OMNIA℠ Health Plan
This plan is available to all State and State College/University Employees.
Our OMNIA Health Plan puts you in control.
This plan is available to all State and State College/University Employees.
In addition to having some of our best benefits, this plan gives you the flexibility to choose from New Jersey’s largest networks: 54,000 local doctors, specialists and other health professionals, and 87 hospitals in 106 convenient locations across New Jersey and parts of Pennsylvania and Delaware.* You also have worldwide access to over 1.7 million providers in our BlueCard® PPO program.
Want to save even more on out-of-pocket costs? Choose from over 41,000 OMNIA Tier 1 doctors and some of the state’s leading hospitals for lower copays, lower out-of-pocket costs and no deductibles.*
All with no referrals and no need to choose a Primary Care Physician.
Employees who enroll in the OMNIA Health Plan for the first time and participate in the plan for at least one Plan Year may be eligible to receive an incentive. Learn if you’re eligible.
IN-NETWORK (IN)
| Tier 1 | Tier 2 | |
|---|---|---|
| Service Area Available | NJ only | Nationwide |
| Specialist Referral | No referral required | No referral required |
| Deductible Deductible applies to all services that require a coinsurance. |
||
| $0 | $1,500 | |
| $0 | $3,000 | |
| Coinsurance | 0% | 20% after deductible |
| Coinsurance Out-of-Pocket Maximum | ||
| n/a | $4,500 | |
| n/a | $9,000 | |
| Total Out-of-Pocket Maximum (Copay+Deductible+Coinsurance) | ||
| $2,500 | $4,500 | |
| $5,000 | $9,000 | |
HEALTH CARE SERVICES
| Tier 1 | Tier 2 | |
|---|---|---|
| Primary Care Office Visit | $5 | $20 |
| Annual Routine Physical (In-Network Only) | $0 | $0 |
| Direct Primary Care (DPC) | $0 | $0 |
| First Responders Docs (FRDOCS) | $0 | $0 |
| Horizon CareOnline (Telemedicine) | Cost share may apply | Cost share may apply |
| Specialist Office Visit | $20 | $35 |
| Annual Routine Vision (In-Network Only) | $20 | $35 |
| Chiropractic 25 visits per calendar year |
$20 | $35 |
| Physical/Occupational/Speech Therapy 30 visit maximum each per calendar year |
$20 office visit $20 outpatient facility |
$35 office visit 20% after deductible at an outpatient facility |
DIAGNOSTIC LABORATORY/RADIOLOGY/ADVANCED IMAGING
Laboratory services must be rendered by an in-network participating provider, with some exceptions based on medical policy.
| Tier 1 | Tier 2 | |
|---|---|---|
| Outpatient Laboratory/Radiology/Advanced Imaging | $20 | 20% after deductible |
| Freestanding Laboratory/Radiology/Advanced Imaging | $0 | $0 |
EMERGENCY/URGENT MEDICAL SERVICES
| Tier 1 | Tier 2 | |
|---|---|---|
| Urgent Care Center | $35 | $50 |
| Emergency Room | $100 | $100 |
| Ambulance | $0 | $0 |
OTHER SERVICES
| Tier 1 | Tier 2 | |
|---|---|---|
| Inpatient Facility | $150 per admission $150 per admission does not apply to inpatient childbirth, hospice or inpatient behavioral health/substance use disorder. |
20% after deductible |
| Outpatient Facility | $150 | 20% after deductible |
| Outpatient Behavioral Health | $20 | $35 office visit/20% after deductible at an outpatient facility |
| Durable Medical Equipment (DME) | $0 | $0 |
OUT-OF-NETWORK (OON)
No out-of-network benefits
This document is for informational purposes only and does not constitute a binding agreement. The information provided by this document is not intended to replace or modify the terms, conditions, limitations and exclusions contained within health, dental or vision benefit plans issued or administered by Horizon BCBSNJ. In the event of a conflict between the information contained in this document and your plan documents, your plan documents shall control.
Retirees: Please visit state.nj.us/treasury/pensions for information regarding available retiree plans.
This is not a complete list of all covered services. Exclusions and limitations apply to some services. Visit state.nj.us/treasury/pensions/member-guidebooks.shtml for more information.
