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24/7 Nurse Line
Benefit Booklet/Benefit Certificate
Coinsurance
Consumer-Directed Health Plans (CDH)
Coverage Advisor
Deductible
Feature Compare
Flexible Spending Account (FSA)
Health Reimbursement Arrangement (HRA)
Health Savings Account (HSA)
High-Deductible Health Plan
Hospital Comparison Tool
In-Network
Interactive Voice Response (IVR) System
Member Handbook
Member Online Services
Out-of-Network
Out-of-Pocket Costs
Out-of-Pocket Maximum
Participating Provider
Preventive Care
Prior Authorization/Preapproval
Qualified Medical Expenses (QMEs)
Rollover
Urgent Care
Visa Debit Card
We, Us, Our
- The 24/7 Nurse Line is available 24 hours a day, seven days a week so that whenever you have a health care question, a nurse is just a phone call away.
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- A booklet that outlines specific benefits and exclusions. The Benefit Booklet/Benefit Certificate is used in conjunction with the Horizon MyWay Member Handbook.
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- The percentage of a covered charge that a member must pay. Coinsurance does not include deductibles, copayments, or noncovered charges.
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- Also referred to as CDH. A new type of coverage that offers employees the security of a Horizon BCBSNJ high-deductible health plan coupled with tax-advantaged accounts. The funds in the accounts may be used to pay for qualified medical expenses or may be saved for future medical needs. Generally, CDH plans have lower premiums than do traditional types of coverage.
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- An online, decision-support tool that helps members understand their out-of-pocket costs along with the amounts they would pay if they had no health insurance. To become smarter health care consumers, members use Coverage Advisor to estimate out-of-pocket costs and flexible spending. The Coverage Advisor is powered by WebMD.
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- The out-of-pocket amount that each Horizon MyWay member must pay before the plan coverage kicks in. Typically, funds used from Horizon MyWay accounts may be applied to the deductible.
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- An online decision-support tool that gives members a simple way to compare benefit plan choices. Members have the ability to compare benefit options based on their needs and preferences in dynamic, side-by-side charts. The Feature Compare is powered by WebMD.
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- Used to fund expenses not covered by insurance. In an FSA, the employee, employer, or both may fund the account with pre-tax dollars. The employer maintains the FSA and the employees draw reimbursement as they incur qualified expenses. Any unused FSA balances revert back to the employer at the end of each year.
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- An employer-provided reimbursement arrangement that helps pay for medical expenses incurred by an employee or dependent.
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- A tax-advantaged personal account that is coupled with a High-Deductible Health Plan (HDHP). Employees use the HSA to pay for current and future qualifying medical expenses. HSAs were introduced as part of the Medicare Modernization Act of 2003.
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- A qualified high-deductible health plan (HDHP) is a health insurance plan with a minimum individual deductible and a minimum family coverage deductible. The U.S. Treasury defines the rules for a qualified HDHP. Once an employee hits the deductibles, the insurance plan will cover benefits at 100%. Almost all services are applied to the deductible, including prescriptions. The law allows an exception for preventive care, such as annual physical exams and immunizations, which can be covered without being applied to the high deductible.
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- An online, decision-support tool that provides members with comparisons of specific hospitals. Members can generate an individualized report that rates hospitals according to evidence-based measures they select as important for their analysis. To use the tool, a member enters his/her zip code and how far he/she is willing to travel for care, and then selects a specific diagnosis or procedure from the approximately 160 that are available within the tool. The Hospital Comparison Report will provide detailed side-by-side comparisons of each hospital's performance outcomes including, but not limited to, patient volume, complication rates, and performance data. The Hospital Quality Comparison Tool is powered by WebMD.
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- Doctors, hospitals, and other providers who participate in the Horizon BCBSNJ Networks. Generally, using an in-network provider saves members money and the provider files claims for them.
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- This interactive phone system allows members and their health care providers obtain Horizon MyWay information during and after our regular business hours. The IVR is accessible 24 hours a day, seven days a week (generally including weekends and holidays). When using the IVR, please be sure to listen carefully to the prompts and speak your responses in a clear voice.
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- An easy-to-read and easy-to-understand reference booklet that explains how to use the Horizon MyWay plan. The handbook includes information on Member Services, preventive care, emergency care, hospitalization, appeals, and much more.
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- Horizon BCBSNJ's secure, self-service feature available through our Web site. Once registered for Member Online Services, members can view the status of claims, check prior authorizations, request ID cards or forms, and much more.
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- Doctors, hospitals, and other providers who do not participate in the Horizon BCBSNJ Network. (Sometimes called "non-network" or "nonparticipating.") Generally, out-of-network care costs more than care received from a participating physician or hospital.
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- Health care costs that the member pays for directly. Out-of-pocket costs can include deductibles, coinsurance, or ineligible medical expenses.
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- Horizon MyWay plans include an out-of-pocket maximum as a safeguard for members. The out-of-pocket maximum limits the amount an individual or family must pay before the health insurance kicks in. Once the predefined out-of-pocket maximum is met, remaining eligible expenses are paid at 100% by Horizon BCBSNJ for the remainder of the calendar year.
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- A physician or other medical-services professional or organization (hospitals, labs, etc.) that contracts with us to offer services to Horizon MyWay members.
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- Covered services that can help keep members well and possibly identify serious health problems early, when they are the most treatable. Examples include annual physicals, well-child care, immunizations, and cancer screenings.
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- Written approval from us for a doctor or other health care professional to provide specific services or supplies prior to the date of service. Services and supplies that require prior authorization but have not been authorized in writing, will not be covered.
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- HRAs and HSAs may be used to pay for a variety of medical expenses, including some that are generally excluded in health insurance plans. The Internal Revenue Service established Code Section 213(d) to define the qualified medical expenses that HRAs and HSAs may be used for. Some examples of QMEs include health insurance plan deductibles; copayments and coinsurance amounts; dental services, including orthodontics, bridges and crowns; and vision care, including Lasik surgery, examinations and vision hardware.
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- In some Horizon MyWay plans, members may roll over funds to the next year. If unused balances remain in a reimbursement account at year end, Horizon MyWay HSA allows participants to carry funds over to the subsequent year. Rolled-over funds are cumulative; that is, they are added to the funding toward the account for the following year. Rollover does not apply to (FSAs) Flexible Spending Accounts.
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- Outpatient or out-of-hospital medical care required for an unexpected illness or injury that is not life-threatening or a medical emergency, but should be treated by a provider within 24 hours.
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- All Horizon MyWay members are issued a Visa Debit Card. This card can be used to directly pay for qualified medical expenses.
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- Horizon Blue Cross Blue Shield of New Jersey.
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