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Changes to Access to Health Care Information 

Applies to: All Markets

Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) respects our members’ privacy and is committed to keeping member information secure.

As the person financially responsible for the policy, a subscriber is allowed access to basic claim information for all claims submitted for payment under the policy, including claims for services that may be considered sensitive. Basic claim information includes provider names, type and date of service and cost.

However, subscribers will no longer have access to procedure descriptions, unless specific permission is granted through the Personal Representative designation process.

Letters announcing this change will be sent to impacted subscribers and adult dependents, ages 18 and older, on the following schedule:

  • Small/Midsize/Jumbo/Large/Public/Labor Markets: June 2020
  • Individual Market and SHBP/SEHBP: July 2020
  • National Accounts: August 2020

Appointing a Limited Personal Representative
Members may appoint a Limited Personal Representative to allow a designated individual, including the subscriber, to access information about their health care services and claims. To do this, members simply sign in to HorizonBlue.com, select Profiles & Settings, then Personal Representative. A form can also be downloaded from HorizonBlue.com/privacyforms and returned to the address or fax number listed on the form.

Important: A Limited Personal Representative helps a member with his or her health care and payment for health care, but is not permitted to make policy changes, unless the Limited Personal Representative is also the policy subscriber.

Members may choose to restrict or allow access to sensitive information.

What is Sensitive Information?
Sensitive information is defined as information related to HIV or AIDS, sexually transmitted disease, mental or behavioral health, substance use disorders (including alcohol abuse), genetic information and sexual health (family planning, contraception, abortion and pregnancy). Sensitive information is not disclosed to any person on the policy, including the subscriber and parents of minor children unless permission is granted or required by law. Only the member has access to the sensitive information. Horizon BCBSNJ will only disclose the name of doctors and other health care providers, which may be an indication of a sensitive service, to a subscriber or Limited Personal Representative.

If you have questions, please contact your Horizon BCBSNJ sales executive or account manager.

Published on: June 29, 2020, 02:54 a.m. ET
Last updated on: June 30, 2020, 06:50 a.m. ET