Who Is Horizon Blue Cross Blue Shield of New Jersey?
Horizon Blue Cross Blue Shield of New Jersey is the oldest and largest health insurer in the state. It originally was formed as a multi-hospital prepayment plan and eventually became one of the pioneer Blue Cross plans in the United States.1
It serves 3.8 million members and has more than 33,000 in-network providers to meet your needs. Along with its subsidiaries, Horizon BCBSNJ provides a range of services, from prescription drug coverage to dental and vision insurance to individual and employer plans, both locally and nationally. It also offers Medicare and Medicaid coverage.
Horizon BCBSNJ is a tax-paying not-for-profit company that is an independent licensee of the Blue Cross and Blue Shield Corporation.
Founded in 1932, Horizon BCBSNJ employs more than 5,000 people.2
What You Need to Know
Horizon Blue Cross Blue Shield New Jersey offers insurance plans to individuals and employers.
Its service area is New Jersey, but some coverage features vary by county.
It has more than 30,000 in-network providers.
What Health Insurance Does Horizon BCBSNJ Offer?
Horizon Blue Cross Blue Shield New Jersey provides medical, dental, prescription drug, and Medicare and Medicaid services. Its plans meet the requirements of the Affordable Care Act (ACA), meaning that you might have lower monthly payments if you qualify for subsidies.3
Horizon BCBSNJ also offers worker compensation and personal injury insurance.
Variety of Plans
Horizon Blue Cross Blue Shield of New Jersey offers medical, dental, and prescription drug plans.
What Are Member Benefits With Horizon BCBSNJ?
Horizon BCBSNJ provides a variety of plans to suit your budget and needs. It offers individual, family and group plans. Two examples of Horizon BCBSNJ’s offerings are the OMNIA Health and Advantage EPO plans.
You can save money in the OMNIA plan if you receive services from an in-network Tier 1 provider or hospital.
OMNIA plans come with bronze, silver and gold options, per ACA rules. Bronze has the lowest premiums and highest out-of-pocket costs. The bronze plan is best if you don’t expect to have a lot of medical expenses.
The silver plan on average pays 70% of covered medical costs and you’d pay the remaining 30%, though subsidies may be available if you qualify.
If you’re willing to pay higher monthly premiums in exchange for lower out-of-pocket costs and frequent access to medical services, then the gold plan may be for you. It pays on average 80% of qualifying medical expenses and you pay 20%.
Advantage EPO (exclusive provider organization) also offers bronze, silver and gold options. It doesn’t require you to pick a primary care physician or get referrals to specialists. Out-of-network services aren’t covered except in an emergency or in certain situations.
In addition, Horizon BCBSNJ and its subsidiaries offer Medicare Advantage, Medicare Supplement and Medicaid plans, and supplemental plans including accident insurance, coverage outside New Jersey, and pet insurance.
If you’re homebound but need medical services, Horizon BCBSNJ has Horizon Care@Home, which provides at-home physical therapy, nursing and other care. The plan, in partnership with the post-acute care company CareCentrix, can also provide medical equipment, including diabetic supplies, home infusion therapy and orthotics and prosthetics.
How Do You Enroll in Coverage With Horizon BCBSNJ?
You have several ways to contact Horizon BCBSNJ for information or to enroll.
You can call 866-887-0107 to purchase a new policy or to see if you qualify for financial help, for instance under the American Rescue Plan Act of 2021.
You may also go to their website to book an appointment for an in-person or online consultation to go over your medical needs and what you can afford. The insurance specialist will prepare a customized quote and recommend plans.
For Medicare Advantage or Medicare Supplement plans, visit their website for information or call 877-234-1240.4
Medicare and Medicaid
Horizon BCBSNJ also offers Medicare and Medicaid coverage, including Medicare Advantage and Medicare Supplement plans.
How Do You File Claims With Horizon BCBSNJ?
In many cases, your provider will file a claim. It’s a good idea to first make sure the provider is in your plan’s network and that the service is covered.
Claim forms are available on Horizon BCBSNJ’s website or, if you prefer, you may mail them to: Horizon Blue Cross Blue Shield of New Jersey, P.O. Box 1609, Newark, N.J. 07101-1609.
How Is Horizon BCBSNJ Rated?
J.D. Power ranked Horizon BCBSNJ No. 1 among commercial member health plans in New Jersey for customer satisfaction in the last three out of four years.5
In recent years, Horizon BCBSNJ received an “A” rating from Standard and Poor’s and the Blue Cross Blue Shield Association’s “Brand Excellence for Innovation Award” for its OMNIA Health plans.
Horizon BCBSNJ is not accredited with the Better Business Bureau, but the BBB website shows 1 star out of 5 based on just one review by a member who said she had difficulty resetting her online password and didn’t get enough help from customer service agents. The BBB website reports 20 complaints closed in the past 12 months, and 38 in the last three years.
What Are the Strengths of Horizon BCBSNJ?
Horizon BCBSNJ is a solid health insurance company with a long history. It has been in business since 1932 and reports $13 billion in revenue for 2019, the latest year for which data is available. Horizon BCBSNJ paid out 73.5 million claims in 2019.
In 2015, Standard & Poor’s cited the company’s “well-established provider network and focused multi-channel distribution strategy.”6
What Are the Weaknesses of Horizon BCBSNJ?
The National Association of Insurance Commissioners shows two complaints in 2020, 18 in 2019 and 62 in 2018.7
Next Steps
If you’re interested in Horizon BCBSNJ’s coverage plans, determine your medical needs and how much you can afford in premiums and out-of-pocket costs. That way you can choose the best plan for you.
When you’re ready, reach out to Horizon BCBSNJ’s consultants so they can help guide you through the enrollment process.
