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  • Your EOB or Explanation of Benefits gives you an overview of the claim, including who provided the care, how much was billed, how much your plan covered, and how much you may owe.

    After you visit a doctor, other health care professional, laboratory or hospital, an EOB is generated for you. If your health care provider participates in Horizon’s networks, the claim is submitted to Horizon for you. But if you go to an out-of-network health care provider, you may need to submit the claim yourself.

    An EOB is not a bill. It tells you what costs are covered for medical care or services you’ve received.

    Understanding Your Explanation of Benefits

    Video Transcript

    [“Understanding Your Explanation of Benefits” title and Horizon Blue Cross Blue Shield of New Jersey logo]

    Each time you use your health plan to get care, you’ll get information about the claim your doctor submitted.

    This information is called an “Explanation of Benefits” or EOB.

    Your EOB gives you an overview of the claim, including who provided the care, how much was billed, how much your plan covered, and how much you may owe.

    Your EOB also gives you detailed information about your claim.

    This section lists additional information, including other insurance plan payments, if you have other coverage, and how much you are responsible for paying as a copay, coinsurance or deductible.

    It also lists any “Amount Not Covered,” which may be costs billed by your doctor that are not covered by your plan.

    All of these amounts are included in “What You Owe.”

    Remember: Your EOB is not a bill, so don’t take out your checkbook just yet. Wait until you get a bill from your doctor to pay exactly what you owe.

    You can view your EOBs, 24/7, by signing on to HorizonBlue.com or the Horizon Blue app.

    If you have a question about your benefits or your EOB, sign in to HorizonBlue.com to email your question or chat with us, or give us a call. [1-800-355-BLUE (2583)]

    To learn more, visit “What Happens After My Appointment” at HorizonBlue.com. [HorizonBlue.com/AfterMyAppointment]

    [Horizon Blue Cross Blue Shield of New Jersey logo and disclaimer]

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    Jul 04,2022

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  • A deductible is the amount you must pay each year for covered charges before benefits are paid by your plan.

    What is a deductible?

    Transcript

    Health insurance jargon is confusing. We feel your pain.

    And while there may not be a way around the word deductible, there is a way through it.

    A deductible is the amount of money you have to pay before health insurance kicks in and starts paying for medical treatment and services.

    This is Jill. Jill has a $1,000 annual deductible.

    Let’s say Jill falls out of a tree and breaks her arm. 

    She goes to her In-Network doctor and gets a bill for $700.

    Jill will pay all $700 herself.

    She still has $300 bucks left to meet her annual deductible for the year.

    No insurance help yet.

    In June, Jill twists her ankle while walking her dog.

    This time her bill is $500.

    Since Jill only has $300 to go to meet her deductible, her insurance covers the remaining $200.

    However, some plans may include coinsurance and that will change the amount you owe.

    Jill has now meet her Deductible. For the remainder of the year, Jill won’t have to pay towards her deductible. Horizon will start paying for all eligible services with the exception of your copay and/or coinsurance.

    But in January, it starts all over again.

    It is important to know that your Deductible is different than your copayment and coinsurance. Not all plans include all three types of member responsibility.

    In Jill’s case, she had a copayment at the time she visited her doctor to fix her ankle that she paid in addition to the $300 payment that went to the Deductible.

    Your plan may have a deductible, copayment and/or coinsurance.

    To learn more about your plan, how much you have contributed to your deductible this year, and to verify your deductible, copayment and/or coinsurance amounts, visit HorizonBlue.com/members.

    You can also get answers to your questions by reading our FAQs, sending us a question through Message Center or asking a question through chat.

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    Jan 07,2022

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  • Yes, with the Horizon Blue app, you get 24/7 access to your plan information, care and support from your smartphone or other mobile device.

    To get the app, text GetApp to 422-272 or visit the App Store® or Google Play™. There is no cost to download the Horizon Blue app, but rates from your wireless carrier may apply.

    To sign in to the app, enter the username and password that you used to register for HorizonBlue.com and click Sign In. Biometric sign in (fingerprint or facial recognition) is also available on the Horizon Blue app.

