This amount will not exceed the $100 allowed amount. Because your doctor has agreed to receive a discounted rate from Horizon BCBSNJ, the total amount your doctor can collect is our contracted payment, plus any applicable coinsurance or copayment from you. For example, if your participating doctor charges $200 for a service, and our allowed amount is $100 for that service, the participating doctor is not permitted to charge you the remaining $100. Participating doctors, dentists, other health care professionals and hospitals are not permitted to “balance bill” you for any difference between their charges and Horizon BCBSNJ's allowed amount for a covered service. Use our Doctor & Hospital Finder to look for a participating doctor, dentist, other health care professional or hospital. Additionally, non-participating providers can balance bill you up to their total charges. If you receive non-emergent services from a non-participating provider, you will have to pay the provider's total charges out of your pocket. There are no out-of-network benefits, except in emergency situations, for Individual consumers enrolled in the Horizon Advantage EPO or OMNIA Health Plans. For eligible dental services to be covered, members must use participating dentists in the dental PPO Network. Members in the medical plans must use doctors, other health care professionals and hospitals in the Horizon Managed Care Network. Horizon BCBSNJ is also offering three types of dental plans on the Individual Marketplace for 2023 – Horizon Young Grins, Horizon Family Grins and Horizon Family Plus. Horizon BCBSNJ is offering two types of medical plans on the Individual Marketplace for 2023 – Horizon Advantage EPO and OMNIA Health Plans. Three Penn Plaza East, Newark, New Jersey 07105.OUT-OF-NETWORK LIABILITY AND BALANCE BILLING © 2023 Horizon Blue Cross Blue Shield of New Jersey. The Horizon® name and symbols are registered marks of Horizon Blue Cross Blue Shield of New Jersey. The Blue Cross® and Blue Shield® names and symbols are registered marks of the Blue Cross Blue Shield Association. Both are independent licensees of the Blue Cross Blue Shield Association. Communications are issued by Horizon Blue Cross Blue Shield of New Jersey in its capacity as administrator of programs and provider relations for all its companies. Medicare Supplement plans are provided by Horizon Insurance Company. Products are provided by Horizon NJ Health. Enrollment in Horizon NJ TotalCare (HMO D-SNP) depends on contract renewal. Horizon NJ Health has a Medicare contract and a contract with the State of New Jersey Medicaid Program to offer Horizon NJ TotalCare (HMO D-SNP) an HMO Medicare Advantage Dual Eligible Special Needs plan. Enrollment in HIC Medicare products depends on contract renewal. Horizon Insurance Company ("HIC") has a Medicare contract to offer Part D Medicare plans, including group Part D Prescription Drug Plans. We’re here for you 24 hours a day, 7 days a week. Visit /DSNP or call Member Services at 1-80. If you have questions about your plan, we’re here to help. Use it as often as you like, at no cost to you. You can also schedule virtual therapy and behavioral health appointments. Talk privately with a doctor using video or phone for things like stomach pain, fevers or skin irritations. Horizon CareOnlineSM lets you get care from the comfort of home. Visit /DSNP to learn more about your OTC benefits. You also have a separate allowance to buy personal health items from our OTC Benefit Catalog. Talk to your Care Manager for more information. You will also get an extra allowance to pay for utilities. If you qualify as chronically ill, you can use your Horizon EXTRA Benefits Card to purchase healthy food and produce. At a participating retail store, or get them shipped to you with free delivery. You have two easy ways to purchase these items. Your balance is automatically added to your card every quarter. You get a preloaded Horizon EXTRA Benefits Card to help you pay for personal health care items, like cold medicine, vitamins, dental care products and diabetic socks. Prime Therapeutics will manage your prescription benefits.ĭon’t miss a refill! Sign up for mail-order delivery. Your coverage includes Medicare Part B and Part D prescription medicines, plus Medicaid-covered drugs. This includes a Plan of Care and help with prior-authorizations and community resources. A personal Care Manager will help coordinate your care. Plus, you don’t need a referral to see a specialist. All of your care is covered at no cost to you when you use an in-network provider. Here are five things you need to know about your plan. Horizon NJ TotalCare (HMO D-SNP) manages all of your Medicare and Medicaid benefits in one plan, all at no cost to you. Eligibility Information & Enrollment Instructions
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