Member Newsletters
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A newsletter for Horizon NJ Health Members
horizonNJhealth.com
Issue 4, 2015
MEMBER SERVICES
Our Member Services toll free
number is: 1-877-7NJ-HEALTH
(1-877-765-4325),
24 hours a day, seven days a week.
Members with speech or hearing
impairments may call TDD/TTY
toll free at 711.Horizon NJ Health
210 Silvia Street
West Trenton, NJ 08628
BlueNotes
MEMBER SERVICES
Horizon NJ Health Online Member Portal
To register to use Horizon
NJ Health?s member portal, visit our
website at horizonnjhealth.com.
From the home page, click
Member Support, then Resources,
then Member Online Services.
We encourage you to sign up for the
online member portal as soon as possible.
We hope you find this self-service tool
to be a useful resource for managing
your health plan!
Horizon NJ Health is excited to offer you access
to our new online member portal!
This member portal will allow you to interact with
your health plan, 24 hours a day, 7 days a week ?
at your convenience. The following features will be
available to you once you sign up:
? Request an ID card ? if you need a new ID card, you can easily request
one to be sent to you.
? View your covered benefits ? learn about your benefit level, what is
covered under your plan, and whether or not you have copayments for
certain services.
? Complete a health assessment ? complete a survey about your health,
learn about your risks, and see how you can make changes to your lifestyle
to improve your health.
? Change your PCP (Primary Care Provider) ? if you need to change your
doctor, you can easily do so on the portal.
? Wellness Topics ? get personalized health news articles from WebMD,?
based on the information you provide in your health assessment.
? Enroll in disease management ? if you have a chronic condition,
like asthma or diabetes, you can enroll in a specific disease management
program to help manage your health issue(s).
? Enroll in Mom?s GEMS maternity program ? if you are pregnant,
you can enroll in the Mom?s GEMS program to get information for
a healthy pregnancy and healthy baby.
horizonNJhealth.com Page 2Blue Notes Issue 4, 2015
Flu Shot Reminder
If you haven?t already, it?s time
to get your annual flu shot.
The flu shot will protect you from getting the flu.
You can get your flu shot from your
primary care provider.
If you are over 65, ask your
doctor or nurse about the
pneumonia shot and if
you need one. Most
people will only need
to get the shot once
after age 65.
Antibiotic Over-use
Did you know that antibiotics
do not fight viral infections like
colds, flu, and most sore throats?
Taking antibiotics when they are not
needed may cause you more harm than good.
When you take antibiotics and they do not work,
it can cause longer-lasting illnesses, more doctor
visits, the need for stronger medicines, and
life-threatening illness.
Do NOT:
n Take an antibiotic for a viral infection, unless your
doctor has prescribed one. Some of these viral
infections are:
? Colds or flu
? Most coughs and bronchitis
? Sore throats not caused by strep
? Runny nose/congestion
? Most sinus infections
n Take an antibiotic prescribed for someone else
n Skip medication doses, save it for later use, or
let anyone else use it ? always follow the doctor?s
instructions for taking and finishing your
medicine
Rapid Strep B Test
Strep throat is a bacterial throat infection and most
usually occurs in school-aged children. Before your
child?s doctor prescribes an antibiotic, he or she may
give your child a rapid Strep B test if your child?s
throat and symptoms seem like more than just a viral
sore throat. This test is done by brushing the child?s
throat with a cotton swab and testing for the
streptococcus bacteria. The results are usually ready
within 15 minutes. If your child has strep throat,
the doctor will prescribe an antibiotic to treat the
infection. If your child has strep throat, it is
important to follow the doctor?s instructions for
taking the prescribed antibiotics.
You can learn more about these topics by
visiting our website at horizonnjhealth.com.
From the home page, click Member Support,
then Resources. You can also get more
information about the topics below in your
Member Handbook.
Member Rights & Responsibilities
As a member of Horizon NJ Health, you have a partner
who will help you get the care you need. Horizon
NJ Health will treat you with respect and there are
certain rights you can expect. There are also certain
responsibilities that Horizon NJ Health expects
from you.
Utilization Management (UM) Decisions
You can contact Horizon?s Utilization Management
(UM) to discuss any medical decisions for which you
may have questions.
