Advantage EPO
Horizon Advantage EPO provides integrated medical and pharmacy benefits, including wellness and emergency care. In New Jersey, members have access to all doctors, specialists and hospitals that participate in Horizon BCBS’ Managed Care Network. That means access to over 6,400 Primary Care Physicians (PCPs) and over 23,500 specialists throughout the state.*
Advantage EPO also provides members with access to doctors and hospitals outside of New Jersey with BlueCard® PPO. More than 600,000 physicians and over 6,000 hospitals participate in the network, the largest health care network in the nation.*
If care is received from a nonparticipating provider, there is no benefit coverage. It is the member’ responsibility to confirm that the doctors and specialists they are seeing participate in the network. Claims will not be paid if care is received from a doctor who is not in the network.
No PCP or Referral Needed
With the Advantage EPO plan, members do not need to select a PCP, and referrals are not needed to access specialty care. Members can access any network doctor or hospital at any time and enjoy the in-network level of benefits. Although members are not required to select a PCP, there are lower out-of-pocket costs when care is coordinated through a PCP.
When in New Jersey, care must be received from doctors, hospitals and health care professionals in the Managed Care network. If members are outside of New Jersey, care should be received from a participating BlueCard PPO doctor, hospital or other health care professional.
In a life- or limb-threatening emergency, members should go to the nearest hospital regardless of their network participation status.
Easy Service—No Hassles
Horizon BCBS offers toll-free customer service Monday through Friday, 8 a.m. to 6 p.m., Eastern Standard Time, so members can get the help they need when it’s convenient for them. Members also have access to Member Online Services, where they can look up claim status and enjoy other online services designed to make their health care experience more satisfying.
Finding in-network doctors and hospitals
Members can locate in-network Advantage EPO doctors and hospitals using the Doctor & Hospital Finder.
The National Doctor and Hospital Finder or the BlueCard Access Line 1-800-810-BLUE (2583) can be used to find doctors and hospitals outside of New Jersey.
Portable Benefits Coverage
The BlueCard® PPO program links you directly to care anywhere in the country and in the world. So, whether traveling or living in another state, members can take advantage of their benefits by presenting their ID cards to any participating doctor or hospital. Once enrolled, members simply carry our easily identifiable ID cards with a PPO in a suitcase logo, which lists a toll-free number to help reach a BlueCard PPO provider.
*Numbers accurate at time of posting.