OMNIA Health Plans - Horizon Blue Cross Blue Shield of New Jersey
OMNIA Bronze HSA
The OMNIA Bronze Health Savings Account (HSA) Plan is our lowest premium Bronze plan and offers our lowest monthly premium and highest out-of-pocket costs when compared to other OMNIA Health Plans. Bronze plans, on average, pay for 60% of the covered medical expenses; you pay 40%. With HSA plans, you make tax-free contributions to your account to cover higher deductible costs in exchange for a significantly lower premium. The OMNIA Bronze HSA Plan is a good option for healthy members who don’t expect to use a lot of medical services but want coverage for unexpected health issues.
Features
- Plan includes a Health Savings Account (HSA).
- Coverage for preventive care and unexpected health issues.
- One-step easy access on your mobile phone to chat with a nurse or get help making an office appointment.
- Money back on gym memberships with HorizonbFit—Up to $240 per year*.
- Your premium may be less if you qualify for government financial assistance—Use our online estimator.
*HorizonbFit is only available to individual consumers.
| Covered Services | TIER 1 | TIER 2 | Coverage Details |
|---|---|---|---|
| Individual Deductible | $3,000* | $3,000* |
|
| Family Deductible | $6,000 | $6,000 | |
| Individual Max Out-of-Pocket | $6,550 | $6,550 | |
| Family Max Out-of-Pocket | $13,100 | $13,100 | |
| Primary Care Physician Visit | Deductible then $30 copayment | Deductible then 50% coinsurance | |
| Specialist Visit | Deductible then $50 copayment | Deductible then 50% coinsurance | |
| Outpatient Surgery | Deductible then 50% coinsurance | Deductible then 50% coinsurance | |
| Inpatient Hospital Stay | Deductible then $500 Per Day Copayment | Deductible then 50% coinsurance | |
| Emergency Room | Deductible then $100 copayment & 50% coinsurance |
Deductible then $100 copayment & 50% coinsurance |
*Members receiving cost-sharing reduction subsidies may not be eligible for an HSA under this plan as some variations of this plan do not meet the IRS requirements of a High-Deductible Health Plan.
**Based on physician data as of 8/1/18 and is subject to change.
OMNIA Silver
The OMNIA Silver Plan is our lowest premium Silver plan and offers a mid-level monthly premium and out-of-pocket costs when compared to other OMNIA Health Plans. Silver plans, on average, pay for 70% of the covered medical expenses; you pay 30%, and cost-sharing subsidies may be available. The OMNIA Silver Plan is a good choice if you want a balance between monthly premiums and out-of-pocket costs.
Features
- Our lowest premium, non-HSA, Silver plan.
- A balance between monthly premiums and out-of-pocket costs.
- One-step easy access on your mobile phone to chat with a nurse or get help making an office appointment.
- Money back on gym memberships with HorizonbFit—Up to $240 per year*.
- Your premium may be less if you qualify for government financial assistance.—Use our online estimator.
*HorizonbFit is only available to individual consumers.
| Covered Services | TIER 1 | TIER 2 | Coverage Details |
|---|---|---|---|
| Individual Deductible | $1,500 | $2,500 |
|
| Family Deductible | $3,000 | $5,000 | |
| Individual Max Out-of-Pocket | $7,350 | $7,900 | |
| Family Max Out-of-Pocket | $14,700 | $15,800 | |
| Primary Care Physician Visit | $30 copayment | Deductible then 50% coinsurance | |
| Specialist Visit | $50 copayment | Deductible then 50% coinsurance | |
| Outpatient Surgery | Deductible then $250 copayment | Deductible then 50% coinsurance | |
| Inpatient Hospital Stay | Deductible then $500 per day copayment | Deductible then 50% coinsurance | |
| Emergency Room | $100 copayment & deductible | $100 copayment & deductible |
*Based on physician data as of 8/1/18 and is subject to change.
OMNIA Silver HSA
The OMNIA Silver Health Savings Account (HSA) Plan, like other Silver plans, pays for 70% of your covered medical expenses on average; you pay 30%, and cost-sharing subsidies may be available. With HSA plans, you make tax-free contributions to your account to cover higher deductible costs in exchange for a significantly lower premium. The OMNIA Silver HSA Plan is a good option for healthy members who don’t have ongoing care but want more comprehensive coverage for unexpected health issues.
Features
- Plan includes a Health Savings Account (HSA).
- High deductible with a significantly lower premium.
- One-step easy access on your mobile phone to chat with a nurse or get help making an office appointment.
- Money back on gym memberships with HorizonbFit—Up to $240 per year*.
- Your premium may be less if you qualify for government financial assistance.—Use our online estimator.
*HorizonbFit is only available to individual consumers.
| Covered Services | TIER 1 | TIER 2 | Coverage Details |
|---|---|---|---|
| Individual Deductible | $1,800* | $2,500* |
|
| Family Deductible | $3,600 | $5,000 | |
| Individual Max Out-of-Pocket | $6,000 | $6,550 | |
| Family Max Out-of-Pocket | $12,000 | $13,100 | |
| Primary Care Physician Visit | Deductible then $15 copayment | Deductible then $30 copayment | |
| Specialist Visit | Deductible then $30 copayment | Deductible then $50 copayment | |
| Outpatient Surgery | Deductible then 30% coinsurance | Deductible then 50% coinsurance | |
| Inpatient Hospital Stay | Deductible then 30% coinsurance | Deductible then 50% coinsurance | |
| Emergency Room | Deductible then $100 copayment & 30% coinsurance |
Deductible then $100 copayment & 30% coinsurance |
*Members receiving cost-sharing reduction subsidies may not be eligible for an HSA under this plan as some variations of this plan do not meet the IRS requirements of a High-Deductible Health Plan.