The Right to Appeal
You have the right to file a complaint or appeal with
Horizon NJ Health. There is a specific procedure you
will need to follow if you would like to do so.
Important Member Information
horizonNJhealth.com Page 3Blue Notes Issue 4, 2015
Horizon NJ Health would like to let
you know about the recent changes to
our drug formulary list (see box).
The changes found in this list will be added to
our drug formulary list on the Horizon NJ Health
website, horizonNJhealth.com. You can also
find the formulary guide, which includes an
explanation and listing of step therapy,
quantity/age/gender limits and drugs requiring
prior authorization, on the Horizon NJ Health
website.
Please talk with your Primary Care Provider
(PCP) about these changes. If your PCP decides
that, for medical reasons, you must take a drug
that is not on the formulary list or needs
pre-approval, including a brand name
medication exception, he or she can call us
Here is a list of recent changes: Formulary Changes
Formulary Change
Description
Brand (Generic)
Drug Name
Alternatives
(if applicable)
Not Covered Xyrem (sodium
oxybate)
Provigil, amphetamine,
methamphetamine,
dextroamphetamine,
methylphenidate, and
selegiline
Not Covered Syprine (trientine
hydrochloride)
Penicillamine
Covered Xarelto (rivaroxaban)
Covered Bydureon pen (exena-
tide extended-release)
and ask for special permission (prior authorization) for
you to get the drug.
Your PCP may call the Horizon NJ Health Pharmacy
Department at 1-800-682-9094 to request a prior
authorization.
Staying Safe
this Winter
With the cold weather comes ice and snow. Staying safe
during the winter months is very important and there are a
number of things you can do to reduce your risk of injury.
Avoiding falls
Did you know that falls are the main cause of injury-linked deaths
in adults 65 and older?
? If you are going to be outside in ice and snow, wear
rubber-soled boots or waterproof footwear.
? Be careful on snowy or icy sidewalks and steps.
Keeping Warm
? Stay mostly indoors during very cold temperatures.
? Layer your clothing and wear a hat and gloves when outside.
Ask for Help
? Ask a friend or family member to do the shoveling ? especially
if you have a chronic condition like heart disease or asthma,
if you have heart problems, or if you are elderly.
? Pay a neighbor or a shoveling service to shovel your front steps
and front walk.
horizonNJhealth.com Page 4Blue Notes Issue 4, 2015
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Member Services 1-877-7NJ-HEALTH (1-877-765-4325) (TTY: 711)
24 hours a day, seven days a week. horizonNJhealth.com
Fraud, Waste and Abuse Hotline: 1-855-FRAUD20 or
1-855-372-832 (TTY: 1-800-654-5505)
BLUE NOTES is published as a community service for the friends and patrons of
Horizon NJ Health, 210 Silvia St., West Trenton, NJ 08628. Information in
BLUE NOTES comes from a wide range of medical experts. If you have any concerns
or questions about specific content that may affect your health, please contact
your health care physician. Models may be used in photos and illustrations.
Horizon NJ Health is part of the Horizon Blue Cross Blue Shield of New Jersey enterprise,
an independent licensee of the Blue Cross and Blue Shield Association.
? 2015 Horizon Blue Cross Blue Shield of New Jersey.
Three Penn Plaza East, Newark, NJ 07105
BlueNotes
Colorectal Cancer ? Cancer of the colon or rectum ?
affects both men and women. Regular screenings
can catch colorectal cancer early, which is important for
successful treatment.
When should you get screened?
Screening for colon cancer should begin at 50 years old or when
your doctor says screening is needed. Talk to your doctor to see
when you should be screened and what type of test you should get.
Regular screenings are important and could save your life.
Tests to screen for colorectal cancer:
? Fecal occult blood test (FOBT) and fecal immunochemical test (FIT):
Doctors check stool samples for blood, which may be a sign of a polyp or cancer.
? Sigmoidoscopy: The doctor puts a flexible, lighted tube into the rectum and lower colon to
check for polyps and cancer.
? Colonoscopy: The doctor uses a longer, flexible tube to look at the entire colon and rectum.
? Double contrast barium enema: An X-ray test of the colon and rectum.
