
» Tax$ave Essential Guide (PDF)
» Commuter Tax$ave Program Fact Sheet (PDF)
» Flexible Spending Account Enrollment Form (PDF)
and the doctor gave me an ultrasound.
You know, you're going to see the baby whatever,
it's going to be a normal thing.
Yeah, it's normal, until you look over and you see
it's two…it's two babies here.
I jumped up, I cried.
I called my mom crying, jumping up. I was panicking.
And she said, "Mom, it's two babies."
She's like, "What am I gonna do?"
And I started laughing immediately.
And I was like, there's two babies. I was like,
"Oh my gosh! That's such a blessing. You're blessed.
Like, don't feel nervous. You have support.
You have family that are going to be there to help you."
Hi, I'm Brielle. I'm from New Jersey, born and raised.
I'm in nursing school.
I work. And I have twin daughters.
So the first complication that I ran into was…
I was bleeding.
You never really expect to need health care until you need it.
The children needed special care and I needed special care.
I started, you know, being concerned, like hey you know,
the bills and how's the medical care going to be?
I phoned into Horizon NJ Health.
She spoke like she had children. She's been here, done that. Very nurturing,
very assured in her position, in that she can provide me with what I needed.
And she reassured me that everything was going to be taken care of.
When I realized that I wasn't on my own
with health care and medical expenses,
it took so much weight off of my shoulders.
The twins now are active. They're intelligent. They're social.
They are amazing.
Being a single mom of twins is motivation.
I have two girls. I want more for my daughters. I want to excel.
I want to be a great example.
I want them to look at me as, "My mom is strong."
So, it pushes me to show them what a successful woman can be.
And what they can grow up to be.
Medicaid does get a bad rap. Saying, you know,
"You're only going to have this."
Or you're just going to be part of the…a number.
I was definitely not a number. I was a customized experience.
I was shocked. So, I was like, okay, we're going to see how long this goes.
Is the pediatrician going to be this great?
Is the facility, the hospital going to be this great?
