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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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    Nov 10,2022

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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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  • 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. However, 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, use our Treatment Cost Estimator.

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    22 votes with an average rating of 3.8.

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    Oct 19,2022

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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.
    • 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 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.

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    Aug 18,2022

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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 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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    24 votes with an average rating of 3.2.

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    Oct 13,2022

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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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    20 votes with an average rating of 3.3.

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    Sep 01,2022

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

    • You can submit out-of-network medical claims using the Horizon Blue App (which does not require a claim form) or by mail. This includes claims for the following:

      • Behavioral health (mental health and substance use disorders)
      • Prescriptions
      • Eyeglasses
      • Durable medical equipment like breast pumps, sleep apnea machines, diabetic supplies, orthotics, etc.


      Submitting a Medical or Behavioral Health Claim

      To submit a medical or behavioral health claim using the Horizon Blue App, sign in and tap Claims, then Submit a Claim.

      To submit a medical or behavioral health claim by mail:
       

      1. For all members except State Health Benefit Program (SHBP) or School Employees’ Health Benefits Program (SEHBP), download and complete the Horizon Health Insurance Claim Form

        For State Health Benefit Program (SHBP) or School Employees’ Health Benefits Program (SEHBP) members, download and complete the SHBP/SEHBP Medical Plan Claim Form
         
      1. Follow the instructions on the claim form to include an itemized bill. This includes:  
        • Patient name
        • Member ID number
        • Date of service
        • Diagnosis code(s)
        • Procedure code(s)
        • Place of service
        • Total charge
      1. Mail medical claims to the address on the claim form. Mail behavioral health claims to:

        Horizon Blue Cross Blue Shield
        Horizon Behavioral Health
        P.O. Box 10191
        Newark, NJ 07101-3189

       

    • You can submit out-of-network dental claims by mail only.

      For all members except State Health Benefit Program (SHBP) or School Employees’ Health Benefits Program (SEHBP), download and complete the Claim Form - Dental. Mail it to the address on the form.

      For State Health Benefit Program (SHBP) or School Employees’ Health Benefits Program (SEHBP) members, download and complete the Dental Claim Form. Mail it to the address on the form.

       

    • You can submit out-of-network prescription claims by mail only. Follow these steps:

      1. Sign in to HorizonBlue.com.
         
      2. Under Doctors & Care, click Prescriptions.
         
      3. If you see Go to Prime Therapeutics: Mail the Prescription Drug/COVID-19 At Home Test Kit Claim Form to the address on the form.
         
      4. If you do NOT see Go to Prime Therapeutics: Follow the instructions on screen to be redirected to the appropriate vendor. You can obtain the prescription claim form from their website, or call the number on your prescription drug identification card.

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    17 votes with an average rating of 3.4.

    Last updated:

    Nov 03,2022

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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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    8 votes with an average rating of 3.5.

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    Oct 31,2021

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  • The state of New Jersey offers New Jersey residents the option to order a free saliva-based PCR test, shipped directly to their homes.

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    Sep 01,2022

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  • No-cost flu shots are available to members enrolled in a Horizon medical plan.

    To get a no-cost flu shot, you must go to one of the following locations, or you can see your in-network doctor.

    If you live in New Jersey, go to one of the New Jersey pharmacies listed below:

    If you live outside of New Jersey, go to a MinuteClinic® at select CVS locations. You can also visit the Blue Cross® Blue Shield® National Doctor and Hospital Finder to find an in-network pharmacy or retail health center. Under “What are you searching for today?” click “Places by Type”. Then, type “Retail Health.”

    Pharmacies listed above are independent from Horizon Blue Cross Blue Shield of New Jersey and the Blue Cross Blue Shield Association.

    MinuteClinic® is a registered mark of CVS Caremark Corporation.

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    4 votes with an average rating of 5.

    Last updated:

    Nov 10,2022

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