NJ Horizon Blue Cross Blue Shield (BCBSNJ) is New Jersey’s largest health insurer. Serving over 3.7 million members, it offers a range of plans for individuals, families, and businesses.
As an independent licensee of the Blue Cross Blue Shield Association, it provides quality healthcare across the state. This article explores its plans, benefits, and services in simple terms.
About NJ Horizon Blue Cross Blue Shield
NJ Horizon Blue Cross Blue Shield has been a trusted name since 1932. Headquartered in Newark, it’s a not-for-profit health service corporation.
The company serves all of New Jersey, from High Point to Cape May. Its mission is to improve healthcare access and affordability for members.
With a network of over 67,000 providers and every New Jersey hospital, it ensures broad coverage. Horizon BCBSNJ focuses on community health and member satisfaction. It’s known for innovative programs and strong customer service.
Types of Health Plans Offered
NJ Horizon Blue Cross Blue Shield offers diverse health plans. These include HMO, PPO, POS, and Medicare Advantage plans. Each plan balances cost and flexibility to suit different needs. Members can choose based on their healthcare preferences.
HMO plans require a primary care physician (PCP) to coordinate care. PPO and POS plans offer more flexibility to see providers without referrals. Medicare Advantage plans cater to seniors, combining hospital and medical coverage.
Coverage for Individuals and Families
Horizon BCBSNJ provides plans for individuals and families through Get Covered NJ. These plans include essential health benefits like doctor visits, hospital stays, and prescriptions. Preventive care, such as annual checkups and vaccines, is often covered at no cost. Members can access plans with varying premiums and deductibles.
The Horizon Blue app makes managing coverage easy. You can view your ID card, check benefits, or find in-network providers. Plans also include mental health and substance abuse treatment.
Employer-Based Plans
NJ Horizon Blue Cross Blue Shield offers group plans for businesses. These cover small businesses, large employers, and public sector employees through programs like SHBP/SEHBP. Plans include wellness programs to promote employee health. Employers can customize coverage to fit their workforce.
The OMNIA Health Plan is a popular choice for businesses. It offers tiered networks to balance cost and access. Employees benefit from discounts at participating New Jersey YMCAs.
Medicaid and Horizon NJ Health
Horizon NJ Health, a subsidiary, manages Medicaid for over 1 million New Jerseyans. It covers low-income individuals, families, children, and pregnant women. Services include doctor visits, dental care, and prescriptions with low or no copays. The program ensures care for all kids, regardless of immigration status.
Members can access a large network of doctors and specialists. Horizon NJ Health also offers care coordination for chronic conditions. To renew or apply, call 1-800-637-2997.
Medicare Advantage Plans
NJ Horizon Blue Cross Blue Shield provides Medicare Advantage plans for seniors. These plans combine Parts A, B, and often D for comprehensive coverage. Many include extras like dental, vision, and hearing benefits. Walgreens is a preferred pharmacy for some plans, lowering copays.
Braven Health, a Horizon affiliate, offers Medicare Advantage plans with similar benefits. Members can access virtual care and a 24/7 nurse line. Plans are designed to keep costs manageable.
Key Benefits and Services
Horizon BCBSNJ emphasizes preventive care and wellness. Plans cover screenings, vaccinations, and annual wellness visits at no cost. The 24/7 nurse line provides professional medical advice anytime. Members can also access virtual care through Horizon CareOnline.
Additional services include:
- Behavioral health support for mental health and addiction.
- Specialty pharmacy programs for complex conditions.
- Care coordination for chronic diseases like diabetes.
- Discounts on gym memberships and wellness programs.
These benefits help members stay healthy and manage costs.
BlueCard Program for Nationwide Coverage
The BlueCard program extends coverage beyond New Jersey. If your NJ Horizon Blue Cross Blue Shield plan includes BlueCard, you can access care nationwide. Look for a suitcase logo on your insurance card to confirm eligibility. Over 90% of U.S. doctors and hospitals participate.
This is ideal for travelers or those living outside New Jersey. Use the National Doctor and Hospital Finder to locate providers. The program covers care in all U.S. states, Puerto Rico, and the U.S. Virgin Islands.
Coverage for Specific Treatments
NJ Horizon Blue Cross Blue Shield covers a range of treatments. For example, the Orally Administered Cancer Medication Coverage Law ensures fair access to oral cancer drugs. Plans also cover infertility treatments and specialty pharmaceuticals. Some medications require prior authorization.
Addiction treatment is covered through partnerships like ChoicePoint. Horizon NJ Health includes dental and vision for Medicaid members. Always check your plan for specific coverage details.
Provider Network and Accessibility
Horizon BCBSNJ boasts one of New Jersey’s largest provider networks. With over 67,000 doctors and every hospital in the state, access is convenient. A recent agreement with Hackensack Meridian Health ensures in-network care at their facilities. Use the Doctor & Hospital Finder to locate providers.