    With the Horizon Blue app, you can:

    • Display, download, print and share your member ID card.
    • Quickly connect with health care professionals.
    • Check your notifications.
    • View your claims to see how much your health plan paid and any amount you may owe.
    • Find doctors and hospitals, and even schedule appointments.
    • Check if a specific treatment or service is covered.
    • Track your deductible, if applicable, and maximum out-of-pocket costs.
    • Email or Chat with a Member Services Representative to get answers to your questions.
    • If you are an Individual, Medicare Supplement or Medicare Advantage member who purchased insurance for yourself or your family directly through Horizon BCBSNJ or through the NJ State Based Exchange (SBE), you can pay your premium bill online and set up Auto Pay.

    For website or app-related questions or technical issues, please contact the eService Desk by:

    1. Calling 1-888-777-5075, weekdays between 7 a.m. and 6 p.m., Eastern Time (ET); or
    2. Signing in and clicking Email Us or Chat then Technical Support. (Please note: Some members may not have access to all support options.)

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    Last updated:

    Jan 06,2022

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  • For members with coverage through an employer: Contact your employer’s benefits administrator or human resources department to cancel your coverage.

    If you purchased your coverage through the Exchange (the federal Marketplace): Go to HealthCare.gov or call the Exchange Call Center at 1-800-318-2596 to cancel your coverage. Please provide the Exchange at least 14 days advance notice of when you want to terminate your coverage.

    If you purchased your health coverage through the NJ State Based Exchange (SBE): Go to Get Covered New Jersey or call 1-800-224-1234 to cancel your coverage. Please provide the SBE at least 14 days advance notice of when you want to terminate your coverage.

    If you purchased your coverage directly through Horizon BCBSNJ and not through the Exchange (the federal Marketplace) or the NJ State Based Exchange (SBE): You can voluntarily terminate your coverage at any time for any reason with a future termination date. Complete the Request for Termination Form and submit it using one of the options on the form.

    Horizon BCBSNJ sells a number of insurance plans. For help selecting a different Horizon BCBSNJ plan, call 1-888-765-7786.

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    7 votes with an average rating of 2.8.

    Last updated:

    Oct 30,2021

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  • With our OMNIA Health Plans, doctors and other health care professionals in the Horizon Managed Care Network and all hospitals in the Horizon Hospital Network are placed into one of two tiers – OMNIA Tier 1 or Tier 2. Members can use theDoctor & Hospital Finderto find participating doctors, health care professionals and hospitals and their designated tier.

    OMNIA Health Plan members maximize their benefits and lower their out-of-pocket costs by using the doctors, specialists, other health care professionals and hospitals designated as OMNIA Tier 1. However, members can still choose to see doctors and hospitals in Tier 2, but they will not have the same cost-saving opportunities that they would if they had chosen a 1 health care professional designated as OMNIA Tier 1.

    All ancillary providers are considered OMNIA Tier 1; however, exceptions may apply when an ancillary provider shares a Tax Identification Number (TIN) with a Tier 2 hospital-owned practice.

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    Oct 31,2021

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  • To find out the tier of a doctor, hospital or other health care professional, visit our Doctor & Hospital Finder and:

    1. Under “What type of care are you looking for?”, choose between Medical, Behavioral Health, Dental or Vision.
    2. Select the appropriate OMNIA health plan and location, if applicable (when you are signed in, the menu defaults to Your Plan).
    3. Begin typing in search criteria, such as the doctor’s or health care professional’s last name, or name of the hospital, or the specialty. Click from the results that best matches your input.
    4. The results page will only show those health care professionals who accept your OMNIA Health Plan and meet the search criteria you set. The results will also show if the doctor or hospital is designated as OMNIA Tier 1 or Tier 2. Be sure to check the health care professional’s tier status for each office location. Some health care professionals may be part of more than one group practice. You can also find out who is joining and leaving the plan.
    5. Click View Profile to find out more about a doctor, other health care professional or hospital. The profile includes group affiliation, specialty, hospital affiliation, information on the plan selected and more. You can even have the name, address and phone number texted to your mobile or web-enabled device.¹

    Members in an OMNIA Health Plan can receive eligible care or services from any doctor or other health care professional in the Horizon Managed Care Network and any hospital in the Horizon Hospital Network. However, when members choose doctors, other health care professionals or hospitals designated as OMNIA Tier 1, they will maximize their benefits and pay less out-of-pocket. Doctors, other health care professionals and hospitals that do not participate in the Horizon Managed Care Network or Horizon Hospital Network will not display in the search results.

