Horizon Blue Cross and Blue Shield of New Jersey
New Jersey • EPO, Medicaid, High-Deductible Health Plan (HDHP)
This prefix is associated with an EPO plan. Exclusive Provider Organization coverage combines elements of HMO and PPO plans: members must stay in-network like an HMO, but can self-refer to specialists like a PPO. Out-of-network services are not covered except for emergencies.
Under this prefix, the member may have Medicaid coverage managed by this BCBS plan. Medicaid claims have specific rules around cost-sharing, balance billing, and timely filing that override the plan's standard commercial policies. Contact the plan's Medicaid provider services line for submission details.
HDHP (High-Deductible Health Plan) coverage means the member has a higher deductible than traditional plans, often paired with a Health Savings Account (HSA). Most services require the member to pay out-of-pocket until the deductible is met. Preventive care is typically covered before the deductible. Submit claims normally to the payer listed above.
Largest health insurer in New Jersey serving over 3.8 million members with commercial, Medicare and Medicaid plans.