Members can visit urgent care centers like AM/PM Walk-In, which accepts Horizon plans. No referrals are needed for in-network specialists in many plans. This flexibility simplifies getting care.
Common Plan Types and Features
Here’s a table of popular NJ Horizon Blue Cross Blue Shield plans:
| Plan Type | Key Features | Best For |
|---|---|---|
| HMO | Requires PCP, low copays | Those who prefer coordinated care |
| PPO | No referrals, flexible provider choice | Members wanting more freedom |
| POS | Combines HMO and PPO benefits | Those balancing cost and flexibility |
| Medicare Advantage | Includes extras like dental, vision | Seniors seeking comprehensive coverage |
| OMNIA | Tiered network, cost savings | Employers and cost-conscious members |
Plan details vary, so review your coverage documents. Contact member services for clarification.
Member Tools and Resources
The Horizon Blue app is a key tool for members. It lets you view your ID card, track claims, and find providers. You can also chat with member services for quick answers. The app is free but may incur data charges.
The Horizon Blue website offers similar tools. Members can access forms, check benefits, and learn about wellness programs. For technical support, call 1-888-777-5075.
How to Enroll or Get a Quote
To enroll in NJ Horizon Blue Cross Blue Shield, visit Get Covered NJ for individual plans. Employers can work with Horizon or brokers like HealthMarkets. Call 1-800-355-BLUE (2583) for quotes or assistance. Spanish-speaking members can get help with select plans.
Medicaid enrollment is handled through Horizon NJ Health. Call 1-800-637-2997 to apply or renew. Medicare Advantage plans are available through Horizon or Braven Health websites.
Managing Claims and Costs
Horizon makes claim management straightforward. Providers often file claims directly with Horizon BCBSNJ. Members can track claims via the Horizon Blue app or website. If you have out-of-network benefits, submit receipts for reimbursement.
Nearly 90% of premiums go toward medical claims and provider payments. Plans like OMNIA offer lower costs with tiered networks. Always verify provider participation to avoid higher costs.
Customer Service and Support
Horizon BCBSNJ offers robust customer support. Call 1-800-355-BLUE (2583) for general questions, Monday through Friday. Hours vary by day, with Thursday starting at 9 a.m. The 24/7 nurse line is available for medical advice.
For fraud concerns, contact Horizon NJ Health’s Fraud Hotline at 1-855-372-8320. The website and app provide chat and email options. Members can also visit offices in Newark, Wall, or Hopewell.
Community and Wellness Programs
Horizon BCBSNJ is committed to community health. The Horizon Foundation supports organizations making New Jersey healthier. Employees contribute thousands of volunteer hours through Horizon Cares. This strengthens community ties.
Wellness programs encourage healthy living. Members get discounts at New Jersey YMCAs and access to virtual care. Preventive care benefits promote regular checkups and screenings.
Challenges and Considerations
Navigating health insurance can be complex. Some members find prior authorization for medications confusing. Out-of-network care may lead to higher costs, so always check provider status. The Horizon Blue app helps clarify coverage details.
Medicaid renewals require updated contact information. Call 1-800-682-9090 to avoid coverage gaps. Horizon’s customer service can address these challenges promptly.
Summary
NJ Horizon Blue Cross Blue Shield is New Jersey’s leading health insurer, covering 3.7 million members. It offers HMO, PPO, POS, Medicare Advantage, and Medicaid plans through Horizon NJ Health.
With a vast network of 67,000 providers and every NJ hospital, access is easy. Benefits include preventive care, virtual visits, and wellness programs.
The BlueCard program extends coverage nationwide, ideal for travelers. Tools like the Horizon Blue app simplify managing plans. While some processes, like prior authorization, can be tricky, robust support is available. NJ Horizon Blue Cross Blue Shield delivers quality care with a focus on community health.
FAQ
What plans does NJ Horizon Blue Cross Blue Shield offer?
Horizon offers HMO, PPO, POS, Medicare Advantage, and Medicaid plans. These suit individuals, families, and businesses. Check Get Covered NJ or Horizon’s website for details.
Does NJ Horizon Blue Cross Blue Shield cover out-of-state care?
Yes, the BlueCard program provides access to care nationwide. Look for the suitcase logo on your ID card. Use the National Doctor and Hospital Finder.
How do I enroll in Horizon NJ Health for Medicaid?
Call 1-800-637-2997 to apply or renew. Horizon NJ Health covers doctor visits, dental, and prescriptions. Kids qualify regardless of immigration status.
What tools help manage my Horizon plan?
The Horizon Blue app lets you view your ID card, track claims, and find providers. The website offers similar tools. Call 1-800-355-BLUE for support.
Are preventive services covered by Horizon plans?
Yes, preventive care like checkups and vaccines is covered at no cost. Plans also include wellness programs and YMCA discounts. Check your plan for specifics.