Yes, all vaccines recommended by the Centers for Disease Control and Prevention (CDC) are 100% covered. That means you will not pay any money out of your pocket to get the vaccine.

At this time, the COVID-19 vaccines will be covered 100% through in- and out-of-network doctors, hospitals, pharmacies and other health care professionals, as well as through vaccine administration sites.

This applies to all fully insured members, including those covered through Medicaid, Medicare Advantage, Individual and Small Group policies, as well as members covered by the State Health Benefits Program (SHBP) and the School Employees’ Health Benefits Program (SEHBP).

This also applies to all non-grandfathered self-insured customers. Please refer to your plan document if you are covered by your employer’s self-insured health plan. Horizon will continue to work with self-insured customers that provide coverage for their employees on their specific plan designs.

Our digital brochure provides you with information you can understand and trust about the COVID-19 vaccines.

Horizon BCBSNJ covers FDA-authorized antibody testing performed by a lab that has the appropriate Clinical Laboratory Improvement Amendments (CLIA) certification and when testing is performed consistent with the Centers for Disease Control and Prevention (CDC)’s Interim Guidelines for COVID-19 Antibody Testing ‌. Horizon BCBSNJ’s in-network labs — LabCorp, Quest and BioReference — are all CLIA certified.

The test must be for a diagnostic purpose consistent with CDC guidelines and ordered by a licensed doctor or health care professional. These CDC guidelines specifically note Serologic testing should not be used to determine immune status in individuals until the presence, durability, and duration of immunity is established. Currently, the clinical use of serologic or antibody testing for COVID-19 is to support a diagnosis of COVID-19 in patients who are seeking care late in their course of illness or in patients who are seeking care for late complications, such as multisystem inflammatory syndrome in children.

Antibody tests should not be used as a sole basis for diagnosis.

Watch this video from the FDA about antibody testing.

For most members, if your doctor determines that you should be tested for COVID-19, your out-of-pocket costs for testing will be waived. The waiver of out-of-pocket costs for COVID-19 testing is in place now and will continue at least:

• 90 days after the end of both the New Jersey public health emergency, which ended on June 4, 2021, and the New Jersey State of Emergency, which is still in effect;
  OR
• To the end of the national public health emergency, which is still in effect.

Additionally, through June 30, 2021, most members will not pay any cost share (copay, coinsurance, deductibles) for covered services related to inpatient or outpatient treatment when the primary diagnosis is COVID-19.

This information applies to all fully insured members, including those covered through Horizon NJ Health, Medicare Advantage, Individual and Small Group policies, and members covered by the State Health Benefits Program (SHBP) and the School Employees’ Health Benefits Program (SEHBP).

Horizon will continue to work with other self-insured customers that provide coverage for their employees on their specific plan designs.

COVID-19 viral testing with an FDA-authorized test is covered when performed for diagnostic purposes in health care settings, including pharmacies and drive-up testing sites.

Home test kits for members showing symptoms of COVID-19, and for members who are asymptomatic but have a known exposure to COVID-19, are also covered. However, shipping and handling, and any administration fees charged by the lab, are not covered.

Regardless of where diagnostic testing is performed — in a health care setting or pharmacy, at a drive-up testing site or through a home test kit — testing must be ordered by a health care professional.

Any test for population screening (for example, back to school or return-to-work purposes) is not covered.

Horizon BCBSNJ will waive PA requirements for:

• A visit to a primary care physician, urgent care center or ER for evaluation of upper respiratory symptoms, fever, shortness of breath or other symptoms that may represent COVID-19.
• Diagnostic tests and for covered services that are medically necessary and consistent with CDC guidance if diagnosed with COVID-19.
• Lab studies or diagnostic testing for COVID-19 required during an ER evaluation or inpatient hospital stay.

Yes. To help you get the care you need, Horizon is waiving out-of-pocket costs for covered services when provided through telemedicine for at least 90 days after the end of both New Jersey’s public health emergency, which ended June 4, 2021, and State of Emergency, which is still in effect. This means, Horizon is:

• Relaxing its telemedicine rules so members can get covered services by phone, video (including common video platforms such as FaceTime and Skype) and chat from in-network and out-of-network health care professionals.
• Waiving member out-of-pocket costs for members enrolled in a fully insured plan for covered services provided by an in-network health care professional for a telemedicine visit provided by primary care doctors, specialists, therapists, mental health and substance use treatment professionals, or urgent care doctors.
  • Members enrolled in self-insured plans can get care for covered services through a telemedicine visit, but will pay based on their plan’s provisions.
  • Members with out-of-network benefits who get care from an out-of-network health care professional will be responsible for costs according to their benefits.

We encourage you to call your in-network doctor to find out if they offer telemedicine (by phone, video or chat) as an option for you to get care. If they do, you may be able to avoid a visit to their office.

In addition, all Horizon members have free, 24/7 access to registered nurses through Chat for Care from the Horizon Blue app. Nurses are available to answer your questions about COVID-19 symptoms, as well as other health questions or concerns, and can connect you to a doctor, if needed.

Members enrolled in a fully insured plan may also call 1-888-624-3096, 24/7, to speak with a registered nurse to understand COVID-19 symptoms and other health concerns. These members will see the following statement on the back of their member ID card: Insured by Horizon BCBSNJ.

Members enrolled in the State Health Benefits Program (SHBP) or School Employees’ Health Benefits Program (SEHBP) can call 1-800-414-SHBP (7427) to access the nurse line and Horizon Health Guide services.

Testing asymptomatic individuals is not medically indicated and against the current advice of the CDC and World Health Organization.

CDC recommends voluntary home quarantine‌ for those who have traveled to/from countries where COVID-19 has spread or who have been exposed to individuals with the virus.

