Your Horizon HMO Access plan offers coverage at in-network hospitals in New Jersey and in certain Pennsylvania and Delaware counties.
Except for emergency care, services provided by hospitals that do not participate in the Horizon Hospital Network are not covered. You’ll be responsible for the total cost of any services you get from out-of-network hospitals, except in an emergency.
For details about hospital coverage and your out-of-pocket costs under your plan, please refer to your SPD or Benefit Booklet.
Hospital Stays and Prior Authorization
If you need to be hospitalized, your PCP or in-network specialist “must contact us for prior authorization”. Once your hospital stay is authorized, we will give your PCP or specialist a prior authorization number.
For all elective services, it’s your responsibility to ensure that all authorizations and referrals are on file with Horizon BCBSNJ prior to getting those services.
If you need emergency care, go directly to the nearest hospital or emergency facility without worrying about in-network status or call 911. If you are admitted to the hospital, you or the hospital’s admitting staff must call to let us know.
Maternity Hospital Stays
New mothers are certified for a hospital stay of 48 hours following a vaginal delivery or 96 hours following a cesarean section (c-section) delivery. Your hospital stay may be extended if your doctor thinks it's medically necessary. To be covered, your doctor will need to contact us for approval of the additional days.
Your doctor may decide that you're ready to leave the hospital early – within one day after a vaginal delivery or within two days after a c-section delivery.
If you do leave early, you are eligible for a home care visit to support your move from hospital to home. To be covered, your Ob/Gyn must schedule the visit to occur within seven days for a nurse/lactation consultant and 14 days for a home health aide, after you’ve left the hospital.