Q. What is Horizon POS?
A. Horizon POS is a point-of-service plan, which gives you flexibility in choosing your medical care. Coordinate your care with the Primary Care Physician (PCP) you select through your Horizon POS plan. Your PCP refers you to specialists available to you through your Horizon POS plan and submits your claims. Or you can go directly to any other licensed physician in exchange for paying more costs and submitting your own claims.

As a Horizon POS member, you have access to many health care services and programs and our large participating physician and hospital networks. We've made your health care plan easy for you to understand and use. We offer preventive health care benefits, an easy-to-use referral system, direct access to your Ob/Gyn, emergency medical care, and much more. You also have the choice of going directly to any provider for care. We refer to this as out-of-network care.

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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 8 p.m., Eastern Standard Time.

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Q. If I am traveling away from home and require medical care, how does Horizon POS help me?
A. Horizon POS covers you for emergencies when traveling outside the state. You are covered at the in-network level of benefits if you call Member Services within 48 hours of a true medical emergency. If you receive nonemergency care in another state, you have coverage at the out-of-network level for eligible and medically necessary services.

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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. Out-of-network care is any medical care or service you receive from a physician or other health care professional without a referral form from your PCP. Even if the physician or other health care professional participates with Horizon POS, without a referral form from your PCP, your care is considered out of network. Eligible out-of-network care is paid at a lower level of benefits. This means you share in more of the costs when you are not referred by your PCP, and you must file your own claims.

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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. Yes. Horizon POS covers your children for emergencies when traveling outside the state. You are covered at the in-network level of benefits if you call Member Services within 48 hours of a true medical emergency. If you receive nonemergency care in another state, you have coverage at the out-of-network level for eligible and medically necessary services.

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Q. What do I do in a medical emergency if I am away from home?
A. Horizon POS members are covered for medical emergency care 24 hours a day, seven days a week. If you find yourself in a medical emergency, please follow the steps below to receive your care at the in-network level and save on medical costs:

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 call, 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 appropriately coordinate your care and ensure you receive the right care, at the right time, in the right setting.

Remember to your call your PCP or participating doctor. If you don't call your PCP or participating doctor within 48 hours, and it is determined that your visit was not a medical emergency, your medical expenses may not be covered at the in-network level of benefits.

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