Health insurance contracts issued by Horizon BCBSNJ and across the industry require that employees covered by group plans be continuously active at work, be employed full time and perform the normal and customary duties of their job.

However, through June 30, 2021, unless extended, Horizon BCBSNJ:

• Is waiving the “actively at work” requirements for all group health plans impacted by COVID-19.
• Is allowing group plan sponsors to maintain coverage for furloughed, temporarily laid-off and employees whose full-time status has otherwise been reduced.

Call Horizon BCBSNJ’s Special Investigations Unit (SIU) hotline and explain what happened.

• If you are covered by Horizon NJ Health, call 1-855-372-8320.
• If you are covered by any other Horizon BCBSNJ plans, call 1-800-624-2048.

Tests for COVID-19 are not offered by phone or door-to-door. Phone calls asking for your member ID number or other information for free testing/services are likely to be scams.

Current guidance about COVID-19 testing is available on the CDC website.

No. This email is likely to be a spear phishing email that could download malicious software (malware) onto your computer without your knowledge. If that happens, cybercriminals can take control of your computer, log your keystrokes or access your personal information and financial data.

A COVID-19-themed phishing email may look like it’s from the CDC. However, there are a couple of things that should tip you off:

• Scammers purposefully create a sense of urgency, curiosity or fear to fool you into taking immediate action such as clicking on a link; this is especially true for COVID-19-themed attacks.
• Be suspicious of emails that do not use your name and contain grammatical and spelling errors.

When you’re in a rush or eager for information, it’s easy to click a link you shouldn’t. Taking a few extra seconds to stop and think is always a good idea.

Due to the national emergency related to COVID-19, during the time period between March 1, 2020 and until 60 days after the announced end of the national emergency, you have additional time beyond the usual 30-day (or 60-day, in certain circumstances) time period to file an appeal with Horizon BCBSNJ. This applies to you only if you’re covered under a group health plan subject to the Employee Retirement Income Security Act (ERISA).

If you’re enrolled in a self-insured plan, please check with your employer or plan documents for information on how this applies to you.

Due to the national emergency related to COVID-19, during the time period between March 1, 2020 and until 60 days after the announced end of the national emergency, you have additional time to file a claim with Horizon BCBSNJ. This applies to you only if you’re covered under a group health plan subject to ERISA. If you’re enrolled in a self-insured plan, please check with your employer or plan documents for information on how this applies to you.

Due to the national emergency related to COVID-19, between March 1, 2020 and until 60 days after the announced end of the national emergency, you have additional time to request a special enrollment if you’re covered under a group health plan subject to ERISA. This means that during this time period, you may elect to enroll under the group’s health plan beyond the 30- or 60-day time period usually allowed. Horizon BCBSNJ will retroactively enroll members as needed.

If you’re enrolled in a self-insured plan, please check with your employer or plan documents for information on how this applies to you.

Due to the national emergency related to COVID-19, if you are an employee of an affected group health plan and you experience a loss in coverage, you may elect COBRA coverage past the usual 60-day limit during the time period between March 1, 2020 and until 60 days after the announced end of the national emergency. Horizon BCBSNJ will retroactively enroll those individuals as needed. This applies to you only if you’re covered under a group health plan subject to ERISA. If you’re enrolled in a self-insured plan, please check with your employer or plan documents for information on how this applies to you.

On September 14, 2020, a state law went into effect affecting workers’ compensation (WC) benefits. The law created a rebuttable presumption that “essential workers” who contract COVID-19 during the public health emergency, contracted it in the workplace. This law is retroactively effective to March 9, 2020.

However, the law is no longer in effect as of June 4, 2021, now that the COVID-19 public health emergency in New Jersey has ended.

With the expiration of the law, the rebuttable presumption that “essential workers” who contracted COVID-19 during the public health emergency, contracted it in the workplace only applies for claims with dates of service March 9, 2020 through June 4, 2021.

Essential workers may still be eligible for Workers’ Compensation benefits for COVID-19 treatment now that the law has expired; however, the burden of proof for establishing compensability for a COVID-19 infection will return to the higher standard of establishing that the illness was contracted in the workplace and was work-related.

Under this law, “essential workers” include employees who, during the Governor-declared State of Emergency, are:

• Public safety workers/first responders (for example, fire, police or other emergency responders);
• Workers providing medical/health care services, emergency transportation or social services, including services in health care facilities, residential facilities or homes; and
• Workers performing services in physical proximity to members of the public and who are essential to the public’s health, safety and welfare, including transportation services, hotel and other residential services, financial services, and the production, preparation, storage, sale and distribution of essential goods such as food, beverages, medicine, fuel and supplies for conducting essential business and work at home.

For essential workers diagnosed with COVID-19, it’s beneficial to have treatment handled as a WC claim because WC covers 100% of medical costs, without copays or deductibles, from the first date of injury or illness to the date that maximum medical improvement is achieved. Under WC, this period may extend for one day or a lifetime. This is important since many COVID-19 cases appear to have long-lasting medical implications.

In addition, under WC benefits, partial wage replacement is also available.

If you are an essential worker as described above, and you have tested positive for COVID-19 and have received or need treatment for COVID-19, talk with your employer about having your case covered through WC benefits. Your employer should refer you to the company’s WC insurer who will review your case for coverage for all medical care required to treat the covered illness until you achieve maximum medical improvement. This includes medical care for “long haul” COVID-19 claims that may require treatment for months or even longer. In addition to medical care, WC benefits may also include partial wage replacement.

When getting care for COVID-19, be sure to provide your doctors with your WC carrier details so your medical bills are handled appropriately under WC insurance coverage.