Your Coverage
Understanding the Horizon HMO Plan
Your Horizon HMO plan covers medically necessary care and services provided or arranged by doctors, health care professionals and hospitals participating in the Horizon Managed Care Network and the Horizon Hospital Network.
Under your Horizon HMO plan, you must select a Primary Care Physician (PCP). In general, PCPs are licensed family practitioners, general practitioners, internists, pediatricians or health care professionals specializing in obstetrics and gynecology who have passed our credentialing process. They have agreements with us to participate in the Horizon Managed Care Network.
Check your Horizon BCBSNJ member ID card or refer to your Evidence of Coverage (EOC) for specific out-of-pocket costs, benefit information and exclusions.
Understanding the Horizon HMO Access Plan
Your Horizon HMO Access plan gives you access to safe and effective care through our many programs and services, and our large networks of participating doctors, other health care professionals and hospitals. Other Horizon HMO Access features include:
- Preventive health care benefits
- Direct access to your participating Ob/Gyn
- Emergency medical care coverage
- Discounts on health products and services
Out-of-Network Doctors and Hospitals: Except for emergency care, services provided by doctors and hospitals that don’t participate with Horizon HMO Access are not covered. This Horizon HMO Access plan provides coverage for in-network services only. Unless referred by your Primary Care Physician (PCP) (if selected) and authorized by Horizon BCBSNJ (if needed), there is no out-of-network coverage. In certain circumstances, out-of-network urgent and emergency care may be covered. The general service area of your Horizon HMO Access plan is the state of New Jersey.
Understanding the Away From Home Care Program
While you are in New Jersey, your Horizon HMO plan through the Away From Home Care Program provides benefits for medically necessary, covered care and services provided or arranged by doctors and health care professionals participating in the Horizon Managed Care Network and hospitals in the Horizon Hospital Network. Your Home Blue Plan is the plan in which you are originally enrolled. Horizon BCBSNJ is considered your Host Blue Plan through the Away From Home Care Program.
While enrolled in the Away From Home Care Program, your benefits may not be exactly the same as your Home Blue Plan’s benefits. Please read all materials provided by Horizon BCBSNJ. When you return home, your benefits will revert to your original Home Blue Plan benefits.
Under your Horizon HMO plan through the Away from Home Care Program, you must select a Primary Care Physician (PCP). In general, PCPs are licensed family practitioners, general practitioners, internists, pediatricians or health care professionals specializing in obstetrics and gynecology who have passed our credentialing process. They have agreements with us to participate in the Horizon Managed Care Network.
Check your Horizon BCBSNJ member ID card or refer to your SPD or Benefit Booklet for specific out-of-pocket costs, benefit information and exclusions.
