{"id":13281,"date":"2022-11-01T09:54:46","date_gmt":"2022-11-01T13:54:46","guid":{"rendered":"https:\/\/www.monmouth.edu\/hr\/?page_id=13281"},"modified":"2025-01-23T09:23:56","modified_gmt":"2025-01-23T14:23:56","slug":"direct-access-375","status":"publish","type":"page","link":"https:\/\/www.monmouth.edu\/hr\/benefits\/medical\/direct-access-375\/","title":{"rendered":"Direct Access 375"},"content":{"rendered":"\n<p>The Direct Access Plan 375 provides you with the flexibility to receive care from both in-network providers and out-of-network providers&nbsp;<\/p>\n\n\n\n<p>In New Jersey, members have access to all doctors, specialists and hospitals that participate in Horizon\u2019s Managed Care Network (\u201cDirect Access\u201d).&nbsp; Outside of New Jersey throughout the United States and worldwide, members have access to doctors and hospitals through the BlueCard\u00ae PPO program.&nbsp; Alternatively, members may seek treatment through any licensed provider outside of the Managed Care Network.<\/p>\n\n\n\n<p>In-network preventive care services as defined by the plan are covered at 100%, meaning there is no copay for these types of services and these services are not subject to the deductible. &nbsp;&nbsp;All other in-network services are covered at 100% after meeting the in-network deductible of $375 for an individual or $750 for those members in a two-person or family contract.&nbsp; Once the deductible is met the applicable copay for the service and\/or facility will apply.&nbsp; Copays are $20 for primary care office visit, $40 for specialist office visit and $100 for emergency room visit.&nbsp; Laboratory services must be performed at the in-network lab facility, LabCorp or Quest. Prescription copays are $10 for preferred generic drugs, $25 for preferred name brand drugs and $50 for non-preferred drugs.&nbsp; There is a mail-order option through Prime Therapeutics which can result in cost savings.<\/p>\n\n\n\n<p>For out-of-network services, you are responsible for paying the full cost of care until you reach the out-of-network deductible. You are then responsible for a portion of the cost of care (your coinsurance of 30%) until you reach the out-of-pocket maximum. Refer to the <a href=\"https:\/\/www.monmouth.edu\/hr\/documents\/direct-access-375-2025-summary-of-benefits-and-coverage.pdf\/\" target=\"_blank\" rel=\"noreferrer noopener\">Summary of Benefits and Coverage<\/a> for additional information.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The Direct Access Plan 375 provides you with the flexibility to receive care from both in-network providers and out-of-network providers&nbsp; In New Jersey, members have access to all doctors, specialists [&hellip;]<\/p>\n","protected":false},"author":11,"featured_media":0,"parent":993,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_EventAllDay":false,"_EventTimezone":"","_EventStartDate":"","_EventEndDate":"","_EventStartDateUTC":"","_EventEndDateUTC":"","_EventShowMap":false,"_EventShowMapLink":false,"_EventURL":"","_EventCost":"","_EventCostDescription":"","_EventCurrencySymbol":"","_EventCurrencyCode":"","_EventCurrencyPosition":"","_EventDateTimeSeparator":"","_EventTimeRangeSeparator":"","_EventOrganizerID":[],"_EventVenueID":[],"_OrganizerEmail":"","_OrganizerPhone":"","_OrganizerWebsite":"","_VenueAddress":"","_VenueCity":"","_VenueCountry":"","_VenueProvince":"","_VenueState":"","_VenueZip":"","_VenuePhone":"","_VenueURL":"","_VenueStateProvince":"","_VenueLat":"","_VenueLng":"","_VenueShowMap":false,"_VenueShowMapLink":false,"_mu_eop_enabled":false,"_mu_eop_name":"","_mu_eop_name_override":false,"_mu_eop_description":"","_mu_eop_description_override":false,"_mu_eop_url":"","_mu_eop_url_override":false,"_mu_eop_program_type":"","_mu_eop_educational_credential":"","_mu_eop_time_to_complete":"","_mu_eop_number_of_credits":"","_mu_eop_occupational_category":"","_mu_eop_occupational_category_code":"","_mu_eop_program_prerequisites":"","_mu_eop_application_deadline":"","_mu_eop_application_start_date":"","_mu_eop_start_date":"","_mu_eop_end_date":"","_mu_eop_day_of_week":"","_mu_eop_time_of_day":"","_mu_eop_educational_program_mode":"","_mu_eop_financial_aid_eligible":"","_mu_eop_maximum_enrollment":"","_mu_eop_offers_price":"","_mu_eop_offers_currency":"USD","_mu_eop_offers_price_per":"","_mu_eop_offers_preset":"","_mu_eop_salary_upon_completion":"","_mu_eop_training_salary":"","_mu_eop_recognized_by_name":"","_mu_eop_recognized_by_url":"","_mu_eop_concentrations":"","_mu_eop_identifier_cip":"","_mu_eop_provider_name":"","_mu_eop_provider_name_override":false,"_mu_eop_provider_url":"","_mu_eop_provider_address":"","_mu_eop_provider_city":"","_mu_eop_provider_state":"","_mu_eop_provider_zip":"","_mu_eop_provider_country":"","footnotes":""},"class_list":["post-13281","page","type-page","status-publish","hentry"],"publishpress_future_action":{"enabled":false,"date":"2026-04-30 13:11:17","action":"change-status","newStatus":"draft","terms":[],"taxonomy":"","extraData":[]},"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"_links":{"self":[{"href":"https:\/\/www.monmouth.edu\/hr\/wp-json\/wp\/v2\/pages\/13281","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.monmouth.edu\/hr\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.monmouth.edu\/hr\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.monmouth.edu\/hr\/wp-json\/wp\/v2\/users\/11"}],"replies":[{"embeddable":true,"href":"https:\/\/www.monmouth.edu\/hr\/wp-json\/wp\/v2\/comments?post=13281"}],"version-history":[{"count":8,"href":"https:\/\/www.monmouth.edu\/hr\/wp-json\/wp\/v2\/pages\/13281\/revisions"}],"predecessor-version":[{"id":15039,"href":"https:\/\/www.monmouth.edu\/hr\/wp-json\/wp\/v2\/pages\/13281\/revisions\/15039"}],"up":[{"embeddable":true,"href":"https:\/\/www.monmouth.edu\/hr\/wp-json\/wp\/v2\/pages\/993"}],"wp:attachment":[{"href":"https:\/\/www.monmouth.edu\/hr\/wp-json\/wp\/v2\/media?parent=13281"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}