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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.

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.

Most OMNIA Health Plan members do not have out-of-network benefits for nonemergency care. However, if you or an eligible dependent will be outside New Jersey for at least 90 consecutive days, but no more than 365 days, you may be eligible to apply for the Away From Home Care Program.

Some Large Group members have access to BlueCard benefits. Check with your benefits administrator to see if this applies to your plan.

Some of the highlights of the OMNIA Health Plans are:

1. No requirement to select a Primary Care Physician;
2. No referrals to see participating specialists;
3. Lower premiums than comparable plans;
4. Lower copayments and deductibles (and in some cases, no deductibles), when using OMNIA Tier 1-designated doctors, hospitals and other health care professionals.

OMNIA Health Plans are offered statewide and give members the choice to use or receive care from any hospital in the Horizon Hospital Network and any doctor or other health care professional in the Horizon Managed Care Network. For OMNIA Health Plan members, participating doctors, hospitals and other health care professionals are grouped into two tiers – OMNIA Tier 1 and Tier 2. Members can use the Doctor & Hospital Finder to find participating doctors, health care professionals and hospitals and check the designated tier.

In an emergency, always go to the nearest Emergency Room (ER), regardless of participation. If you go to a Tier 2 or out-of-network ER for a true medical emergency, the services in the ER will process and pay as OMNIA Tier 1. Any services outside of the ER, such as professional services or hospital claims if you are admitted to the hospital, will be processed at the hospital’s/doctor’s designated tier level.

As always, in a true medical emergency you should seek immediate treatment by going to the Emergency Room (ER) or calling 911 or your local emergency response number.

OMNIA Health Plan members have access to a convenient, confidential telemedicine service, Horizon CareOnline. Through this service, you can talk with a licensed, board-certified doctor via video, chat or phone, 24 hours a day, seven days a week, no appointment needed.

Horizon CareOnline does not replace your relationship with your Primary Care Physician (PCP) or personal doctor. You can use Horizon CareOnline when:

1. Your doctor’s office is closed.
2. You feel too sick to drive.
3. You are traveling and need medical care.

For more information, once you are signed in click Doctors & Care and then click Telemedicine from the top of the screen. You can also call 1-877-716-5657.