Horizon Value Access Plans
Our Horizon Value Access plans — Horizon Value Access Silver and Horizon Value Access Bronze — offer an affordable health care insurance solution to consumers who reside in Hunterdon, Morris, Sussex and Warren counties.
Enrolled members can receive care exclusively from a subset of providers in the Horizon Managed Care Network and Horizon Hospital Network who are located in one of the four New Jersey counties listed above.
Features of Our Horizon Value Access Plans:
- Primary Care Physician (PCP) selection is required.
- Referrals are required for certain services.
- Certain services/supplies require prior authorization.
- Horizon Value Access members must use physicians, ancillary providers and facilities, and other health care professionals, that participate specifically with the Horizon Value Access plans; all others are considered out of network. Horizon Value Access plans do not include out-of-network benefits, except in cases of medical emergencies.
Horizon Value Access plans use a subset of the providers who participate in the Horizon Managed Care Network, as well as a subset of the facilities in the Horizon Hospital Network.
Participating providers must have physical locations within Hunterdon, Morris, Sussex or Warren counties. Not all providers who participate in the Horizon Managed Care Network and who are located in this four-county area are participating in our Horizon Value Access plans.
Providers located outside this four-county area do not participate in our Horizon Value Access plans.
Participation in the Horizon Value Access plans is at the group level. All providers who bill for services under the group practice’s Tax ID Number (TIN) or Medicare ID number are considered either all participating or all nonparticipating when treating members.
The evaluation criteria for Horizon Value Access plans is available in our Participation Status in Products that Utilize Tiering and/or a Subset of an Existing Horizon Network administrative policy. To access this policy, please log on to NaviNet.net, select Horizon BCBSNJ from the My Health Plans menu and:
- Mouse over References and Resources and click Provider Reference Materials
- Mouse Policies & Procedures and click Policies.
- Click Administrative Policies.
Visit Horizon’s to Doctor & Hospital Finder check your participation status with the Horizon Value Access plans.
Hospitals that participate in the Horizon Value Access Plans
Only the following network hospitals are participating in the Horizon Value Access plans.
- Morristown Medical Center (Morris)
- Chilton Medical Center (Morris)
- Hackettstown Regional Medical Center (Warren)
- Hunterdon Medical Center (Hunterdon)
- Newton Medical Center (Sussex)
How to Determine Patient Eligibility
Please check member eligibility and plan details on NaviNet.net. You can also view the member’s ID card on NaviNet.
You can also use our Eligibility and Benefits Cost Share Estimator available on NaviNet.net to check member cost sharing responsibility for services to be provided to your Horizon Value Access patients.
To access the Eligibility and Benefits Cost Share Estimator, sign in to NaviNet.net and from the Horizon BCBSNJ plan central page:
- Select Eligibility and Benefits from the Workflows for this Plan menu
- Click on Cost Share Estimator
Sending Patients for Additional Care
Horizon Value Access plans require referrals to specialist care and other services. Participating PCPs are required to refer patients to participating Horizon Value Access specialists, other providers and facilities.