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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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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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Only members who bought their insurance directly from Horizon will be able to view tax documents online when clicking the Tax Documents tab. We mailed your Form 1095-B sometime in late January or early February.
All other members:
- If you bought insurance through GetCoveredNJ, you will receive Form 1095-A from the State. Please contact GetCoveredNJ directly if you have any questions.
- If you have insurance through your employer, you will receive Form 1095-C from your employer. Please contact your employer directly if you have any questions.
- If you don’t have fully insured coverage from Horizon, you will receive a different 1095 form from your employer or federal government. You will not see “Insured by Horizon BCBSNJ” on the back of your member ID card.
Contact your tax advisor, attorney or consult the IRS for additional questions. Horizon cannot provide tax advice.
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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:
- Merck members: Merck Health Insurance Claim Form
- Organon members: Organon Health Insurance Claim Form
- State Health Benefit Program (SHBP) and School Employees’ Health Benefits Program (SEHBP) members: SHBP/SEHBP Medical Plan Claim Form
- All other members: Horizon Health Insurance Claim Form
- Under Doctors & Care, click Prescriptions.
- 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.
- Click Vision under Doctors & Care.
- 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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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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To find out the tier of a doctor, hospital or other health care professional, use our Doctor & Hospital Finder and follow the steps below:
- Select the type of care that you are looking for.
- Enter the appropriate health plan and location, if applicable (the menu defaults to Your Plan when signed into your account).
- Type your search criteria (e.g., doctor’s name), or click Browse by Category.
- On the results page, a blue box next to the provider’s information will show if the doctor or hospital is designated as “OMNIA Tier 1” or “OMNIA 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.
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.
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Due to the end of the federal COVID-19 public health emergency, over-the-counter (OTC) tests for COVID-19 will no longer be covered beginning May 12, 2023. Please do not submit claims for OTC COVID-19 tests that were purchased on or May 12, 2023 as we will not reimburse for them.
However, if you purchased OTC COVID-19 tests out-of-pocket before May 12, 2023, you can still submit a pharmacy claim form for reimbursement for up to 12 months after the date of purchase. 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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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.
You can sign in to view your EOBs, 24/7, or view them with the Horizon Blue app.
Understanding Your Explanation of Benefits
[“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]
Sample Explanation of Benefits (EOB)
Terms used in an EOB
A. Date of Service: The date you received your care.
B. Type of Service: The service or care given to you by the provider.
C. Amount Billed: The amount charged by the provider for each service on the claim.
D. Allowed Amount: The amount the provider agrees to be paid for a specific service. It may include a deductible, coinsurance and/or copay.
E. Your Plan Paid: The total amount paid by Horizon BCBSNJ to you or the provider for the services that were covered by the plan.
F. Your Other Insurance Paid: The amount paid by another insurance carrier, if you are covered under another health insurance plan.
G. Copay: A copay is a fee that you pay each time you go to the provider. You pay the copay at the time you receive the care or service.
H. Coinsurance: The coinsurance is the amount you pay out-of-pocket after you have paid your deductible, if any. You pay the coinsurance amount directly to the provider.
I. Deductible: The amount you must pay before your plan pays for covered services. You are responsible for paying this amount directly to the provider.
J. Amount Not Covered: The fee charged for care that is not covered by your plan. You may be responsible for paying this amount in addition to any deductible, coinsurance and/or copay.
K. What You Owe: The total amount you owe the provider. The total amount includes:
- Any copay, coinsurance and/or deductible
- Costs for services you receive that are not covered by your plan
- The difference between the billed and paid amounts for out-of-network services
L. Claim Detail: These codes refer to specific messages for each claim that help explain how we processed your claim and calculated any payment.
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- How much was paid on my claim and what do I owe?
- How can I update my information about additional insurance/coordination of benefits so I know my claim will be processed correctly?
- What does it mean if my claim was denied for benefit or service excluded?
- What is a deductible?
- What is a copayment?
- What is coinsurance?
- Why can’t I view the information of another member on my policy online?
You cannot update your address using our member website or the Horizon Blue App. Instead, to request that we change the address we have on file for you, be sure to provide your name, member ID number and new address when contacting us below.
If you purchased coverage through the NJ state-based exchange (SBE): Go to Get Covered New Jersey or call 1-833-677-1010 (TTY 711).
If you purchased your insurance directly through Horizon:
- Use our Email Us tool. Under Category, choose Enrollment;
- Fax your information to 1-973-274-4413; or
- Check the box titled Report Address Change and complete the information on your invoice when sending your premium payment by mail.
State Health Benefits Program (SHBP) and School Employees’ Health Benefits Program (SEHBP) members except for Rutgers employees:
Log into Benefitsolver, a tool of the SHBP/SEHBP via your MyNewJersey account. Rutgers employees must update their address and phone number directly with Rutgers.
Medicare Supplement members (other than SHBP and SEHBP members):
- Use our Email Us tool. Under Category, choose Enrollment; or
- Send a written request to: Horizon, PO Box 10138, Newark, NJ 07101
For other members with coverage through an employer not mentioned above: You may need to work directly with your employer’s benefits administrator or human resources department to update your mailing address. If you are not sure if this applies to you or if you need additional help, contact us through our Email Us or Chat tools. We will let you know if you need to contact your employer directly, or if we can make the change.
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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?
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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Can't Find an Answer to Your Question?
Browse our Help Center categories and topics. For questions about your medical plan or technical support, sign in to send us an email or start a live chat. For other questions, visit the Contact Us information page on HorizonBlue.com.