Horizon HMO

Your Primary Care Physician guides and coordinates your health care, including filing your claims. When needed, your PCP refers you to specialists, hospitals, and other health care professionals available to you through your Horizon HMO plan.

As a Horizon HMO member, you have access to many health care services and programs, as well as access to one of the largest participating physician networks in the state. We offer preventive care benefits, an easy-to-use referral system, direct access to your Ob/Gyn, emergency medical care, and value-added programs.

Good health beings with your Primary Care Physician

Your Horizon HMO plan starts with your Primary Care Physician (PCP). Your PCP is a duly licensed practitioner who has entered into an agreement with us to participate in the Horizon BCBSNJ Managed Care Network and is responsible for coordinating all aspects of your medical care, including referrals to specialists, ancillary providers, or inpatient facilities. Your PCP:

• understands your medical history;
• determines the best treatment for you; and
• refers you to the right specialist in our participating network.

Easy service with no hassles

When using Horizon HMO doctors and hospitals, members have no claim forms to file and virtually no paperwork. All Horizon HMO providers handle all of the paperwork for members. Horizon BCBSNJ offers toll-free customer service Monday through Friday, 8 a.m. to 6 p.m., Eastern Time (ET), so members can get the help they need. Members also have online access to claim status and other services to help make their health care experience more satisfying.

How to locate a Horizon HMO provider

Members can locate Horizon HMO network providers with the Doctor & Hospital Finder or they can call Member Services at 1-800-355-BLUE (2583).

Portable benefits coverage

Horizon HMO covers you and your family no matter where you travel or reside temporarily — whether away for business or vacation, or for dependent children away at college. Use a nationwide network of health care professionals, the largest HMO network in the country, serving more than 250 major cities, all 50 states, and Puerto Rico. Just call the 24-hour hotline at 1-800-810-BLUE (2583).

If you're away from home for an extended time (90 consecutive days or longer), you and your family can enroll in a Blue Cross and Blue Shield-sponsored HMO in another state as a guest membership. The Guest Membership benefit allows you and your family to receive health care from a host HMO, which includes emergency care, urgent care, and routine care offered by the host HMO. The Guest Membership benefit is available in most states¹, including the District of Columbia, and is comparable to your Horizon HMO plan. Just call Member Services at the number on your ID card for information and ask about Guest Membership.

¹Excludes Alaska, Mississippi, Montana, South Dakota, Tennessee, Utah, Vermont, West Virginia, and Wyoming.

Individual & Family Summary of Benefits and Coverage