• John DiMartino

NJ Direct & Freedom 0


On September 17, 2018 the SEHBP Plan Design Committee approved the implementation of a new plan option for the Active population, effective 1/1/2019. The NJ Direct 0 / Freedom 0 will be offered by both Horizon and Aetna, alongside the existing plans.

Features of the NJ Direct 0 / Freedom 0:

  • Out of Network Cost Basis: The OON Cost Basis will be 200% of CMS.

  • Eliminate Primary Care and Specialist Copays: The primary care physician and specialist copays will decrease to $0 per visit.

  • Increase Emergency Room Copays: The emergency room copay will be $50 per visit.

  • Limit Chiro and Acupuncture Therapies from OON Coverage: Plan will pay no more than $35 per visit for Chiro and $60 per visit for acupuncture or 75% of the in-network cost per visit, whichever is less.

  • Physical Therapy OON Reimbursement Change: Will be limited to the average in-network rate for physical therapy services.

  • Implement Mandatory Generic: All non-preferred drugs will be reimbursed based on their generic equivalent - members will pay the difference.

  • Implement Closed Formulary: New formulary limits access to some prescriptions, all of which have clinically-equivalent medications on the formulary

  • NJWELL Incentive Increase: All of those enrolled in this plan will now have a $500 incentive instead of a $250 incentive.

Rates for the NJ Direct 0 / Freedom 0:

Benefits Summary for the NJ Direct 0 / Freedom 0:

John DiMartino

President


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