OMNIA℠
The OMNIA Health Plan consists of 4 tiers that provide different levels of savings:
- Inner Circle Prime
- HMH Inner Circle
- OMNIA Tier 1
- Tier 2
It gives you and your eligible dependents access to a large network of doctors, specialists, hospitals and facilities in New Jersey. You’ll enjoy the highest level of benefits at the lowest out-of-pocket costs when you use facilities, doctors and health care professionals that participate in HMH Inner Circle programs. Choose Inner Circle Prime for the greatest savings with no copays and no deductibles when you use participating doctors, hospital and other health care professionals, or Inner Circle for the same high level of benefits, with no deductible and a low copay. As part of this plan you’ll also have access to in-network coverage outside of New Jersey using BlueCard®.
There are no out-of-network benefits with this plan.
New for 2021: OMNIA℠
Annual Deductible
Inner Circle Prime | Inner Circle | OMNIA Tier 1 | Tier 2 | |
Individual | $0 | $0 | $1,500 | $2,000 |
Family | $0 | $0 | $3,000 | $4,000 |
Coinsurance
Inner Circle Prime | Inner Circle | OMNIA Tier 1 | Tier 2 |
Plan Pays 100% | Plan Pays 100% | Plan Pays 70% | Plan Pays 50% |
Out-Of-Pocket Maximum
Inner Circle Prime | Inner Circle | OMNIA Tier 1 | Tier 2 | |
Individual (Medical & Rx) | $1,000 | $1,000 | $4,000 | $5,000 |
Family (Medical & Rx) | $2,000 | $2,000 | $8,000 | $10,000 |
Lifetime Maximum | Unlimited | Unlimited | Unlimited | Unlimited |
Precertification Requirements
$400 Penalty Applies For Each Failure To Precert
Inpatient Covered Services
Inner Circle Prime | Inner Circle | OMNIA Tier 1 | Tier 2 | |
Hospital
Copay Applied Before Deductible, Per Admission |
None | None | None | None |
Semi-Private Room | 100% | 100% | 70% After Deductible | 50% After Deductible |
Inpatient Physician | 100% | 100% | 70% After Deductible | 50% After Deductible |
Surgery Direct | 100% | 100% | 70% After Deductible | 50% After Deductible |
Outpatient Covered Services
Inner Circle Prime | Inner Circle | OMNIA Tier 1 | Tier 2 | |
Primary Care Office Visit | 100% | 100% After $5 Copay | 100% After $50 Copay | 50% After Deductible |
Specialist Visit | 100% | 100% After $15 Copay | 100% After $100 Copay | 50% After Deductible |
Outpatient Surgery | 100% | 100% | 70% After Deductible | 50% After Deductible |
Preventive Care Including Routine Physicals & Immunizations Frequency Limits May Apply |
100% | 100% | 100% | 100% |
Chiropractic Care 30 Visits Per Year |
100% | 100% After $15 Copay | 100% After $100 Copay | 50% After Deductible |
Diagnostic X-Ray, Lab Services And Treatments | 100% | 100% | 70% After Deductible | 50% After Deductible |
Mental Health/Substance Abuse
Inner Circle Prime | Inner Circle | OMNIA Tier 1 | Tier 2 | |
Inpatient Care | 100% | 100% | 70% After Deductible | 50% After Deductible |
Outpatient | 100% | 100% After $5 Copay | 100% After $50 Copay | 50% After Deductible |
Emergency Services
Inner Circle Prime | Inner Circle | OMNIA Tier 1 | Tier 2 | |
Emergency Room | $0 Copay For True Emergencies $200 Copay For Non-Emergencies |
$0 Copay For True Emergencies $200 Copay For Non-Emergencies |
$0 Copay For True Emergencies $200 Copay For Non-Emergencies |
$0 Copay For True Emergencies $200 Copay For Non-Emergencies |
Ambulance Service (Medically Necessary) |
100% | 100% | 100% | 100% |
Urgent Care | 100% | 100% After $15 Copay | 100% After $30 Copay | 50% After Deductible |
Other Services
Inner Circle Prime | Inner Circle | OMNIA Tier 1 | Tier 2 | |
Physical, Occupational, Speech and Cognitive Therapy 60 Visits Per Year |
Facility - 100% Office - 100% |
Facility - 100% Office - 100% After $15 Copay |
Facility - 70% After Deductible Office - 100% After $100 Copay |
50% After Deductible |
Radiation, Chemotherapy And Cardiac Therapy | 100% | 100% | 70% After Deductible | 50% After Deductible |
Dialysis | 100% | 100% After $15 Copay | 70% After Deductible | 50% After Deductible |
Home Health Care 120 Visits Per Year |
100% | 100% | 70% After Deductible | 50% After Deductible |
Extended Care/ Skilled Nursing 120 Visits Per Year |
100% | 100% | 70% After Deductible | 50% After Deductible |
Hospice Care | 100% | 100% | 70% After Deductible | 50% After Deductible |
Durable Medical Equipment | 100% | N/A | 70% After Deductible | 50% After Deductible |
Acupuncture Includes Coverage For Pain Management | 100% | 100% After $15 Copay | 100% After $100 Copay | 50% After Deductible |