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FAQs — Questions and answers about our indemnity health plans
Q. What is an indemnity health plan?
A. A Horizon BCBSNJ indemnity health plan is a fee-for-service health plan with the freedom to select any doctor and hospital for medical care. Members may also use providers in our network, including access to the national BlueCard® indemnity network.
Q. What is BlueCard®?
A. BlueCard is a national program that links participating doctors and hospitals to
Blue Cross and/or Blue Shield Plans throughout the United States. 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 the suitcase logo, which lists a toll-free number to help you reach a provider.
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.
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.
Q. If I am traveling away from home and require medical care, how does my indemnity health plan 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
traditional indemnity physicians, health care practitioners, and hospitals. When participating BlueCard
indemnity physicians, health care practitioners, and hospitals provide your medical care, you receive
in-network benefits with low out-of-pocket costs.
Q. How do I find a participating BlueCard provider?
A. Call 1-800-810-BLUE (2583) toll free from any location.
(This phone number is printed on your ID card.) You may also call the provider's office directly to verify
that he/she is a participating BlueCard physician or health care practitioner. You can also find
information online via this Web site by selecting the Physician Directory feature.
Q. Will the physician or health care practitioner file my claim?
A. When you use a participating BlueCard 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.
Q. What happens if I use a nonparticipating provider?
A. When you use a nonparticipating provider, you are responsible for paying for care
upfront at the time of service. You then submit the bill, along with a completed claim form, for
reimbursement. To obtain a claim form, call Horizon BCBSNJ Member Services at
1-800-355-BLUE (2583).
Q. Are there services that require pre-authorization?
A. Yes, certain services may require pre-authorization. Check with Horizon BCBSNJ's
Member Services Department 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.
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.
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 BlueCard traditional indemnity, 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. BlueCard indemnity takes care of the rest. They can use any BlueCard indemnity
provider in the state where they are residing just as they would if they were home with you.
Q. Is it easy for my children attending college in another state to find a participating provider?
A. The BlueCard indemnity 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 8,600 participating hospitals and more than 800,000 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.
Q. How do I enroll in a traditional indemnity health plan?
A. How you enroll varies based on your employer. Please contact your employer's
benefit 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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