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Horizon Blue Cross Blue Shield of New Jersey

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September 8, 2010
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Members

Home :  Members :  NJ FamilyCare Advantage :  Member Benefits
NJ FamilyCare Advantage Member Benefits Español

BenefitNJ FamilyCare Advantage
AcupunctureCoverage limited to when performed as a form of anesthesia in connection with covered surgery
AudiologyCovered
Blood and Blood PlasmaCoverage limited to administration of blood, processing of blood, processing fees and fees related to autologous blood donations
DentalCoverage is limited to preventive dental services (including X-rays and sealants) for children under the age of 12
Diabetic Supplies and EquipmentCovered
Emergency Medical Care/
Emergency Services
Covered with a $35 copayment
EPSDT (Early and Periodic Screening, Diagnosis and Treatment)Coverage is limited to well-child care, immunizations, lead screening and treatment
Family PlanningCoverage includes medical history and physical exams (including pelvic and breast), diagnostic and lab tests, drugs and biologicals, medical supplies and devices, counseling, continuing medical supervision, continuity of care and genetic counseling
Home Health & Visiting Nursing ServicesCoverage is limited to skilled nursing for homebound member that is provided or supervised by an RN and a home health aide when the purpose of the treatment is skilled care. Coverage includes medical social services that are necessary for treatment of the member's medical condition
Hospice ServicesCovered, including room and board in an institutional setting
Hospital Services (Inpatient)Covered. Horizon NJ Health is not responsible when the primary admitting diagnosis is mental health or substance abuse related
Hospital Services (Outpatient)Covered with a $5 copayment for each visit
Laboratory ServicesCovered with a $5 copayment when not part of office visit
Maternity ServicesCovered, including related newborn care and hearing screening
Medical SuppliesCoverage limited to diabetic supplies
Nurse MidwifeCovered with a $5 copayment for each visit
Nurse PractitionerCovered with a $5 copayment for each visit
Optical AppliancesMembers are eligible for eyeglasses or contact lenses every 24 months or more frequently if medically necessary. Members are eligible for eyeglasses or contact lenses from the select assortment of fashion frames or contact lens manufacturers covered by the plan
Optometrist ServicesCovered for one routine eye exam per year with a $5 copayment per visit
Organ TransplantsCoverage is limited to transplant-related physician costs for donor and recipient
Outpatient Diagnostic TestingCovered
Podiatrist ServicesCovered with a $5 copayment for each visit. Routine hygienic care of feet, including the treatment of corns, calluses, trimming of nails and other hygienic care, in the absence of a pathological condition, is not covered
Prescription Drugs from a Retail PharmacyCovered with a $1 copayment for generic drugs, $5 copayment for brand name drugs, $10 copayment for a supply of more than 34 days. Atypical antipsychotics and opiate addiction medications such as Suboxone/Subutex and methadone (specifically prescribed for opiate addiction) are not covered
Primary Care, Specialty Care and Women's Health ServicesCovered with a $5 copayment for each visit
ProstheticsCoverage limited to the initial provision of a prosthetic device that temporarily or permanently replaces all or part of an external body part lost or impaired as a result of disease, injury or congenital defect. Repair and replacement services are covered when due to congenital growth
Radiology Services - Diagnostic & TherapeuticCovered with a $5 copayment when not part of an office visit
Rehabilitation Services - InpatientCovered
Self-initiated care from a non-participating provider without referral/authorizationThe member shall be held responsible for the cost of care
Transportation ServicesCoverage limited to ambulance for medical emergency only

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