? CT colonography (virtual colonoscopy): A type of CT scan of the colon and rectum
Talk to Your Doctor About a Colorectal Screening
NJ Addiction
Services
Hotline
Do you or someone you know need help with
a drug or alcohol problem? For assistance and
a referral to treatment, call the NJ Addiction
Services Hotline toll-free at 1-844-276-2777.
Help is available 24 hours a day, 7 days a week.
horizonNJhealth.com
As of March 31, 2014, Horizon
NJ Health no longer offers its
NJ FamilyCare ADVANTAGE plan.
This is Horizon NJ Health?s program
for children who lack health care
coverage and whose family income
levels make them ineligible for
Medicaid or NJ FamilyCare.
If you have questions about this
change, please call Member
Services at 1-877-7NJ-HEALTH
(1-877-765-4325), TTY: 1-800-654-
5505. You can also visit our website
at horizonNJhealth.com to learn more.
Important
NJ FamilyCare ADVANTAGE
Announcement
See Participating Providers
Our Member Services toll free
number is: 1-877-7NJ-HEALTH
(1-877-765-4325),
24 hours a day, seven days a week.
Members with speech or hearing
impairments may call TDD/TTY
toll free at 1-800-654-5505.
MEMBER SERVICES
Horizon NJ Health
210 Silvia Street
West Trenton, NJ 08628
A newsletter for Horizon NJ Health Members Issue 1, 2014
As a Horizon NJ Health member, you have access to the largest
network of participating Medicaid providers in the state of
New Jersey. In order to have your medical services covered,
you must see a provider in the Horizon NJ Health network. If you
see a provider who does not participate with Horizon NJ Health,
you may have to pay for the full cost of the services on your own.
Your primary care provider (PCP) can arrange all of your
medical care. Every Horizon NJ Health member has a PCP, and
you can change your PCP at any time. The name of your PCP is
on the front of your Horizon NJ Health ID card. Call this doctor
first whenever you need medical care. Your PCP can also refer
you to a specialist who participates with Horizon NJ Health if
you need extra care.
To find providers who participate with Horizon NJ Health,
you can use the online
Provider Directory.
Go to horizonNJhealth.com
and click Provider
Directory.
BlueNotes
horizonNJhealth.com Page 2Blue Notes Issue 1, 2014
Prostate cancer is the
second most common type
of cancer in American men.
One in six men will be
diagnosed with prostate
cancer during his lifetime,
according to the American
Cancer Society.
But if the cancer is found and treated early, most
men have a very good chance of surviving it.
That?s why prostate cancer testing should start
when you turn 50 years old or when your doctor
thinks it is the right time for you. It is even more
important for men with any of these risk factors to
be screened:
? Being African-American
? Having men in your family with prostate cancer
? Eating a lot of food high in saturated fat, like red
meat and high-fat dairy foods
? Being overweight
There are different tests used to screen for
prostate cancer. For most men, a PSA blood test
and digital rectal exam should be done every year.
Horizon NJ Health covers prostate cancer testing
when it is recommended by your doctor. Talk with
your doctor about being screened today.
You can also take steps to help prevent prostate
cancer:
? Eat plenty of fruits and vegetables each day.
? Limit foods like steak and hamburger and dairy
like ice cream, butter and cheese.
? Stay at the weight that is healthy for you.
Breast cancer is the second most common type
of cancer among women, but more women are
surviving the deadly disease because of routine
testing. Every woman should have breast exams
and/or mammogram screenings to help prevent
breast cancer.
Clinical Breast Exam
A clinical breast exam is a simple exam done by
your provider. Women in their twenties and thirties
should have an exam at least every three years and
women 40 and older should have an annual exam.
Mammogram
A mammogram is an X-ray of the breast that
checks for problems, such as tumors and cysts.
Women 40 years old and older should have a
mammogram every year.
Self-Breast Exam
Women should also check themselves with
monthly self-breast exams. Your provider can
teach you how. Tell your provider right away about
any changes to how your breasts usually look
and feel.
You may need screenings earlier or more often
if you have
a high risk
of breast
cancer.
Talk to your
doctor
about when
and how
often you
should be
tested.
Prostate Cancer Testing for Men
Breast Cancer Screening for Women
horizonNJhealth.com Page 3Blue Notes Issue 1, 2014
The goal of the Horizon NJ Health Quality Improve-
ment Program is to help you live a healthier life.
