Under the Horizon supplemental plans, claims are coordinated by first submitting them to Medicare. This coordination of benefits with Medicare is han-dled by Horizon.
Full Answer
Is NJ direct a Medicare Advantage Plan?
Yes. The Horizon Medicare Advantage NJ DIRECT (PPO) plans provide in- and out-of-state coverage.
Is Horizon NJ Family Care Medicaid or Medicare?
Horizon NJ Health is the leading Medicaid and NJ Family Care plan in the state and the only plan backed by Horizon BCBSNJ. Our members get the health benefits they can count on from a name they trust.
Is Horizon NJ Health Medicare?
Horizon NJ TotalCare (HMO D-SNP) is an HMO Medicare Advantage Dual Eligible Special Needs plan with a Medicare contract and a contract with the State of New Jersey Medicaid Program.
What type of plan is Horizon NJ Direct?
managed care planHorizon Direct Access is a managed care plan that gives members referral-free access to many health care services and programs and one of the largest national doctor networks in the nation.
Is NJ FamilyCare covered by Medicare?
New Jersey Medicaid, also known as the New Jersey Family Care program, is a health care program for those in financial need, funded by the federal government and the NJ state government. It's different from New Jersey Medicare.
Is Horizon NJ Health the same as NJ FamilyCare?
The NJ FamilyCare program allows eligible children, single adults and families to get affordable, quality health care through Horizon NJ Health. You can apply for NJ FamilyCare onlineapply for NJ FamilyCare online opens a dialog window. We can also help you complete your application.
How long does Horizon NJ Health last?
If you have NJ FamilyCare or Medicaid, you must renew every 12 months and stay current with any premium you owe. Those who do not renew their eligibility or do not pay their premiums on time will lose their benefits with Horizon NJ Health. Certain members will not be able to reenroll.
What is Horizon NJ Total Care?
Horizon NJ TotalCare (HMO D-SNP) is the FIDE-SNP plan under Horizon Blue Cross Blue Shield of New Jersey. Horizon NJ TotalCare (HMO D-SNP) coordinates all Medicaid and Medicare managed care benefits, including primary care and preventive services, behavioral health and long-term care.
Can I use Horizon NJ Health out of state?
Horizon NJ Health will not cover care received outside of the United States and its territories. For more information on emergency care please visit “When to Use the Emergency Room".
Is Horizon NJ direct a PPO plan?
The plan also covers you throughout the United States and around the world through the BlueCard® PPO program. Horizon Direct Access is a managed care plan that gives you access to many health care services and programs and our large national participating physician network.
What is NJ Direct?
NJ DIRECT HDHP provides both in-network and out-of-network benefits. Eligible preventive services are covered at 100 percent and are not subject to the deductible. Both medical and prescription drug coverage is included.
Does Horizon NJ Health cover braces?
Covered Coverage includes (but is not limited to) arm, leg, back and neck braces; artificial eyes; artificial limbs and replacements; certain breast prostheses following mastectomy; and prosthetic devices for replacing internal body parts or functions. Also covers certified shoe repair, hearing aids and dentures.
Does SHBP reduce Medicare?
If you are paying the full cost of your SHBP/SEHBP coverage, that cost generally decreases when you and/ or your dependents enroll in Medicare Parts A and B because most medical plans charge lower pre-miums for Medicare-eligible members.
Does Aetna cover SHBP?
Aetna serves as the carrier for the SHBP/SEHBP Medicare Advantage Plans. Under Aetna plans, the coverage provided is a Medicare Advantage plan, which means that eligible claims are paid by the med-ical plan. You do not need to coordinate coverage be-tween Medicare and Aetna.
What is NJ Direct?
The SEHBP plans are self-funded. Funds for the payment of claims and services come from funds supplied by the State, participating local employers, and members. Refer to APPENDIX VII for more information on contacting the SEHBP plans, the Division of Pensions & Benefits, and related health services. Except where noted, the SEHBP plans follow the same policies and parameters.
What is Horizon Health Guide?
The Horizon Health Guide helps members with chronic conditions take better care of their health, understand their care choices and improve their health. This program is available at no added cost to eligible members with:
How long does it take to appeal a substance use disorder in New Jersey?
This section applies to all substance use disorder appeals related to inpatient care beyond the first 28 days. A member (or a provider acting for the member, with the member’s consent) who is dissatisfied with the results of Horizon BCBSNJ's internal appeal process with respect to an adverse benefit determination can pursue a Substance Use Disorder External Appeal, an expedited external appeal with an IRO assigned by the DOBI. All appeals filed in accordance with this paragraph must be filed with the Independent Health Care Appeals Program in the New Jersey Department of Banking and Insurance.
What is SEHBP coverage?
The SEHBP is required to ensure that only eligible employees and retirees, and their dependents, are receiving health care coverage under the program. Employees or retirees who enroll dependents for coverage (spouses, civil union partners, domestic partners, children, disabled dependents, and over age children continuing coverage) must submit supporting documentation in addition to the enrollment application. For more information about the documentation a member must provide when enrolling a new dependent for coverage, please refer to the REQUIRED DOCUMENTATION FOR DEPENDENT ELIGIBILITY AND ENROLLMENT section of this Guidebook.
How long do you have to enroll in SEHBP?
If you do not enroll all eligible members of your family within 60 days of the time you or they first become eligible for coverage, you must wait until the next Open Enrollment period. Open Enrollment periods generally occur once a year, usually during the month of October. Information about the dates of the Open Enrollment period and effective dates for coverage is announced by the Division of Pensions & Benefits.
When a live donor is used in the egg retrieval, shall the medical costs of the donor be covered?
Where a live donor is used in the egg retrieval, the medical costs of the donor shall be covered until the donor is released from treatment by the reproductive endocrinologist;
Who is eligible for Medicare Part A and B?
IMPORTANT: A Retired Group member and/or dependent spouse, civil union partner, eligible same-sex domestic partner, or child who is eligible for Medicare coverage by reason of age or disability must be enrolled in both Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) to enroll or remain in SEHBP Retired Group coverage.
