Horizon Blue Cross and Blue Shield of New Jersey
New Jersey • Traditional Indemnity, EPO, Medicare Advantage
Traditional indemnity coverage means the member has fee-for-service insurance with no network limitations. Any licensed provider can be seen without referrals. Claims are reimbursed based on usual, customary, and reasonable (UCR) charges. The member typically pays a deductible and a percentage of allowed charges.
This is an Exclusive Provider Organization (EPO) prefix. EPO plans do not cover out-of-network care except in genuine emergencies. Members can see any in-network specialist without a referral from their primary care physician. Claims for out-of-network non-emergency services will be denied.
This prefix is associated with Medicare Advantage. MA plans combine hospital (Part A) and medical (Part B) coverage, and many include prescription drug coverage (Part D). When billing, confirm whether the plan uses the same payer ID for MA claims as for commercial claims, as many BCBS companies use separate IDs.
Largest health insurer in New Jersey serving over 3.8 million members with commercial, Medicare and Medicaid plans.