We focus on your health and the care you get when you
see a doctor. We want to make sure you are satisfied
with your care and the services you get.
The goals of the program are to make sure that:
? You have doctors available to you and that you get
the best care possible
? You are happy with Horizon NJ Health and your doctors
? We are making it easy for you to get good health care
? We are obeying the laws and standards set for Horizon
NJ Health by the state of New Jersey and accrediting
groups
If you would like more information about our
Quality Improvement Program, visit our website,
horizonNJhealth.com, or call 1-800-682-9094
(TTY: 1-800-654-5505) and ask for the Quality
Department.
If you would like to get
family planning
contraception services,
please call Member Services at 1-877-7NJ-HEALTH
(1-877-765-4325), TTY: 1-800-654-5505.
We can help you get the care you need and will tell
you where you can find a doctor or clinic near you.
You do not need a referral from your primary care
provider (PCP) for family planning services.
Most NJ FamilyCare D and NJ FamilyCare ADVANTAGE
members must see participating Horizon NJ Health
providers. All other members can get family planning
services from an out-of-network Medicaid provider
through the Medicaid Program using their Health
Benefits ID (HBID) card.
Quality Program Family
Planning
When you join Horizon NJ Health, you will be sent a
member ID card in the mail. Everyone in your family who is
a Horizon NJ Health member will get his or her own card.
If you did not get a card after you joined Horizon NJ Health,
please call Member Services at 1-877-765-4325
(TTY: 1-800-654-5505).
Check the card when you get it to make sure all of your
personal information, such as your name, is correct. Your primary
care provider?s (PCP) name and phone number are also on the
card. Make sure it lists the PCP you chose. You can change your
PCP at any time by calling Member Services.
Show your card every time you get health care ? when you
see your doctor or dentist, when you are referred to a specialist,
when you fill a prescription, when you have lab work done,
and if you go to an emergency room.
Please keep your Horizon NJ Health member ID card safe and
never let anyone else use or borrow it. If you lose your card, be
sure to call Member Services right away.
Member ID Cards
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horizonNJhealth.com Page 4Blue Notes Issue 1, 2014
A personal representative is a person you choose to work with
Horizon NJ Health for you to manage your enrollment, claims,
premiums, appeals or anything else related to your benefits. Your
personal representative can be a husband or wife, son, daughter or
other family member, a friend, a lawyer, or someone chosen by a court.
Your personal representative stands in for you if you do not feel well
enough to manage your health plan on your own. Even if you choose a
personal representative, you do not lose any of your rights, and you can
change or remove your personal representative at any time.
If you would like to name a personal representative, please fill out and
sign a Request for Personal Representative form. You can get the form
on the Horizon NJ Health website at horizonNJhealth.com or by calling
Member Services at 1-877-765-4325 (TTY: 1-800-654-5505).
If you have any questions, please call Member Services.
Please send your completed form to:
Horizon NJ Health Member Services
Attention: HIPAA Team
210 Silvia Street
West Trenton, NJ 08628
Horizon NJ Health will
cover care for members
younger than 18 years
old following all laws.
Parents or guardians have
the right to make medical
decisions and allow treat-
ment of dependents who are minors, or under
18 years old.
In certain cases, New Jersey law lets minors make
health care choices for themselves. Minors can
make choices without their parents or guardians
in these cases:
? Minors who go to an emergency room for an
emergency
? Minors who want family planning services,
maternity care or sexually transmitted disease
(STD) services
? Minors living on their own who have their
own Medicaid ID number as head of their
household
You Can Name a
Personal Representative
Treatment of Minors
Member Services 1-877-7NJ-HEALTH
(1-877-765-4325) (TDD/TTY: 1-800-654-5505)
24 hours a day, seven days a week.
horizonNJhealth.com
BLUE NOTES is published as a community service for the friends and patrons of
Horizon NJ Health, 210 Silvia St., West Trenton, NJ 08628. Information in
BLUE NOTES comes from a wide range of medical experts. If you have any concerns
or questions about specific content that may affect your health, please contact
your health care physician. Models may be used in photos and illustrations.
