OMNIA Health Plans
OMNIA Health Plans give enrolled members the flexibility to use any hospital participating in our Horizon Hospital Network and any physician, other health care professional or ancillary provider participating in our Horizon Managed Care Network. OMNIA Health Plan members will maximize their benefits and have lower out-of-pocket costs when they use physicians, ancillary providers, hospitals or other health care professionals who are designated as OMNIA Tier 1. There are no out-of-network benefits except in cases of medical emergencies.
Features of our OMNIA Health Plans:
- Primary Care Physicians (PCPs) are not required.
- No referrals.
- Certain services/supplies require prior authorization.
- Members are covered for eligible preventive services (physical exams, well-child care, immunizations, etc.) with no member cost sharing when these services are provided by an in-network physician or other health care professional, regardless of tier status.
- No out-of-network benefits, except in cases of medical emergencies.
- Some OMNIA Health Plans include BlueCard® (out-of-area) coverage.
- Some OMNIA Health Plans are qualified High-Deductible Health Plans (HDHPs) and are compatible with or paired with a Health Savings Account (HSA).
If you participate in the Horizon Managed Care Network, you are in network with our OMNIA Health Plans, and your participation status is either OMNIA Tier 1 or Tier 2. Members will pay less out of their pocket for care when they use OMNIA Tier 1 physicians, other health care professionals, hospitals and ancillary providers.
All participating physicians and other health care professionals under a Tax ID Number (TIN) will participate with OMNIA Health Plans at the same tier.
Check the Doctor & Hospital Finder to check your tier status for our OMNIA Health Plans.
The evaluation criteria for OMNIA Health Plans is available in our Participation Status in Products that Utilize Tiering and/or a Subset of an Existing Horizon Network administrative policy.
Horizon offers a variety of OMNIA Health Plans, depending on market segments. Though many aspects of the plans are standard, OMNIA Health Plans for large group employers may be customized. Please check eligibility, plan details and member cost sharing on our Eligibility and Benefits Cost Share Estimator.
OMNIA Health Plans generally have different copay, deductible and coinsurance amounts for OMNIA Tier 1 and Tier 2 services.
- Copays for some OMNIA Health Plans apply only after the member reaches their OMNIA Tier 1 or Tier 2 deductible.
- Some OMNIA Health Plans do not include a deductible for services provided by OMNIA Tier 1 providers.
- Cost sharing for Tier 2 covered charges do not count toward the OMNIA Tier 1 deductible.
OMNIA Health Plans include separate maximum out-of-pocket (MOOP) limits for providers and hospitals in OMNIA Tier 1 and Tier 2.
MOOP limits for OMNIA Health Plans for coverage types other than Single (for example, two adults, parent + child, family) include a component for each covered person, as well as a “family” limit.
Per the Tier Awareness Policy, in-network providers must discuss the cost sharing implications of using OMNIA Tier 1 or Tier 2 providers with patients, retain documentation of the discussion in patient medical records and make it available to Horizon within 10 business days, upon request.