**Based on physician data as of 8/1/18 and is subject to change.
OMNIA Gold
The OMNIA Gold Plan is our lowest premium Gold plan and offers a higher monthly premium and lower out-of-pocket costs when compared to other OMNIA Health Plans. Gold plans, on average, pay for 80% of the covered medical expenses; you pay 20%. The OMNIA Gold Plan is a good choice if you expect to use a moderate amount of medical services.
Features
- Our lowest premium Gold plan.
- Comprehensive coverage for a moderate amount of medical services.
- One-step easy access on your mobile phone to chat with a nurse or get help making an office appointment.
- Money back on gym memberships with HorizonbFit—Up to $240 per year*.
- Your premium may be less if you qualify for government financial assistance.—Use our online estimator.
*HorizonbFit is only available to individual consumers.
| Covered Services | TIER 1 | TIER 2 | Coverage Details |
|---|---|---|---|
| Individual Deductible | $1,000 | $2,500 |
|
| Family Deductible | $2,000 | $5,000 | |
| Individual Max Out-of-Pocket | $4,500 | $6,350 | |
| Family Max Out-of-Pocket | $9,000 | $12,700 | |
| Primary Care Physician Visit | $10 copayment | Deductible then $30 copayment | |
| Specialist Visit | $25 copayment | Deductible then $50 copayment | |
| Outpatient Surgery | Deductible then $250 copayment | Deductible then 30% coinsurance | |
| Inpatient Hospital Stay | Deductible then $500 per day copayment | Deductible then 30% coinsurance | |
| Emergency Room | $100 copayment & deductible | $100 copayment & deductible |
*Based on physician data as of 8/1/18 and is subject to change.
Advantage EPO Essentials
Horizon Advantage EPO members use the Horizon Managed Care Network in New Jersey and may have access to BlueCard providers outside of New Jersey. This product does not require PCP selection or referrals. There are no benefits for out-of-network services, unless accessed in an emergency or otherwise approved. The Advantage EPO Essentials plan is available to individuals under 30 and is a good choice if you don’t expect to use a lot of medical services.
Features
- Enjoy access to our entire Managed Care Network, the largest physician network in NJ*.
- No primary care physician required.
- No referrals needed.
- Prescription coverage included.
| Covered Services | Coverage | Coverage Details |
|---|---|---|
| Individual Deductible | $7,900 |
|
| Family Deductible | $15,800 | |
| Individual Max Out-of-Pocket | $7,900 | |
| Family Max Out-of-Pocket | $15,800 | |
| Primary Care Physician Visit | $0 copayment for three visits then deductible | |
| Specialist Visit | Deductible then no charge | |
| Outpatient Surgery | Deductible then no charge | |
| Inpatient Hospital Stay | Deductible then no charge | |
| Emergency Room | Deductible then no charge |
*Based on physician data as of 8/1/18 and is subject to change.
Advantage EPO Bronze
Horizon Advantage EPO members use the Horizon Managed Care Network in New Jersey. This product does not require PCP selection or referrals. There are no benefits for out-of-network services, unless accessed in an emergency or otherwise approved. Bronze plans, on average, pay for 60% of the covered medical expenses; you pay 40%, and money-saving subsidies may be available. The Advantage EPO Bronze Plan is a good choice if you don’t expect to use a lot of medical services.
Features
- Enjoy access to our entire Managed Care Network, the largest physician network in NJ*.
- No primary care physician required.
- No referrals needed.
- Prescription coverage included.
| Covered Services | Coverage | Coverage Details |
|---|---|---|
| Individual Deductible | $3,000 |
|
| Family Deductible | $6,000 | |
| Individual Max Out-of-Pocket | $7,900 | |
| Family Max Out-of-Pocket | $15,800 | |
| Primary Care Physician Visit | $30 copayment | |
| Specialist Visit | Deductible then 50% coinsurance | |
| Outpatient Surgery | Deductible then 50% coinsurance | |
| Inpatient Hospital Stay | Deductible then 50% coinsurance | |
| Emergency Room | $100 copayment & deductible then 50% coinsurance |
*Based on physician data as of 8/1/18 and is subject to change.
Advantage EPO Silver
Horizon Advantage EPO members use the Horizon Managed Care Network in New Jersey. This product does not require PCP selection or referrals. There are no benefits for out-of-network services, unless accessed in an emergency or otherwise approved. Like other Silver plans, it pays for 70% of your covered medical expenses on average; you pay 30%, and money-saving subsidies may be available. The Advantage EPO Silver Plan is a good choice if you want a balance between monthly premiums and out-of-pocket costs.
Features
- Enjoy access to our entire Managed Care Network, the largest physician network in NJ*.
- No primary care physician required.
- No referrals needed.
- Prescription coverage included.
| Covered Services | Coverage | Coverage Details |
|---|---|---|
| Individual Deductible | $2,500 |
|
| Family Deductible | $5,000 | |
| Individual Max Out-of-Pocket | $7,350 | |
| Family Max Out-of-Pocket | $14,700 | |
| Primary Care Physician Visit | $30 copayment | |
| Specialist Visit | $50 copayment | |
| Outpatient Surgery | Deductible then 50% coinsurance | |
| Inpatient Hospital Stay | Deductible then 50% coinsurance | |
| Emergency Room | $100 copayment & deductible then 50% coinsurance |
*Based on physician data as of 8/1/18 and is subject to change.