Horizon NJ Health is part of the Horizon Blue Cross Blue Shield of New Jersey enterprise,
an independent licensee of the Blue Cross and Blue Shield Association.
? 2014 Horizon Blue Cross Blue Shield of New Jersey.
Three Penn Plaza East, Newark, NJ 07105
Each year, Horizon NJ Health members are given
a survey that asks what Horizon NJ Health does well
and what it could do better.
Your answers help Horizon NJ Health make the services
we offer better for our members.
What you think matters! If you get a survey,
please fill it out and return it in the mail.
Member Satisfaction Survey
Like us on Facebook
www.facebook.com/HorizonNJH
www.twitter.com/HorizonNJHealth
@HorizonNJHealth
Follow us on Twitter
BlueNotes
? ? ??
?
A newsletter for Horizon NJ Health Members
horizonNJhealth.com
Issue 3, 2015
MEMBER SERVICES
Our Member Services toll free
number is: 1-877-7NJ-HEALTH
(1-877-765-4325),
24 hours a day, seven days a week.
Members with speech or hearing
impairments may call TDD/TTY
toll free at 1-800-654-5505.Horizon NJ Health
210 Silvia Street
West Trenton, NJ 08628
BlueNotes
MEMBER SERVICES
Avoiding the Flu
Do you need a
pneumonia vaccine?
Protect your family and yourself.
Now is a good time to schedule your
annual flu shots. Flu season can start as
early as October and most often peaks
in January/February. You need to get a flu shot each year to
protect yourself from getting the flu.
The flu usually lasts about a week to 10 days. It can lead to
more dangerous lung infections, such as pneumonia, mainly
among young children (6 months to 5 years old), people
65 years and older, and people with certain health issues.
Symptoms of the flu usually come on faster and harder than a
cold, and include fever, body aches, and a great need for rest.
Who needs a flu shot?
? Children age 6 months to 18 years
? People 50 years of age and older
? Pregnant women
? People who care for children younger than 6 months old
? People of any age with chronic illnesses, such as
asthma, diabetes, chronic kidney failure, etc.
? People who live in nursing homes and other
long-term care places
? People who live with, or care for individuals at high risk
for problems stemming from the flu
You can get a flu shot from your primary care provider.
If you are 65 years of age or older,
ask your doctor or nurse about the
pneumonia shot. Most people will
only need to get the shot once
after age 65.
A pneumonia shot is recommended
for people who:
? Have chronic, long-term health
problems like heart, lung or
sickle cell disease, diabetes,
alcoholism, cirrhosis, leaks of
cerebrospinal fluid or a
cochlear implant
? Have a disease or conditions
that lower the body?s resistance
to infection, such as HIV/AIDS,
Hodgkin?s disease, lymphoma
or leukemia
? Have long-term steroid use
? Are an adult with asthma
? Are an adult who smokes
horizonNJhealth.com Page 2Blue Notes Issue 3, 2015
Sexually Transmitted Infections (STI) and your children
Human Papillomavirus (HPV)
How to protect your daughters and sons
against this STI
You may feel a bit uneasy thinking about your child as being
sexually active. But the fact is, sooner or later, they likely
will be. It is very likely that they will be exposed to
human papillomavirus (HPV) ? the most common
sexually transmitted infection (STI). Certain HPV strains may
lead to genital warts and other strains can lead to cancer.
Now, with the HPV vaccine, you can protect your children
from getting HPV. The vaccine is a series of three shots, given
over a six month period of time by your child?s doctor.
Who should get the HPV vaccine?
? Preteens ? both boys and girls who are 11 or 12 years old
? Young women can get vaccinated through age 26
? Young men can get vaccinated through age 21
? People with a disease or condition that lower the body?s
resistance to infection, such as HIV/AIDS
Chlamydia
Chlamydia (Clam-mid-dee-a) is a (STI) that
most often has no immediate symptoms,
so many people do not even know they have it.
It can be easily cured with antibiotics.
However, if it is untreated, chlamydia can
make it hard for women to get pregnant or can
cause a tubal pregnancy.
Any person who is sexually active can get
chlamydia, but young people and men who
have sex with men are at the highest risk.
Chlamydia is transmitted through all types of
unprotected sex ? vaginal, oral and anal.
