NJ FamilyCare

Nothing is more important than the health and well-being of you and your baby. That's why our plan benefits include:

• Choice of Doctor. Find an OB-GYN you trust in our network.
• Prenatal Visits. Care for you before your baby is born.
• Healthy First Steps®. Get extra support to help you and your baby stay healthy.
• Choice of Birth Center. Pick from over 100 network hospitals across New Jersey.

If you have asthma, diabetes or another long-term condition, you can depend on us. Our plan makes sure you get the care, support and services you need. Benefits include:

• Case Management. Personal support from an experienced professional.
• Diabetic Supplies. Insulin, needles and more ordered by your doctor.

Make sure your sight, teeth, speech and hearing are at their best. Benefits include:

• Vision. Routine exams and help paying for eyeglasses and contact lenses.
• Dental. We cover cleanings, checkups and dental work.
• Hearing. Tests, check-ups and hearing aids are covered (some limitations apply).

Understanding Dental Coverage - English Spanish

Get the medical care and equipment you need to recover safely at home. Benefits may include:

• Equipment and Supplies. In-home medical and safety equipment are covered.
• Nurse Visits. Medical care to help you safely recover at home.
• Chore Services. Someone to do your errands, cleaning or laundry.
• Personal Care. Someone to help with dressing, bathing and feeding if needed.

Sometimes you might need a little extra help using your health plan. For those times, you can rely on:

• Interpreters. An interpreter can go with you to medical visits.
• Member Services. Your benefit questions are answered 24/7

The MLTSS program is focused on serving frail, elderly, and disabled individuals. This program combines traditional health care benefits (doctor visits, hospital stays, labs) and long term services and supports (providing help in home or community with daily living activities) such as:

• Care Management. Someone to get you the care and support needed.
• Home and Vehicle Modifications. In-home medical and safety equipment are covered, plus needed modifications to a vehicle.
• Home Meal Delivery. If you can't safely make meals, we'll provide them.
• Mental Health & Addiction Services. Counseling and other treatments are covered.
• Personal Emergency Response System. Sends an urgent request for someone to help you.
• Adult Day Care. Friendship and social activities in a safe setting.
• Respite Care. In-home help to give your caregiver a rest.
• Personal Care. Someone to help with dressing, bathing and dining.

Learn more about the MLTSS program here

Companionship is important. Adult day care provides care and companionship for seniors who need extra help during the day.

Caregivers also benefit, knowing their loved one is well cared for and safe during the day.

Services will vary by the member's coverage type and may include:

• Social connections and friendship.
• Bathing and personal care.
• Meals.

For MLTSS members: Caring for a loved one or a friend is an act of love and devotion. It can also leave the caregiver emotionally and physically exhausted.

Our workshops teach:

• Caregiving basics.
• Healthy eating and help with eating.
• Health insurance basics.
• How to care for yourself while caring for a loved one.
• Caring for a loved one with dementia or Alzheimer's disease.

Along with instruction, caregivers have an opportunity to socialize with others and build a network of support.

Do you or a loved one have a serious health problem or a high-risk pregnancy? If so, our care managers are in your corner. They will:

• Explain medical terms in plain language.
• Coordinate your doctor appointments.
• Provide your care team with your medical records.

Your care manager will stay close by throughout the medical journey. He or she will:

• Think beyond your immediate medical needs.
• Make sure you have support at home, so you can focus on getting better.

You or your child gets a primary care provider (PCP) who is your main doctor. Use the Doctor Lookup tool to see if your doctor is in our network.

If you don't have a doctor, or if your doctor is not in our network, we can help you find a new one close to you.

Your PCP is your main doctor for:

• Preventive care.
• Treatment if you are sick or injured.
• Referrals to specialists for certain conditions.

Where you have your baby is an important choice. That's why you can pick from 100 network hospitals across New Jersey.

We also encourage you to tour the hospital's birthing center. This way you will be familiar with it. And you'll be more relaxed when you have your baby.

For MLTSS members: We want to help you live in the place that is right for you. If needed, our plan will help cover the cost of moving from a nursing facility into your community.

Covered items can include:

• Household goods.
• Security deposit.
• Utility deposit.
• Your first week of food, as needed.

If you are having difficulty performing day-to-day household activities, chore services can step in. They can take on the routine tasks that may be hard for you to do on your own.

Services will vary by the member's coverage type and may include:

• Running errands.
• Cleaning the house.
• Doing laundry.
• Preparing meals.

