Q. What is Horizon HMO?
A. Horizon HMO is a health maintenance organization, which allows you to enjoy minimal costs out of your own pocket by receiving your health care services through your Primary Care Physician (PCP). Your PCP guides and coordinates your health care, including filing your claims. When needed, your PCP refers you to specialists, hospitals, and other health care professionals available to you through your Horizon HMO plan.

As a Horizon HMO member, you have access to many health care services and programs, as well as access to one of the largest participating physician networks in the state. We offer preventive care benefits, an easy-to-use referral system, direct access to your Ob/Gyn, emergency medical care, and value-added programs.

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Q. Who do I call for customer 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. Our Member Services Department is open Monday through Friday, 8 a.m. to 6 p.m., Eastern Standard Time.

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Q. If I am traveling away from home and require medical care, how does Horizon HMO help me?
A. Horizon HMO covers you and your family no matter where you travel or reside temporarily — whether away for business or vacation, or for dependent children away at college. Use a nationwide network of health care professionals, the largest HMO network in the country, serving more than 250 major cities, all 50 states, and Puerto Rico. Just call the 24-hour hotline at 1-800-810-BLUE(2583). If you're away from home for an extended time, you and your family can enroll in a Blue Cross and Blue Shield-sponsored HMO in another state. Just call a customer service representative at the number on your ID card for information and ask about Guest Membership.

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Q. Will the physician or health care practitioner file my claim?
A. When you visit your PCP or network specialist, 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. Your Horizon HMO plan starts with your PCP, a duly licensed practitioner who has entered into an agreement with us to participate in the Horizon BCBSNJ Managed Care Network and is responsible for coordinating all aspects of your medical care, including referrals to specialists, ancillary providers, or inpatient facilities. If you do not select a PCP, all services rendered by any provider are ineligible for payment.

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Q. When do I need a referral?
A. Your Primary Care Physician gives you a referral form if he/she determines that you need specialty medical care or services. Please take this referral form and your ID card to the participating specialty care provider at the time of service.

Remember, you do not need a referral form for routine non-surgical obstetrical or gynecological-related visits to participating Ob/Gyns.

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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 for specifics about which services under your program may require such approval. You or your physician are 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. As a Horizon HMO member, the same benefits you and your family enjoy through your Horizon HMO plan can be accessed no matter where you are. With our Away From Home Care^® program, you have the peace of mind that comes with knowing your coverage extends beyond the Horizon HMO Service Area. The program, which is available to all Horizon HMO members at no extra cost, is designed to meet your health care needs and those of your dependents, whether on a short trip or away from home for an extended period of time. When your children go off to college, their health care benefits travel with them. With Horizon HMO, 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.

For long-term stays (90 consecutive days or longer), the Guest Membership benefit allows your children to receive health care from a host HMO, which includes emergency care, urgent care, and routine care offered by the host HMO. The Guest Membership benefit is available in most states,* including the District of Columbia, and is comparable to your Horizon HMO plan. Just call Member Services at the number on your ID card for information and ask about Guest Membership.

* Excludes Alaska, Mississippi, Montana, South Dakota, Tennessee, Utah, Vermont, West Virginia, and Wyoming.

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Q. What do I do in a medical emergency if I am away from home?
A. Horizon HMO members are covered for medical emergency care 24 hours a day, seven days a week. If you find yourself in a medical emergency situation, please follow the steps below:

1. Go directly to the nearest emergency room or call 911 or your local emergency response number.
2. Call your PCP, if possible. In some situations, you should be able to call your PCP before you go to the emergency room. If you can't, please call your PCP within 48 hours. If you are unable to make the call, please have a family member or friend call. It is important that your PCP be kept aware of your condition. Without this information, your doctor cannot coordinate your care and ensure you receive the right care. Please note: You do not need to call Member Services to notify us of a medical emergency.

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