You can lower your risk for Chlamydia by:
? Having sex with only one partner who has
been tested negative for STIs
? Using a condom every time during sexual
intercourse
? Being abstinent ? not having sexual
intercourse
? Visiting the OB/GYN or family doctor for
regular exams
Get tested every year if you are:
? A sexually active woman younger than
25 years
? Pregnant or about to become pregnant
? An older woman who has a new sex partner or
more than one sex partner
? A sex partner who has a sexually transmitted
infection
? A male who has sex with males
horizonNJhealth.com Page 3Blue Notes Issue 3, 2015
October is Breast Cancer
Awareness Month
Have you scheduled your
mammogram?
Breast cancer is scary, but if it is found early,
women have a greater chance of living.
A mammogram is the best way to find breast cancer
early. A mammogram is an X-ray of your breast and
only takes about 20 minutes, with little discomfort.
It shows small lumps or growths that you or your
doctor may not be able to feel. By comparing one
year?s mammogram to the next, your doctor can tell
what?s normal for you. Changes in your mammogram
may point to breast cancer or illness.
Who needs a mammogram?
? Women should have a baseline mammogram
between ages 35-40
? Every woman over 40 should get an annual
mammogram
? If you have a family history of breast cancer,
you may need a mammogram earlier.
Talk to your doctor about this.
Know your breasts
All women should give themselves a monthly breast
self-exam. If you don?t know how, your doctor can
show you during a clinical breast exam. When you
know for yourself how your breasts are supposed to
look and feel, you can notice changes more easily.
Tell your doctor right away about anything you find
that doesn?t seem normal.
Living Better with Diabetes
If you have diabetes, Horizon NJ Health?s Diabetes
Management Program can help you manage your
condition. As you know, diabetes can cause major health
problems, but with simple tests and treatment,
many problems can be detected early and stopped.
What the Horizon NJ Health Diabetes Management
Program can do for you:
? Teach you about diabetes
? Talk to you about the long-term effects of diabetes
that is not controlled
? Help you learn about medicines used to treat diabetes
? Build a sick day care plan
? Show you how to check your daily progress with a blood
sugar testing machine
? Guide you to diabetes specialists , if needed
Preventive care is vital for controlling your diabetes.
You many need all or some of these tests yearly, or more
often to track and manage your condition.
Important tests for diabetics:
? HgA1C ? a blood test that measures your average
blood sugar over a three-month period
? Dilated retinal eye exam ? finds problems that can
lead to blindness
? Cholesterol ? measures the amount of fat in your blood,
and can identify your risk for heart attack or stroke
? Foot exam ? identifies your risk for a foot sore that can
lead to a serious infection
? Microalbuminuria (Kidney test) ? tests for protein in your
urine and can find kidney damage early
Talk to your doctor to see when or how often you should
have these tests.
To sign up for the Horizon NJ Health Diabetes
Management Program, call toll free at
1-800-682-9094 ext. 89634 (TTY: 1-800-684-5505).
Or, ask your doctor to sign you up.
n Get a mammogram yearly if you are
over 40 years old.
n You do not need a referral from your
doctor for a mammogram.
n Mammograms are covered by
Horizon NJ Health.
horizonNJhealth.com Page 4Blue Notes Issue 3, 2015
? ??? ?
?Member Services 1-877-7NJ-HEALTH
(1-877-765-4325) (TTY: 1-800-654-5505)
24 hours a day, seven days a week.
horizonNJhealth.com
Fraud, Waste and Abuse Hotline:
1-855-FRAUD20 or 1-855-372-8320
(TTY: 1-800-654-5505)
BLUE NOTES is published as a community service for the friends and patrons of
Horizon NJ Health, 210 Silvia St., West Trenton, NJ 08628. Information in
BLUE NOTES comes from a wide range of medical experts. If you have any concerns
or questions about specific content that may affect your health, please contact
your health care physician. Models may be used in photos and illustrations.
Horizon NJ Health is part of the Horizon Blue Cross Blue Shield of New Jersey enterprise,
an independent licensee of the Blue Cross and Blue Shield Association.
? 2015 Horizon Blue Cross Blue Shield of New Jersey.
Three Penn Plaza East, Newark, NJ 07105
BlueNotes
Other Health Insurance
If you have coverage through Horizon NJ Health and another health plan,
such as Medicare, be sure to follow the benefit guidelines of that plan.
