Q. What is the EPO health plan?
A. The EPO (Exclusive Provider Organization) plan delivers in-network-only benefits through the national BlueCard PPO network. EPO members must seek care from participating BlueCard PPO providers, except in the case of a life- or limb-threatening emergency. If care is received from a nonparticipating provider, the claim will not be paid. It is the member's responsibility to confirm that the providers and specialists they are seeing participate in the network. Claims will not be paid if care is received from a provider who is not in the network.

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Q. What is BlueCard PPO?
A. BlueCard PPO is the national network that links participating doctors and hospitals to Blue Cross and/or Blue Shield Plans throughout the United States. Your EPO program uses the BlueCard PPO network. So, whether you or a family member is traveling or living in another state, you can take advantage of your benefits by presenting your member ID card to any participating doctor or hospital. Always carry our easily identifiable ID card with a PPO in a suitcase logo, which lists a toll-free number to help you reach a provider.

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Q. I am not yet an enrolled member but am considering enrolling. Where do I call?
A. Please use the Horizon BCBSNJ Pre-Enrollment Hot Line: 1-800-722-BLUE (2583). This line is specifically set up to accommodate individuals not yet enrolled with Horizon BCBSNJ. When calling, simply specify the name of your employer, so we can access information about your plan. Once enrolled, members will have access to our dedicated Member Services Department. The Member Services number is 1-800-355-BLUE (2583) . Please only use the Member Services line if you are an enrolled member.

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Q. If I am traveling away from home and require medical care, how does the EPO program help me?
A. When you are traveling and need medical care, call the toll-free number on your ID card, 1-800-810-BLUE (2583), for names and addresses of the nearest participating BlueCard PPO physicians, health care practitioners, and hospitals. When participating BlueCard PPO physicians, health care practitioners, and hospitals provide your medical care, you receive in-network benefits with low out-of-pocket costs and do not have to file claim forms. Care must be received from participating BlueCard PPO providers, except in the case of a life- or limb-threatening emergency. Claims will not be paid if care is received from a provider who is not in the network.

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Q. Who do I call for member service?
A. Call Horizon BCBSNJ's dedicated Member Services Department at 1-800-355-BLUE (2583) for any service or claim issue. You can also call this number to obtain claim forms or claim submission information. For your convenience, our Member Services Department is open Monday through Friday, 8 a.m. to 8 p.m., Eastern Standard Time.

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Q. Will the physician or health care practitioner file my claim?
A. When you use an in-network physician or health care practitioner, he/she files claims for you. Horizon BCBSNJ's Member Services representatives can answer any questions about the status or payment of a claim. The toll-free Member Services number is on your ID card.

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Q. What happens if I use a nonparticipating provider?
A. EPO members must seek care from participating BlueCard PPO providers, except in the case of a life- or limb-threatening emergency. If care is received from a nonparticipating provider, the claim will not be paid.

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Q. Are there services that require pre-authorization?
A. Yes, certain services may require pre-authorization. Check with your employer or Horizon BCBSNJ's Member Services Department for specifics about what services under your program may require such approval. You or your physician will be required to contact Horizon BCBSNJ's Care Management Department at the number on your ID card to obtain pre-authorization.

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Q. How do I obtain pre-authorization for other services from Horizon BCBSNJ?
A. Your ID card lists a toll-free number for pre-authorization. It is your responsibility to obtain pre-authorization when it is required. Without pre-authorization, there may be a reduction in benefits or no benefits may be paid, depending on the terms of coverage.

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Q. My children are attending college in another state. Are they still covered under my health plan?
A. When your children go off to college, their health care benefits travel with them. With the EPO, students don't have to worry about filing complicated claim forms or dealing with billing hassles. They simply need to present their ID cards before receiving care from a participating provider and pay any applicable copayments. BlueCard PPO takes care of the rest. They can use any BlueCard PPO provider in the state where they are residing just as they would if they were home with you.

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Q. Is it easy for my children attending college in another state to find a participating provider?
A. The BlueCard PPO program provides established health care networks to more than 95 percent of the United States population. Members enjoy access to the largest health care network in the nation, featuring over 6,000 participating hospitals and more than 600,000 participating physicians, specialists, and subspecialists. To locate the names and addresses of participating practitioners in their area, students can call 1-800-810-BLUE (2583). Students can also use this Web site to locate providers online.

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Q. What do I do in a medical emergency if I am away from home?
A. In case of a medical emergency, you should obtain care at the nearest hospital or emergency facility. If the hospital is not in the BlueCard PPO network, don't worry — you do not receive a reduced level of coverage. All actual medical emergency care is paid at the in-network level of benefits, no matter where you may be.

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Q. How do I enroll in the EPO health plan and access BlueCard PPO?
A. How you enroll will vary based on your employer. Please contact your employer's benefits office for additional direction or Member Services at the Pre-Enrollment Hot Line at 1-800-722-BLUE (2583) for assistance.

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Q. What if I have additional coverage aside from EPO benefits, like dental or prescription drug benefits? How do I obtain information about those programs?
A. You may be eligible for other benefits programs, like dental, prescription drugs, or even flexible spending. Who administers these programs varies based on your employer. Visit the Horizon BCBSNJ Links option on this Web site to obtain information about these other coverage options, if administered by Horizon BCBSNJ. If you are an enrolled member, contact Member Services at 1-800-355-BLUE (2583) for information about other programs. If you are not yet enrolled, contact the Pre-Enrollment Hot Line at 1-800-722-BLUE (2583) for assistance.

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