Routine exams and cleanings every six months help keep teeth and gums strong and healthy. If there is a dental problem that needs to be fixed, that's covered as well. If approved, the plan covers:

• Crowns and bridges.
• Dentures.
• Oral surgery and root canals.

Understanding Dental Coverage - English Spanish

If you have diabetes, you may need insulin, needles, wipes and glucose strips. If medically necessary, we cover all that and more.

Our plan also steps up with services to help you manage your diabetes, including:

• Classes on keeping diabetes in control.
• Coordinating doctor care.
• Meal planning and food choices.

Your health and safety at home are important.

Our plan covers medical equipment ordered by your doctor or case manager. This includes items like:

• Hospital beds.
• Oxygen tanks.
• Wheelchairs or wheelchairs.

Trouble hearing can affect your everyday life in many ways. Our plan includes services and support to help protect your hearing.

We cover:

• Exams, therapy and tests.
• Hearing aids and batteries.

Some limitations apply.

The Healthy First Steps team is here for you. Our program will help you take the right steps to keep you and your baby healthy. 

We will help you:

• Choose a pregnancy provider and a pediatrician (child’s doctor).
• Schedule visits and exams and arrange rides to your visits.
• Get supplies, including breast pumps for nursing moms.
• Connect with community resources such as Women, Infants and Children (WIC) services.

For MLTSS members: Taking care of the basics, like cooking, can be hard to do yourself after an illness or sickness. That's why we'll bring nutritious meals to you to help you through tough times. You can get up to 1 meal delivered per day, if needed.

Our plan pays for all expenses related to a hospital stay, so you can rest and heal.

Our plan covers:

• Nursing care.
• Room and board.
• Supplies and equipment.
• Treatment and therapies.
• Diagnostic tests and exams.

And after you leave the hospital, you are not alone. We make sure you get follow-up care to continue healing at home.

Your doctor and you need to understand each other. Not speaking English well makes this difficult. We can arrange for a medical interpreter to be at your appointment.

We also have people at our phone centers who speak more than one language. Chances are, we have someone who speaks your language.

Knowing what's wrong and finding it early can make all the difference.

• Labs and testing.
• X-rays, scans and other imaging.

We'll help you get the information needed to improve your health or be at your best.

Our plan includes medicines and refills for prescriptions written by your doctor or specialist. Thousands of drugs are covered.

We also cover some over-the-counter medicines with a written order from your doctor.

And we make getting your medicine easy. You can fill your prescriptions at:

• Local pharmacies in our network.
• Services that deliver right to your door.

Sometimes you might need a little help understanding your health care options. With us, you have someone you can call 24/7. We'll answer your questions simply and completely.

We can also help you find:

• Doctors.
• Pharmacies.
• Hospitals or other health facilities.
• Local resources.

Sometimes you may need continued care after you leave the hospital or urgent care center. If your health is at risk after a serious illness, surgery or injury, a nurse will visit you at home to:

• Provide medical care for you.
• Answer your questions and concerns.

Sometimes the basics are hard to do yourself after an illness or injury.

Services will vary by the member's coverage type and may include:

• Dressing.
• Bathing.
• Feeding.

A pregnancy is a journey you'll want to make with the help of friends, family and a pregnancy doctor, or OB-GYN.

All of your recommended prenatal clinical visits and tests are covered.

At these visits, the clinic will:

• Make sure you and your baby are healthy.
• Explain what to expect at each stage of your pregnancy.
• Answer your questions.

For MLTSS members: Do you have family members or friends who care for you at home? If so, we want to support their hard work too. That's why we provide respite care to give your caregivers a rest. Respite care offers caregivers time away from their loved one who is ill or has special care needs.

Routine shots help keep you healthy.

Our plan covers:

• Recommended shots and vaccines.
• Diagnostic tests and exams.

Physical, occupational and speech therapy can help you recover from a serious injury or illness, or simply reach your full potential.

Our plan provides:

• Occupational therapy.
• Physical therapy.
• Speech therapy.

You may have an injury or sudden illness that is not life-threatening but needs immediate attention.

Our plan covers care at:

• Urgent care centers.
• Medical aid units.
• Other walk-in clinics.

You'll get the care, eyeglasses and treatment that let you see life more clearly.

Coverage includes:

• Routine exams.
• Help with paying for eyeglasses and contact lenses.

This benefit is offered by March Vision.

Well visits with your doctor can help keep you healthy. These visits can catch health problems early, so they can be treated.

Preventive services include:

• Checkups for adults and children.
• Well-baby care.
• Care for women expecting a baby.
• Routine shots and tests.
• Mammograms.

There are no copayments for preventive care.