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 Durable Medical Equipment and click Show Coverage Details.
4. Then check the chart(s) to see if the benefit is covered, how much your plan will pay, and if prior authorization is required. You may need to scroll down to view all the information you need.

To find a participating DME provider, visit our Doctor & Hospital Finder and select Other Healthcare Services under What are you looking for? Then, under Service Type, select the DME item or service you need.

Durable Medical Equipment or (DME) is any equipment or supplies which provide therapeutic benefits to a patient due to certain medical conditions and/or illnesses. DME is designed for short-term and long-term use in the home. Examples of DME include, but are not limited to, breast pumps, hospital beds, sleep apnea machines, wheelchairs, orthotics, prosthetics, oxygen tanks and diabetic supplies. Some DME can be rented, while others must be purchased. The decision to rent or purchase depends on several factors, including, but not limited to type of equipment, length of need and information provided by the patient’s doctor.

1. Click Benefits & Coverage.
2. Click What’s Covered.
3. Under the Medical tab, go to the dropdown menu titled Service you may need to select the correct type of diagnostic service (Diagnostic X-Ray or MRI/Cat Scan) and click Show Coverage Details.
4. Then check the chart(s) to see if the benefit is covered, how much your plan will pay, and if prior authorization is required. You may need to scroll down to view all the information you need.

Check the column titled “Prior Authorization” if it is required for this benefit. Your in-network doctor or other health care professional or hospital will be responsible for requesting prior authorization for you.

You can also get help scheduling your test at a participating facility by calling 1-866-969-1234.

1. Click Benefits & Coverage.
2. Click What’s Covered.
3. Under the Medical tab, go to the dropdown menu titled Service you may need to select Chiropractic and click Show Coverage Details.
4. Then check the chart(s) to see if the benefit is covered, how much your plan will pay, how many sessions are covered and if prior authorization is required. You may need to scroll down to view all the information you need.

1. Click Benefits & Coverage.
2. Click What’s Covered.
3. Under the Medical tab, go to the dropdown menu titled Service you may need to select Physical Therapy and click Show Coverage Details.
4. Then check the chart(s) to see if the benefit is covered, how much your plan will pay, how many sessions are covered and if prior authorization is required. You may need to scroll down to view all the information you need.

1. Click Benefits & Coverage.
2. Click What’s Covered.
3. Under the Medical tab, go to the dropdown menu titled Service you may need to select Diagnostic Lab and click Show Coverage Details.
4. Then check the chart(s) to see if lab services are covered and if you need prior authorization. You may need to scroll down to view all the information you need.

To find a participating lab near you, use our Doctor & Hospital Finder and select Other Health Care Services under What are you looking for? Then select Laboratory – Patient Centers under Service Type.

Pathology services provided in a hospital setting to members enrolled in Horizon BCBSNJ managed care plans by a practice that participates in the Horizon Managed Care Network are allowed as an exception to the LabCorp/Quest Diagnostics network use requirements.

• Vaccinations (flu, measles and hepatitis)
• Cancer screenings (colorectal screenings, mammograms and Pap tests)
• Adult well care (cholesterol and blood pressure)
• Newborn care (hearing and blood tests)
• Children well-visits (obesity, evaluation, measurements)
• Pregnancy care (gestational diabetes, screenings)

1. Click Benefits & Coverage.
2. Click What’s Covered.
3. Under the Medical tab, go to the dropdown menu titled Service you may need. Choose the appropriate preventive service. For routine physicals, select Routine Physical. For vaccinations, select Flu Vaccination or Immunizations.
4. Click Show Coverage Details.