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Horizon Patient-Centered Advantage EPO Plans Effective July 1, 2014

Beginning July 1, 2014, Horizon Blue Cross Blue Shield of New Jersey will offer two new Advantage EPO plans to our small group customers:

  • Horizon Patient-Centered Advantage EPO Silver.
  • Horizon Patient-Centered Advantage EPO Bronze.

These new offerings build upon our patient-centered programs, which include our participating Patient-Centered Medical Homes (PCMHs) and Accountable Care Organizations (ACOs).

These new Advantage EPO plans offer lower member cost-sharing levels to encourage enrolled members to preselect and use a Primary Care Physician (PCP) affiliated with one of our established PCMH and/or ACO practices.

While members are not required to select a PCP, members can lower their out-of-pocket costs by preselecting a PCP affiliated with one of our patient-centered programs. However, members enrolled in these plans may use any participating Horizon Managed Care Network PCP.

Horizon Patient-Centered Advantage EPO Silver and Bronze Plan Highlights:

  • Members have access to physicians, facilities and other health care professionals in the Horizon Managed Care Network.
  • No PCP selection is required. However, members pay less out of pocket when they preselect and use a PCP who participates in our patient-centered programs.
  • Eligible preventive services, screenings and immunizations are covered with no member cost share when services are received from an in-network provider.
  • Members have access to one routine physical per calendar year.
  • No referrals are required.
  • No out-of-network benefits, except in the event of an emergency.
  • Emergency coverage while traveling outside of New Jersey.
  • Member cost share for primary care and specialist visits to treat an illness or injury:

Horizon Patient-Centered Advantage EPO Silver

  • Preselected Horizon Managed Care Network Patient-Centered PCP: $20 copayment per visit.
  • Preselected Horizon Managed Care Network PCP: $2,000 individual deductible/$4,000 per family and $30 copayment per visit after the deductible has been met.
  • Nonselected Horizon Managed Care Network PCP or a participating specialist: $2,000 individual deductible/$4,000 per family and 30 percent coinsurance after the deductible has been met.

Horizon Patient-Centered Advantage EPO Bronze

  • Preselected Horizon Managed Care Network Patient-Centered PCP: $40 copayment per visit.
  • Preselected Horizon Managed Care Network PCP: $2,500 individual deductible/$5,000 per family and 50 percent coinsurance after the deductible has been met.
  • Nonselected Horizon Managed Care Network PCP or a participating specialist: $2,500 individual deductible/$5,000 per family and 50 percent coinsurance after the deductible has been met.

More detailed Horizon Patient-Centered Advantage EPO benefit information is available within the Products section of this Provider Reference Materials (PRM) page.

If you have questions about this plan, please speak with a representative within our Physician Services Department at 1-800-624-1110.

Please check our Doctor & Hospital Finder for your practice's participation status in our patient-centered programs. If you are not already participating in our patient-centered programs, please contact PCMHCentral@HorizonBlue.com for details about transforming your practice into a PCMH.

Published on: June 4, 2014, 07:42 a.m. ET
Last updated on: November 24, 2020, 23:13 p.m. ET