Advanced Imaging Services CareCore National, LLC handles authorizations for radiology, cardiology and pain management. Members are not required to choose a PCP Network Benefits Plans offer in network or out of network benefits Preventive Services When provided by a participating provider, no member cost share (no copayment). 2 - In-network Deductible applies to Durable Medical Equipment and Medical Appliances.ħ NJ DIRECT - Prefix NJX Key Features Network Benefits Horizon BCBSNJ SHBP/SEHBP Options NJ DIRECT10 NJ DIRECT15 NJ DIRECT1525 DIRECT2030 In-Network Office Copay - Primary Care $10 $15 $20 In-Network Office Copay - Specialist $25 $20 child1 / $30 adult Emergency Room Copay $50 $75 $125 In-Network Deductible N/A Out-of-Network Deductible $100 Individual / $250 Family $200 Individual / $500 Family Out-of-Network Inpatient Deductible (per confinement) $2002 $200 $500 In-Network Coinsurance 100%3 Out-of-Network Coinsurance 80% 70% In-Network Out-of-Pocket Maximum $400 Individual / $1,000 Family $800 Individual / $2,000 Family Out-of-Network $2,000 Individual / $5,000 Family $5,000 Individual / $12,500 Family 1 - Child is defined as up to 26th year. Behavioral Health and Substance Abuse Benefits Claims and authorizations are handled through Magellan Behavioral Health. For visits to a specialist, referrals are required, except for the HMO Access Product.
#Horizon bcbs direct access providers plus#
Horizon offers 5 different HMO products: Horizon HMO Horizon HMO Access Horizon HMO Access Value Horizon HMO Coinsurance, and Horizon HMO Coinsurance Plus For the HMO product, members must choose a PCP who coordinates their care with specialists and hospitals. Hospital Services All inpatient admissions require authorization. Out-of-Network Benefits No out-of-network benefits, except in an emergency. Preventive Services When provided by a participating provider, no member cost share (no copayment). Referrals required for specialist visits. Horizon HMO - New for 2013 Horizon HMO1525 – New for 2013 Horizon HMO2030 – New for 2013 NJ DIRECT10 NJ DIRECT15 NJ DIRECT1525 NJ DIRECT2030 NJ DIRECT HD1500 NJ DIRECT HD4000ĥ HMO Plans - Prefix SNJ Key Features Preventive Services In 2013, Horizon BCSBNJ is offering the following health plan options under the State Health Benefits Program (SHBP) and School Employees’ Health Benefits Program (SEHBP). 1 HORIZON BLUE CROSS BLUE SHIELD OF NEW JERSEYĢ AGENDA Horizon Products Policies Navinet
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