To learn about your coverage for outpatient facility services, sign in at HorizonBlue.com.

If you do see the blue Support icon in the upper-right corner, follow these steps:

1. Click Benefits & Coverage.
2. Click What's Covered.
3. Under the Medical tab, go to the dropdown menu titled Services. You may need to select Hospital - Outpatient and click Show Coverage Details. Then check the chart(s) to see if the outpatient facility services are covered and if you need prior authorization. You may need to scroll down to view all the information you need.

If you do not see the blue Support icon in the upper-right corner, follow these steps:

1. Click My Coverage.
2. Then click What’s Covered.
3. Then from the dropdown menu marked Service Type Category, select Hospital Services.
4. Under Service Type, select the sub-service category: Hospital – Outpatient.
5. Then, check the chart(s) to see if outpatient facility services are covered, how much your plan will pay, and how much you will pay. You may need to scroll down to view all the information you need.

1. Sign in to Member Online Services (or register first).
2. If you do see the blue Support button in the upper-right hand corner, click Support then click Email Us. If you do not see the blue Support button, click Email Us at the top of the screen. 
3. Click New Message to open the screen that will allow you to begin typing a new message.
4. Under the Select Category dropdown menu, select the category that best describes your question.
5. Click Send.

1. Click My Accounts.
2. Click Premium Payment.
3. Click Pay Bill from the Current Bill section.
4. Click Continue and you will be redirected to our payment vendor’s secure website.
5. Click Set up Auto Pay.

1. Click Claims.
2. Once you find the claim you are looking for in the list of Recent Claims, click View EOB or View PDF to see the details of your claim.
3. If the EOB is not yet available, click Claim Details to view the details.

1. Click My Accounts.
2. Then click Out-of-Pocket Expenses.

You will be able to view the dollar amounts applied to your deductible, as well as your maximum out-of-pocket expenses, by plan member, for a selected benefit period for both in and out of network, as applicable.

Please keep in mind that the deductible information displayed is based on finalized claims as of the date the information is viewed. Claims that are processed or adjusted after you view the information may change the amount of the deductible that has been satisfied.

A deductible is an out-of-pocket expense a member must pay before the program provides any benefits for such charges. The term does not include coinsurance, copayments and non-covered charges. For example, if a member has a health plan with a $200 deductible, the member must meet that deductible before his/her health plan begins to provide benefits for the covered services and supplies.

In addition to collecting your copayment amounts, participating practices may make arrangements with you at the time services are provided for you to pay the amount that will be applied toward your deductible.

If your plan requires you to have a Primary Care Physician (PCP) on file, you can select a PCP or change your current PCP by signing in at HorizonBlue.com.

If you do see the blue Support icon in the upper-right corner, follow these steps:

1. Click Doctors & Care.
2. Click Doctor & Hospital Finder and search for your PCP.
3. Choose the doctor you want to select by clicking their name and then clicking Select as PCP.
4. Select the reason for the change from the dropdown menu and enter an effective date for the change.
5. Click Submit.

If you do not see the blue Support icon in the upper-right corner, follow these steps:

1. Click Get Care.
   
2. Then click Change Doctor.
3. Choose the doctor you want to change, select the reason for the change from the dropdown menu, and enter an effective date for the change.
4. Click Continue.

To submit a claim, download the appropriate claim form from HorizonBlue.com/forms.

Complete the form, include an itemized bill and mail it to the address printed on the form.An itemized bill includes the Provider Tax Identification Number (TIN), patient name, member’s ID number, date of service, diagnosis code(s), procedure code(s), place of service and total charge.

If you have pharmacy benefits from Horizon BCBSNJ and need to submit a pharmacy claim, please include the actual prescription receipt. A cash register receipt is not eligible for reimbursement. Please be sure that the following information is legible on the prescription claim form:

1. Patient’s name
2. Rx number
3. Date filled
4. Amount paid

It may take up to 30 days for Horizon BCBSNJ to process your claim. To check the status of your claim, you can sign in at HorizonBlue.com and click Claims.

If you have other insurance, you can let us know about your other coverage by signing in at HorizonBlue.com.

If you do see the blue Support icon in the upper-right corner, follow these steps:

1. Click Benefits & Coverage.
2. Then click Add Additional Insurance on the Benefits Overview page to update your information.

Please provide the most up-to-date insurance information for all covered family members to help with the processing of your claims.If your claim was denied because Coordination of Benefits (COB) information is requested, please call the Horizon BCBSNJ’s Member Services phone number on the back of your member ID card. Depending on your plan, you may also be able to Email Us or Chat with Us once signed in to Member Online Services.