This includes the need for referrals and using in-network doctors.
If thE SERVICE IS: USE thIS typE of doCtoR:
Use a doctor from that insurance?s network
(does not need to be in the Horizon NJ Health network)
Use a Horizon NJ Health network doctor
An approved, covered benefit from the other insurance,
including referrals from that insurance?s PCP,
prescription drugs and inpatient hospital stays
A medically necessary service that may not be covered by
the other insurance but is covered by Horizon NJ Health
(for example: personal care assistance services,
family planning services)
When You Have Other Insurance and NJ FamilyCare
If thE SERVICE IS: USE thIS typE of doCtoR:
An approved, Medicare-covered benefit
(for example: primary care, lab tests, specialists)
Inpatient hospital care
Emergency care received at a hospital
emergency department
A medically necessary service not covered
by Medicare but covered by Horizon NJ Health
(for example: dental services or hearing aids)
Use a Medicare doctor (does not need to be in the
Horizon NJ Health network)
Use a Medicare hospital. If possible, use a hospital
also in the Horizon NJ Health network
Go to the nearest hospital
Use a Horizon NJ Health network doctor
When You Have Both Medicare and NJ FamilyCare
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A newsletter for Horizon NJ Health Members
horizonNJhealth.com
Issue 2, 2015
MEMBER SERVICES
Our Member Services toll free
number is: 1-877-7NJ-HEALTH
(1-877-765-4325),
24 hours a day, seven days a week.
Members with speech or hearing
impairments may call TDD/TTY
toll free at 1-800-654-5505.Horizon NJ Health
210 Silvia Street
West Trenton, NJ 08628
BlueNotes
Getting the Care You Need
Your Primary Care Provider
(PCP) arranges all of your
care. Call your doctor?s
office first ? at any time,
24 hours a day, seven days a
week ? whenever you need
medical care. Your doctor
will know how to help.
Showing up for every doctor?s appointment is the only way
your doctor can make sure that you and your family are
getting the quality care you deserve. If you cannot keep
an appointment, call and let your doctor or dentist know
right away. That way, your doctor can use the time to help
another patient.
Sometimes, it can take a while to get an appointment, so
do not delay in calling your doctor to schedule one. When
you get to the doctor?s office on time for your appointment,
you should not have to wait longer than 45 minutes.
If you would like to change your PCP or are having
issues getting an appointment, you may call us at
1-877-765-4325 (TTY: 1-800-654-5505). Representatives are
available 24 hours a day, seven days a week, to help you.
Vaccines Offer
Critical Protection
You may recall a recent outbreak of
measles that started in Disneyland
several months ago. This outbreak
was an important reminder that
vaccines are safe, they work, and they save lives.
Vaccines are shots you get that protect against serious conta-
gious diseases that can cause major side effects or even death.
Getting vaccines as a child gives you a lifetime of protection.
It is also important to remember that getting vaccines helps
protect those around you who cannot be vaccinated, such as
infants and some people with weakened immune systems.
Most people who get vaccines do not have any problems.
Some have side effects such as mild fever and mild swelling
where the shot was given. These side effects are not nearly
as bad as the actual illness they protect against.
There are 10 vaccines children should get before age 2.
These vaccines are all covered by your health plan.
Talk to your doctor if you have questions or concerns about
vaccines. You can also find more information and vaccine
schedules on the Centers for Disease Control & Prevention
website at www.cdc.gov/vaccines.
If you or your children are not up to date on your
vaccines, call your doctor right away.
horizonNJhealth.com Page 2Blue Notes Issue 2, 2015
Horizon NJ Health has staff who help members who
have had a major health event or medical diagnosis.
Our goal is to help you get as healthy as possible as quickly
as you can. We can help you find the best place to get care
and share information about resources that can help.
Each member in our complex Case Management program
will get their own plan with goals, resources and benefits.
We help you carry out the plan, watch your progress and
follow up with phone calls to help with any issues.
There are a few ways we find members who may need help:
when your doctor sends us a bill, if you take certain
medicines, if you go to the emergency room or are admitted
to the hospital, or if your doctor asks us to help you.
