Out-of-Area Plan
Our Out-of-Area Plan gives non-New Jersey residents and residents residing in remote New Jersey counties the opportunity to use Inner Circle benefits or get great care with low copays through the Horizon Managed Care network of providers. Plus, you still have access to BlueCard® network coverage outside of New Jersey.
This plan is available to New Jersey residents in these counties:
- Atlantic
- Burlington
- Camden
- Cape May
- Cumberland
- Gloucester
- Hunterdon
- Mercer
- Sussex
- Warren
Annual Deductible
| Inner Circle | Horizon PPO Network | |
| Individual | $0 | $1,500 |
| Family | $0 | $3,000 |
Coinsurance
| Inner Circle | Horizon PPO Network |
| Plan Pays 100% | Plan Pays 80% |
Out-Of-Pocket Maximum
| Inner Circle | Horizon PPO Network | |
| Individual (Medical & Rx) | $4,000 | $4,000 |
| Family (Medical & Rx) | $8,000 | $8,000 |
| Lifetime Maximum | Unlimited | Unlimited |
Precertification Requirements
$400 Penalty Applies For Each Failure To Precert
Inpatient Covered Services
| Inner Circle | Horizon PPO Network | |
| Hospital
Copay Applied Before Deductible, Per Admission |
None | None |
| Semi-Private Room | 100% After Deductible | 80% After Deductible |
| Inpatient Physician | 100% After Deductible | 80% After Deductible |
| Surgery Direct | 100% After Deductible | 80% After Deductible |
Outpatient Covered Services
| Inner Circle | Horizon PPO Network | ||
| Primary Care Office Visit | 100% After $5 Copay | 100% After $5 Copay | |
| Specialist Visit | 100% After $15 Copay | 100% After $15 Copay | |
| Outpatient Surgery | 100% | 80% After Deductible | |
| Preventive Care Including Routine Physicals & Immunizations Frequency Limits May Apply |
100% | 100% | Not Covered |
| Chiropractic Care 30 Visits Per Year |
100% After $15 Copay | 100% After $15 Copay | |
| Diagnostic X-Ray, Lab Services And Treatments | 100% After Deductible | 80% After Deductible |
Mental Health/Substance Abuse
| Inner Circle | Horizon PPO Network | |
| Inpatient Care | 100% | 80% After Deductible |
| Outpatient | 100% After $5 Copay | 100% After $5 Copay |
Emergency Services
| Inner Circle | Horizon PPO Network | |
| Emergency Room | $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% | Emergent 100% Non Emergent 80% After Deductible |
| Urgent Care | 100% After $15 Copay | 100% After $15 Copay |
Other Services
| Inner Circle | Horizon PPO Network | ||
| Physical, Occupational, Speech and Cognitive Therapy 60 Visits Per Year |
100% | 80% After Deductible | |
| Radiation, Chemotherapy And Cardiac Therapy | 100% | 80% After Deductible | |
| Dialysis | 100% After $15 Copay | 80% After Deductible | Not Covered |
| Home Health Care 120 Visits Per Year |
100% | 80% After Deductible | |
| Extended Care/ Skilled Nursing 120 Visits Per Year |
100% | 80% After Deductible | |
| Hospice Care | 100% | 80% After Deductible | |
| Durable Medical Equipment | 100% | 80% After Deductible | |
| Acupuncture Includes Coverage For Pain Management | 100% After $15 Copay | 100% After $15 Copay |
Portable Benefits Coverage
The BlueCard® PPO program links you directly to care anywhere in the country and in the world. So, whether traveling or living in another state, members can take advantage of their benefits by presenting their ID cards to any participating doctor or hospital. Once enrolled, members simply carry our easily identifiable ID cards with a PPO in a suitcase logo, which lists a toll-free number to help reach a BlueCard PPO provider.
