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Horizon BCBSNJ
Direct Access
AP (Low) Plan Option/DZ
(High)
Plan Option
In-Network:
Horizon BCBSNJ's payment for eligible expenses when services are
obtained from one of the providers in our Managed Care Network.
Horizon BCBSNJ reimburses both Primary Care Physicians and
Specialists at the applicable allowance on a fee for service basis.
The member will not be responsible for any balance bill. Direct
Access provides the highest level of benefits for in-network
services and the member does not have to file claims.
Out-of-Network: Horizon
BCBSNJ's payment for eligible services that are not obtained from
one of the providers in our Managed Care Network. The member may see
any physician if he/she is willing to pay a greater share of the
costs. Horizon BCBSNJ reimburses participating providers at the
applicable allowance. Non-network providers are reimbursed up to our
applicable allowance and may balance bill to charges. An annual
deductible and coinsurance applies to all eligible medical and most
supplemental services. Once the member reaches the out of pocket
maximum, the Plan pays 100% of the appropriate allowance for
eligible services for the rest of the year. There is a lifetime
maximum for each member. The member is responsible for complying
with all utilization review and cost containment programs.
Direct Access
AP
Plan Option
(No Referral Required)
| Coverage |
Monthly
Premium |
| Single |
$466.27 |
| Parent & Children |
$825.52 |
| Husband & Wife |
$990.45 |
|
Family |
$1,472.72 |
Rates Effective 1/1/2010 to 1/1/2011
DOWNLOAD PLAN SUMMARY
DOWNLOAD PRESCRIPTION COVERAGE
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Direct
Access
DZ Plan Option
(No Referral Required)
| Coverage |
Monthly Premium |
| Single |
$676.52 |
| Parent & Children |
$1,089.79 |
| Husband & Wife |
$1,439.10 |
Family |
$1,944.71 |
Rates Effective 1/1/2010 to
1/1/2011
DOWNLOAD PLAN SUMMARY
DOWNLOAD PRESCRIPTION COVERAGE
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Rate and Comparison charts on this website are provided for
informational purposes ONLY and are not to be considered as binding. Not all areas or
plans are listed. While every effort is made to maintain the accuracy of this information,
you should contact The OSSA Group to confirm rates and coverages available in your area.
If you are a current
MSSI employee and would like to receive an information pack outlining
the specific plans and rates available to you, contact Joe Marini at The OSSA Group, or call 1–800–582–8203
and he will get one in the mail to you.
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