    ¹ Text messaging and data charges from your mobile carrier may apply.

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    4 votes with an average rating of 4.

    Last updated:

    Oct 31,2021

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  • Addresses cannot be updated on our member website.

    If you purchased your insurance through the Exchange (federal Marketplace): All address change requests must be processed through your account at HealthCare.gov or by calling the Exchange call center at 1-800-318-2596. If you use TTY services, please call: 1-855-889-4325.

    If you purchased coverage through the NJ State Based Exchange (SBE): Go to Get Covered New Jersey or call 1-800-224-1234.

    For members with coverage through an employer: You may need to work directly with your employer’s benefits administrator or human resources department to update your mailing address. If you are uncertain if this applies to you, you can sign in to your account and contact us through our Email Us or Chat tools. We will let you know if you need to contact employer directly, or if we can process the change. Please ensure that your employer’s benefits administrator or human resources department is made aware of the updates you make with Horizon BCBSNJ.


    For all other members (except Medigap): To request that we change the address we have on file for you, please submit the following information:

    • Name
    • Horizon BCBSNJ ID number
    • New address
    • Specify whether this is a residence, temporary or billing address change

    To submit the address change information, you can:

    • Sign in to your account and click Email Us. Under Category, choose Enrollment.
    • Fax your information to 1-973-274-4413. Remember to include your Horizon BCBSNJ member ID number.
    • For Individual Consumers who do not have coverage through the Exchange: In addition to the options above, you can also change your address by checking the box titled Report Address Change and completing the information on your invoice when sending your premium payment by mail.

    For Medigap members: To request that we change the address we have on file for you, please submit the following information:

    • Name
    • Horizon BCBSNJ ID number
    • New address
    • Specify whether this is a residence, temporary or billing address change

    To submit the address change information, you can:

    • Sign in to your account and click Email Us. Under Category, choose Enrollment.
    • Call our toll-free number at 1-888-276-4299. Remember to include your Horizon BCBSNJ member ID number.
    • Send a written request to:
    • Horizon BCBSNJ
      PO Box 10138
      Newark, NJ 07101

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    10 votes with an average rating of 2.9.

    Last updated:

    Jan 11,2022

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  • Submit your claim with the Horizon Blue App in a few easy steps.

    • An itemized bill includes:

      • Patient name
      • Member ID number
      • Date of service
      • Diagnosis code(s)
      • Procedure code(s)
      • Place of service
      • Total charge

      For Medicare claims, you must include a Medicare Explanation of Benefits (EOB). An Explanation of Benefits (EOB) is the notice that your Medicare Advantage Plan or Part D prescription drug plan typically sends you after you receive medical services or items. You only receive an EOB if you have Medicare Advantage or Part D. An EOB is not the same as a Medicare Summary Notice. It is also important to remember that an EOB is not a bill.

      You cannot use the Horizon Blue app to take pictures.

    • When you open the Horizon Blue App, access the menu and tap on Submit a Claim.

    • Upload photos of the claim form and other supporting documents, such as an itemized bill or receipts. You can submit multiple images per claim.

    • Before you submit your claim, you'll be asked to confirm the photos you selected.

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    6 votes with an average rating of 3.7.

    Last updated:

    Jan 07,2022

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  • You must download and use the Horizon Blue app to submit an out-of-network claim electronically.

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    4 votes with an average rating of 3.

    Last updated:

    Jan 07,2022

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  • If you buy eligible tests at the retail pharmacy counter or have them shipped to you from a retail pharmacy, you do not need to submit claims.

    If you choose to pay out-of-pocket and buy tests to diagnose a COVID-19 infection outside of the arrangements we make for you, you will need to submit a pharmacy claim form to Prime Therapeutics LLC for reimbursement. You will be reimbursed for the cost of the test or $12 per test, whichever amount is lower.

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    8 votes with an average rating of 3.5.

    Last updated:

    Apr 25,2022

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