OMNIA℠ Health Plan
The OMNIA Health Plan offers you the benefits of patient-centered care, along with access to all healthcare professionals in the Horizon Managed Care Network. Coverage levels vary depending upon what providers are used.
There is generally no cost to you when you use Domestic Providers - this includes RWJBarnabas Health facility costs, office visits to a physician in the RWJBarnabas Health Medical Group, RWJ Physician Enterprise, or for services from a provider that is employed by RWJBarnabas Health.
The Inner Circle of providers is inclusive of healthcare providers that are affiliated with our healthcare system - doctors that have admitting privileges and work closely with RWJBarnabas Health (but are not employed by RWJBarnabas Health).
Participants may also use the Horizon OMNIA Tier 1 network of participating OMNIA Alliance providers. You can also access the Horizon Tier 2 network in New Jersey and National Blue Card network (for coverage outside of New Jersey). This plan does not provide out-of-network benefits.
|Domestic Tier/Inner Circle||OMNIA℠ Tier 1||Tier 2 (BlueCard® network outside of NJ)||
Generally pays benefits only for services provided by RWJBarnabas Health facilities and employed physicians, as well as an RWJBarnabas Health-affiliated physician or facility
Using providers in this tier provides you with the lowest out-of-pocket costs
Pays benefits for services provided by physicians and facilities that participate in the Horizon OMNIA Tier 1 network
Covers services provided by the remaining physicians and facilities in the Horizon Blue Cross Blue Shield Direct Access Network in New Jersey. Outside of NJ, it covers providers in the national BlueCard network
NOTE THAT THERE IS NO OUT-OF-NETWORK COVERAGE, EXCEPT IN THE CASE OF AN EMERGENCY
Check your member ID card or refer to your benefit booklet for specific out-of-pocket costs, benefit information and exclusions.