Preventive Health

Did you know that Horizon Blue Cross Blue Shield of New Jersey provides full coverage for certain preventive services at no cost to you under the Affordable Care Act?

As long as you and your covered family member(s) get preventive care from an in-network doctor or health care professional, and the only reason for your visit is preventive care, the services are covered with no out-of-pocket costs. Here are the services you and your covered dependents are entitled to with no out-of-pocket costs:

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Preventive Health Guidelines: Birth to age 21 years

Discuss these guidelines with your doctor and use them in planning to get preventive care services that are appropriate for you and your family.

ID: CMC0010141A (0817)

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Preventive Health Guidelines: Adults

Discuss these guidelines with your doctor and use them in planning to get preventive care services that are appropriate for you and your family.

ID: CMC0010141B (0817)

This is only a brief summary of preventive service recommendations issued as part of the Federal Interim Final Rules for Group Health Plans and Health Insurance Issuers Relating to Coverage of Preventive Services under the Patient Protection and Affordable Care Act (PPACA). Please visit HealthCare.gov for more information

  • Recommendations for immunizations were obtained from the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC). Only the member’s health care professional can determine which immunizations are required.
  • Recommendations for screenings and counseling services were obtained from the United States Preventive Services Task Force (USPSTF), a division of the U.S. Department of Health & Human Services’ (HHS) Agency for Healthcare Research and Quality (AHRQ).
  • This document is for informational purposes. The information should not be construed as legal or medical advice. Members should direct questions about the screening tests, immunizations, counseling or supplements to their health care professionals.
  • The information provided is subject to change because it is generally expected that continued guidance from the USPSTF will be released affecting recommended coverage of preventive services under the Affordable Care Act (ACA).
  • For some members, state mandates for certain preventive services may apply rather than federal mandates, if the state mandates are stricter
  • Requirements under PPACA became effective at the beginning of each plan year (or for individual market coverage, policy year) on or after September 23, 2010.
  • PPACA permits health coverage that was effective on or before March 23, 2010 to be “grandfathered” under certain circumstances so that it does not have to comply with certain provisions in PPACA. If the member’s plan is grandfathered, these benefits may not be available to the member
  • If the member’s Horizon BCBSNJ health plan uses a network of participating doctors and other health care professionals, or the member’s Horizon BCBSNJ health plan is a non-network based health plan (such as an Indemnity Plan), the member’s plan provides these preventive services at no cost sharing ONLY through in-network doctors and other health care professionals.
  • If the member’s Horizon BCBSNJ health plan offers in-network and out-of-network coverage, preventive care services received out of network will continue to be covered under the member’s current cost sharing arrangement.
  • A doctor may provide a preventive service, such as cholesterol screening, as part of an office visit. The member may have out-of-pocket costs for the office visit, if the preventive service is not the primary purpose of the visit or if the doctor bills the member for the office visit separately from the preventive care.