If you do not see the blue Support icon in the upper-right corner, follow these steps:

1. Click My Coverage.
2. Then click Update Additional Insurance.

1. Select the type of health care professional you’re looking for from the What are you looking for? drop down menu.
2. Select the name of your OMNIA Health Plan from the Choose a Plan to Start dropdown menu.
3. You can refine your search by using the filter boxes.
4. The results page will only show those health care professionals who accept your OMNIA Health Plan and meet the search criteria you set. The results will also show if the doctor or hospital is designated as OMNIA Tier 1 or Tier 2. Be sure to check the health care professional’s tier status for each office location. Some health care professionals may be part of more than one group practice. You can also find out who is joining and leaving the plan.
5. Click View Profile to find out more about a doctor, other health care professional or hospital. The profile includes group affiliation, specialty, hospital affiliation, information on the plan selected and more. You can even have the name, address and phone number texted to your mobile or web-enabled device.¹

1. Click My Accounts.
2. Click Premium Payments.
3. If you have more than one Horizon BCBSNJ plan, you need to select the correct Account Number from the dropdown menu.
   Note: It is very important that you use the drop-down menu to ensure that the correct account number is selected, even if an account number already appears. If multiple account numbers are available and you do not select the correct one, information may reflect past billing periods, and the Pay Bill button will not appear.
4. In the Current Bill section, click Pay Bill. You will be redirected to a secure third-party site to make an online payment.

An email alert will be sent to you once a payment has been made, indicating the date and amount of the payment. Please allow three to five business days for the payment to post to your account.

Once signed in at HorizonBlue.com, you can also sign up for automatic bill pay. When you have automatic bill pay, your premium payment is deducted from your checking account or billed to your credit card or pinless debit card on the same date each month so you never miss a payment.

Phone
To make a payment 24 hours a day, seven days a week, using our automated phone system, call 1-888-778-2005 and select “Make a Payment.”

You can also speak with one of our Member Services Representatives at 1-800-355-BLUE (2583), Monday through Wednesday and Friday from 8 a.m. to 6 p.m. and Thursday, from 9 a.m. to 6 p.m. to make a premium payment. If you purchased your plan directly through Horizon BCBSNJ (not through the Health Insurance Marketplace), you may be charged an additional $25 fee when using this payment option.

Medicare Advantage members can call 1-800-365-2223, Monday through Friday, from 8 a.m. to 8 p.m., to speak with a Member Services Representative.

Medigap members can call 1-888-276-4299, Monday through Friday, from 8 a.m. to 5 p.m., to speak with a Member Services Representative.

Mail
You may also mail your payment to the address on your invoice. Please be sure to include your nine-digit account number, premium payment and Horizon BCBSNJ statement to avoid delays in posting payments.

Medigap members: Your account number is the second set of numbers at the top of your invoice.

Members who purchased directly through Horizon BCBSNJ and not through the Health Insurance Marketplace –
Horizon Blue Cross Blue Shield of New Jersey
PO Box 10192
Newark, NJ 07101-3120
 
Members who purchased through the Health Insurance Marketplace –
Horizon Blue Cross Blue Shield of New Jersey
PO Box 10193
Newark, NJ 07101-3117
 
Medicare Advantage members –
Horizon Healthcare of New Jersey, Inc.
PO Box 10192
Newark, NJ 07101-3120
 
Medigap members –
Horizon Blue Cross Blue Shield of New Jersey
PO Box 10197
Newark, NJ 07101-311

MoneyGram
You can also make a premium payment at one of MoneyGram’s convenient locations. Horizon BCBSNJ’s MoneyGram code is 11967. Find a MoneyGram location near you.

Yes, if you want to cut down on the mail we send to you, many members* can choose to view certain documents online instead of receiving them in the mail. Simply sign in to Member Online Services and:

If you do see a blue Support icon in the upper-right corner:

1. Click Profile & Settings at the top of the screen.
2. Then choose Paperless Settings to set your preferences.

1. Click the icon next to your name.
2. Select Paperless Settings.
3. From the Paperless Settings page, click Go Paperless.

You can change your preferences at any time through Paperless Settings.

*Note: Some members may not be able to choose to receive documents electronically. These members will not see the Paperless Settings option.

Generally, members can change their coverage during the annual Open Enrollment Period. Learn more.

For members who have coverage through an employer: Check with your benefits administrator or human resources department for dates on your employer’s open enrollment period and when you can make changes to your coverage.

For members who purchase coverage directly from Horizon BCBSNJ, NOT through an employer (Individual Consumers): Individual Consumers can only change their coverage during the annual Open Enrollment Period, which usually begins in November. You do not need to provide proof of life event changes during the annual Open Enrollment Period.

However, you can also change your coverage outside of the Open Enrollment Period, during a Special Enrollment Period, if you experience loss of coverage or certain life events. You are required to provide proof of the life event and the date it occurred. 

Please visit HorizonBlue.com/shop for help with finding a Horizon BCBSNJ plan that is right for you. 

If you are an Individual Consumer and bought your coverage through the Health Insurance Marketplace, you must change your coverage online through your Health Insurance Marketplace account at HealthCare.gov or by calling the Marketplace Call Center at 1-800-318-2596. It is very important that you report any life changes to the Marketplace as soon as possible, because it could change the amount of your advance payments of the premium tax credit and cost-sharing reduction. If you do not report a life change, you might have to pay back some of your tax credit when you file your federal income taxes. 

If you are an Individual Consumer and do not have coverage through the Health Insurance Marketplace, you must complete and submit the Non-Group Enrollment/Change Request Form to the address or fax number listed on the form to change your coverage information. You can use this form for coverage changes including: adding or removing an eligible spouse or dependent, changing your name, changing your plan, and other Special Enrollment Period related changes. You must submit the application and supporting documentation within 60 days from the date of the loss of coverage or life event. Generally, this information will be processed within five to seven business days once both the completed application and proof of the event are received by Horizon BCBSNJ.