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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 health coverage through the NJ state-based exchange (SBE): Go to Get Covered New Jersey or call 1-833-677-1010 (TTY 711). 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 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.

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    41 votes with an average rating of 3.8.

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    Oct 13,2022

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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. You can use the Doctor & Hospital Finder to look up the tier status for participating doctors, health care professionals and hospitals.

    OMNIA Health Plan members get the most from their benefits and lower their out-of-pocket costs by using doctors, other health care professionals and hospitals designated as OMNIA Tier 1. Members can still choose to see doctors and hospitals in Tier 2, but may pay more than they would if they had chosen a health care professional designated as OMNIA Tier 1.

    For more information about the services covered under your plan and how costs will vary based on if you see an OMNIA Tier 1 or Tier 2 doctor, hospital or other health care professional, many members can use our Treatment Cost Estimator.

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    36 votes with an average rating of 3.8.

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    Jan 20,2023

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  • Choose the type of claim you'd like to submit.

    • When you submit out-of-network medical and behavioral claims using the Horizon Blue app, you do not need to submit a claim form. Simply sign in to the Horizon Blue app and tap Claims, then Submit a Claim.

      When you submit out-of-network claims by mail, please include the appropriate claim form below and mail it, and the required information listed on the form, to the address on the form:

      1. Under Doctors & Care, click Prescriptions.
      2. If you see Go to Prime Therapeutics: Mail the Prescription Drug/COVID-19 At Home Test Kit Claim Form, and the required information listed on the form, to the address on the form. If you do NOT see Go to Prime Therapeutics: Follow the instructions on screen to be redirected to the appropriate vendor’s website, where you can find information about submitting prescription claims.

    • Complete the Claim Form - Dental and mail it, and the required information listed on the form, to the address on the form. You can submit out-of-network dental claims by mail only.

      1. Click Vision under Doctors & Care.
      2. Follow the instructions on screen to be redirected to the appropriate vendor’s website, where you can locate information about submitting vision claims.

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    29 votes with an average rating of 3.9.

    Last updated:

    Dec 20,2022

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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 for reimbursement.

    To access pharmacy claim forms, click Prescriptions under Doctors & Care. If you see Go to Prime Therapeutics: Mail the Prescription Drug/COVID-19 At Home Test Kit Claim Form, and the required information listed on the form, to the address on the form. If you do NOT see Go to Prime Therapeutics: Follow the instructions on screen to be redirected to the appropriate vendor’s website, where you can find information about submitting pharmacy claims.

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    27 votes with an average rating of 3.2.

    Last updated:

    Dec 22,2022

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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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    21 votes with an average rating of 4.2.

    Last updated:

    Nov 10,2022

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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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    10 votes with an average rating of 3.4.

    Last updated:

    Oct 31,2021

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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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    15 votes with an average rating of 4.1.

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    Jan 07,2022

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  • Medical Member ID Cards

    You can sign in to print your medical member ID card or use the Horizon Blue app within 48 to 72 hours after your enrollment has been processed. Your member ID card will be mailed within 5-10 business days after you are enrolled in your selected plan. Member ID cards are not mailed every year, but are typically mailed when you change plans, have a change in level of coverage, or if you are enrolled in an HMO plan and change your Primary Care Physician (PCP). Other situations may also apply.

    If you have a new plan and your member ID card is not available when you try to view it online, your enrollment request may still be processing. If you have questions about the status of your enrollment, use our Email Us or Chat tools and select Enrollment.

    Dental Member ID Cards

    You can sign in to view your dental ID card online or use the Horizon Blue app, unless you’re enrolled in Horizon Dental Choice. If you’re enrolled in Horizon Dental Choice, call Horizon Dental at 1-800-4DENTAL (433-6825) for additional information about dental ID cards.

    Vision Member ID Cards

    If you have a Davis Vision plan, visit davisvision.com and register for an account to view your vision plan details. For more information regarding your vision member ID card, call Davis Vision at 1-800-278-7753.

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    8 votes with an average rating of 3.5.

    Last updated:

    Dec 20,2022

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  • Yes. The Horizon Blue app provides you with 24/7 access to care, support and plan information 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 an option.

    With the Horizon Blue app, you can:

    • Submit out-of-network medical and behavioral health claims.
    • Display, download, print and share your member ID card.
    • Quickly connect with health care professionals.
    • View your claims, see how much your health plan paid, and any amount you may owe.
    • Find doctors and hospitals.
    • 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 purchased insurance for yourself or your family directly through Horizon or through the NJ state-based exchange (SBE), you can pay your premium bill online and set up Auto Pay.

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    7 votes with an average rating of 3.3.

    Last updated:

    Jan 20,2023

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  • Yes. Horizon health plans have always covered testing to diagnose a COVID-19 infection when a doctor orders the test.

    However, effective January 15, 2022, for our commercial market members, Horizon health plans will cover up to eight over-the-counter, at-home tests per member every 30 days when the tests are for personal use to diagnose a COVID-19 infection. Members do not need a doctor to prescribe these at-home tests. This coverage will be available through the end of the federal Public Health Emergency (PHE) period.

    If you purchase the over-the-counter, at-home tests to test for going to work or to school, for travel or for some other reason not related to illness, then your testing is considered for “surveillance.” These claims are not covered by your health plan.

    You can read more about this guidance from the Biden-Harris Administration online at cms.gov/files/document/11022-faqs-otc-testing-guidance.pdf

    You can also order four COVID-19 test kits per household for free from the federal government.

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    12 votes with an average rating of 3.5.

    Last updated:

    Dec 22,2022

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