How can we help?

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.

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.

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.

The following health systems, their aligned doctors and a multispecialty physician group have joined Horizon BCBSNJ to form the OMNIA Health Alliance:

• AtlantiCare
• Atlantic Health System
• Hackensack Meridian Health
• Hunterdon Healthcare
• Inspira Health Network
• RWJBarnabas Health
• Summit Medical Group

For a complete list of hospitals in the Horizon Hospital Network, visit the Doctor & Hospital Finder. You will need to select your Horizon BCBSNJ plan from the drop down menu to complete your search.

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 a line of products designed to support Horizon BCBSNJ’s efforts to improve the quality of care our members receive, enhance their overall patient experience and lower the total costs of care. With the OMNIA Health Plans, members have access to all the doctors and other health care professionals in the Horizon Managed Care Network and hospitals in the Horizon Hospital Network. OMNIA members also have the option to save on out-of-pocket costs when they use doctors, other health care professionals and hospitals designated as OMNIA Tier 1.

The OMNIA Health Plans are a part of Horizon BCBSNJ’s portfolio of plans that we offer to our customers.

The OMNIA Health Alliance is changing health care in New Jersey by providing organized, personalized and coordinated care, powered by the secure sharing of information, processes and best practices to help our members get and stay healthy.

Population health management is a term that describes a model of care where doctors and other health care professionals are responsible for the outcomes of a group of patients (or a population). If, on average, the doctors deliver high quality, efficient care to a population, they are rewarded for their high performance.

The idea behind population health management is to encourage doctors and other health care professionals to keep their patients healthy, thereby reducing the unnecessary use of expensive services, like Emergency Room visits, hospitalizations and multiple office visits.

Population health management offers consumers:

1. Improved clinical outcomes – Tighter coordination of care, supported by enhanced data integration and collaboration.
2. Better patient experience – Increased efficiency to ensure consumers get the right care, at the right time, in the right setting.
3. Lower cost of care – A new model of care focused on value rather than volume.

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.