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HMO SERVICES PROVIDED
To visit Horizon NJ Health, click here
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Where
Medical Care is Provided:
(Where you go to get health care)
|
Private
doctor's offices, health centers, hospital based
centers, or Federally Qualified Health Centers. |
Choosing
a Doctor:
(What are the choices for a personal doctor)
|
Choose
a doctor from the plan's network. If you have not
talked to Member Services, call 1-800-543-5656 to
choose a personal doctor right away. |
Referral
Process:
(What to do to see a specialist)
|
Your
personal doctor will give you a referral to see
a specialist when needed. |
Obstetrician/Gynecologist
Services:
(What to do to see an OB/GYN)
|
You
can use any OB/GYN in the plan's provider network.
Plan members do not need a referral to see an OB/GYN. |
Seeing
a Dentist:
(What to do to see a dentist)
|
Choose
a dentist from the plan's provider network. No referral
is needed to see the child's primary care dentist.
For Plan D, coverage is limited to preventive
services for children under 12. |
Eye
Care and Glasses:
(What eye care services are provided)
|
Plan
A, B, C members are eligible for 1 eye exam and
$100 allowance for eyeglasses or contact lenses
every benefit year.
Plan D members are eligible for 1 eye exam (including
routine care) and $100 allowance for one pair of
eyeglasses or contact lenses every 24 months. No
referrals are needed for an eye exam. Exams, frames
and lenses are available through network providers. |
Emergency
Care:
(Who you should call first and where you should
go in case of an emergency. When are emergency room
visits covered) |
If
possible, contact your personal doctor when an emergency
occurs. If life threatening, go to the nearest emergency
room. Follow-up care must be provided by the child's
personal doctor. |
Other
Benefits:
(Other things the HMO offers) |
The
MomÍs GEMS prenatal program for pregnant members.
The Asthma Relief Management Program. Health and
member education available to all members. The Social
Case Management Outreach program designed to help
members with special medical and social needs. Multi-lingual
member support/services staff. For Plans A, B, C
over-the-counter medicines and vitamins, as prescribed
by your doctor.
Plan D members do not receive the over-the-counter
benefit. |
Pharmacy:
(What pharmacies can be used) |
You
can use any pharmacy in the “PAID” pharmacy
network. They are identified by the “PAID”
symbol on the pharmacy door or you can call Member
Services to find a “PAID” pharmacy in
the network.
 |
Member
Services:
(Customer helpline number) |
Multi-lingual
Member Services Helpline, 24 hours, 7 days a week,
1-877-765-4325.
TDD 1-800-684-5505 |
