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Horizon Blue Cross Blue Shield of New Jersey Medical
Horizon Blue Cross Blue Shield of New Jersey
Quick facts
Overall Deductible
$0
Overall Deductible (Family)
$0
Out-of-Pocket Limit (Individual, Medical)
$5,000
Out-of-Pocket Limit (Family, Medical)
$10,000
Primary Care Visit Copay
$10 copay/visit
Specialist Visit Copay
$25 copay/visit
Emergency Room Care
$100 copay/visit
Urgent Care Copay
$30 copay/visit
More details (25)
Generic Drugs
$3 copay/prescription (retail and mail order)
Preventive Care/Screening/Immunization
No charge
Children's Eye Exam
Not covered
Prescription Drug Out-of-Pocket Limit (Individual)
$1,600
Prescription Drug Out-of-Pocket Limit (Family)
$3,200
Diagnostic Test (Non-Hospital)
$15 copay/visit
Diagnostic Test (Hospital)
$75 copay/visit
Imaging (Non-Hospital)
$100 copay/visit
Imaging (Hospital)
$200 copay/visit
Select Specialty Drugs/Biosimilars (Generic)
$3 copay/prescription (mail order)
Select Specialty Drugs/Biosimilars (Brand)
25% coinsurance (mail order)
Outpatient Surgery Facility Fee
$100 copay/visit (ambulatory surgery center); $200 copay/visit (hospital)
Emergency Medical Transportation
$100 copay/trip
Hospital Facility Fee
$200 copay/day, up to $400/admission
Mental/Behavioral Health Outpatient Services
$10 copay/office visit; $30 copay/day, up to $400/episode of care for other outpatient services
Pregnancy Office Visits
$10 copay/visit
Childbirth/Delivery Services
$200 copay/day, up to $400/admission
Home Health Care
$10 copay/visit
Skilled Nursing Care
$50 copay/day, up to $400/admission
Durable Medical Equipment
20% coinsurance
Hospice Services
No charge
Children's Dental Check-up
Not covered
Brand Name Drugs
$20 copay/prescription (retail and mail order)
Mental/Behavioral Health Inpatient Services
$200 copay/day, up to $400/admission
Rehabilitation Services
$15 copay/visit (non-hospital); $35 copay/visit (hospital)
Carrier contact
1-866-686-0003 — member services
Group number: 176B
Your member ID card: check the carrier website or app, or ask HR for a copy.
Plan documents
Confirm details with your carrier for current plan information.