Covered Services - Horizon NJ Health (2024)

FAQs

What is covered by Horizon NJ Health? ›

Generic and brand name prescription drugs on the Approved Drug List (formulary) Laboratory Services, no copays when part of an office visit. Vision Services, no or low copays for routine eye exams, glasses and contact lenses. Maternity Services, no copays, including related newborn care and hearing screening.

The following covered services require Prior Authorization: crowns, bridges, full dentures, partial dentures, gum treatments, root canals, surgical extractions, complex oral surgery, implants when medically necessary to support a complete denture, and orthodontics.

Applications currently take about 30 to 45 days to process. If you create a NJ FamilyCare account, you can check the status of your application after you submit it. You will get a letter in the mail whether or not you qualify for coverage. Receiving NJ FamilyCare does not make you a public charge.

According to the NJ FamilyCare/Medicaid “HMO Performance Report” released last month, Horizon NJ Health received a 92% overall performance score, the highest of all New Jersey's Medicaid managed care plans and the only plan to improve its overall score from previous reports.

The NJ FamilyCare Program (Medicaid) provides dental benefits so members can have regular dental check-ups, cleanings and needed dental treatment. Cavities and gum disease are preventable dental problems.

Vision Services

Benefits include exams, eyeglasses, corrective lenses and contact lenses. Members may self-refer. Benefit is for one routine eye exam each year. If a condition that requires additional care is detected during the annual exam, the PCP must be contacted.

Horizon BCBS of NJ recently announced that bariatric coverage will be available for members who have type 2 diabetes and a body mass index (BMI) of 30 or higher. The previous guidelines began coverage at a BMI of 35, so the update will expand coverage to many people who can benefit from bariatric surgery.

Examples of covered services include (but are not limited to): oral evaluations (examinations); x-rays and other diagnostic imaging; dental cleaning (prophylaxis); topical fluoride treatments; fillings; crowns; root canal therapy; scaling and root planing; complete and partial dentures; oral surgical procedures (to ...

As a member of Horizon NJ Health, you get the benefits and services you are entitled to with the NJ FamilyCare Program. The medical care and services you get through Horizon NJ Health are free or low cost.

Once determined eligible for Medicaid, annual redeterminations are done to ensure a Medicaid recipient still meets the financial eligibility requirements. However, a Medicaid agency can ask for bank statements at any time, not just annually.

At what age does NJ FamilyCare end? ›

All adults age 19-64 with income up to 138% of the Federal Poverty Level can apply for NJ FamilyCare.

HMO plans typically have lower monthly premiums. You can also expect to pay less out of pocket. PPOs tend to have higher monthly premiums in exchange for the flexibility to use providers both in and out of network without a referral. Out-of-pocket medical costs can also run higher with a PPO plan.

NJ FamilyCare includes New Jersey residents; all are eligible to apply. Financial eligibility will be determined by the latest federal tax return which, when filed, will be electronically verified.

MoneyGeek's top pick for the best health insurance in New Jersey is Aetna CVS Health. This provider offers four Silver EPO plans. Its average plan rate is $424 per month, and the average MOOP cost for these plans is $8,850. Aetna CVS Health provides Silver EPO plans.

A prior authorization is an approval that the doctor needs to get from us before we cover the cost. Certain over-the-counter (OTC) products are covered with a written prescription from the prescriber. Some medicines are not covered under your pharmacy benefit.

Horizon is No. 3 on Insure.com's Best Health Insurance Companies list. It earned 4.12 stars out of 5.

Horizon NJ Health, New Jersey's largest managed healthcare company serving the publicly insured, provides quality healthcare services for more than 500,000 children and adults in the Medicaid and NJ FamilyCare programs. Horizon NJ Health provides benefits for New Jersey residents enrolled in the Medicaid program.