Please call Horizon NJ Health at 1-800-682-9094, exten-
sion 89634 if you would like help (TTY: 1-800-654-5505).
Complex Case Management
Help Managing Your Disease
Horizon NJ Health offers programs
to help you manage all your
health care needs.
Our care management programs teach
members how to best deal with their
illness. Members get education, resources
and phone calls from Horizon NJ Health
nurses to help them reach their goals.
Horizon NJ Health provides support and
education for these disease management programs
and many others:
? Congestive heart failure (CHF)
? Chronic obstructive pulmonary disease (COPD) ? Diabetes
? High blood pressure (hypertension) ? Asthma
Members may enroll themselves in a care management
program or be enrolled at their Primary Care Provider?s
suggestion.
If you would like to enroll in a care management program,
please call Horizon NJ Health toll-free at 1-800-682-9094,
extension 89634 (TTY: 1-800-654-5505). All members can
get care management and can disenroll from care
management at any time.
Behavioral Health Care
Horizon NJ Health provides mental health and
substance abuse benefits for members of the
Division of Developmental Disabilities (DDD).
DDD members can call Horizon Behavioral Health
toll-free at 1- 877-695-5612 (TTY: 1-800-654-5505)
for more information.
Most Horizon NJ Health members get mental health
and/or substance abuse services through the
Medicaid program. To get services for adults 18 years
old and older, call your Primary Care Provider or
the NJ FamilyCare Hotline for mental health services
at 1-800-356-1561 during business hours.
Starting July 1st, 2015, you can contact the
IME (Interim Managing Entity) at 1-844-276-2777
for substance use disorder services (available
24 hours a day).
For after-hours service, call NJ Mental Health Cares
toll-free at 1-866-202-4357 (TTY: 1-877-294-4356).
To get services for children younger than 18 years
of age, call the Children?s System of Care at
1-877-652-7624 (TTY: 1-866-896-6975).
If you need these complex
Case Management services,
our nurses and care managers
can help you get the care you
need and guide you through
the health care system.
horizonNJhealth.com Page 3Blue Notes Issue 2, 2015
Does Your Child Have a Fever?
If you think your child is sick, use a thermometer
to take their temperature. This is the only
real way to know if your child has a fever.
Be sure to read the instructions that come with
the thermometer and store the paper with the
thermometer in case you need to read them again.
There are a few different ways to take a temperature.
Talk to your child?s doctor about how to get the best
reading or if you have questions about taking your
child?s temperature.
? Rectum. This method gives you the best reading for
children under age 3. Lubricate the tip of a digital
thermometer with a water-soluble jelly such as
KY Jelly. Insert just the tip of the thermometer into
the child?s bottom ? no more than half an inch.
Keep the thermometer still until the temperature
shows up on the screen.
? Mouth. You may use this method for children who
can keep a thermometer under their tongue with
their mouth closed. Do not let your child eat or
drink anything for 15 minutes before you take a
temperature. Put the thermometer under the
child?s tongue and have your child close their lips
around it. Have your child sit still. You may hold
the thermometer in place until the temperature
shows up on the screen.
? Armpit. This method may not give you the most
accurate reading. Make sure the skin under your
child?s arm is dry. Place the tip of the thermometer
into the center of the armpit. Hold your child?s
elbow down closely against their body.
Keep the thermometer still until the temperature
shows up on the screen.
Wash the tip of the thermometer with soap and warm
water when you are done. (Do not put the whole
thermometer in water.) If you use a thermometer in
the rectum, never use the same one in the mouth.
A normal tempera-
ture range is between
97.5?F and 99.5?F.
Most pediatricians
consider a tempera-
ture above 100.4?F
a sign of a fever.
According to the American Academy of
Pediatrics, call your child?s doctor if your child:
? Is younger than 3 months old and has a temperature
of 100.4?F or higher
? Has a fever that rises above 104?F repeatedly
? Looks very ill, is unusually drowsy, or is very fussy
? Has been in a very hot place, such as an
overheated car
? Has other symptoms, such as a stiff neck, severe
headache, severe sore throat, severe ear pain, an
unexplained rash, or repeated vomiting or diarrhea
? Has immune system problems, such as sickle cell
disease or cancer, or is taking steroids
? Has had a seizure
? Still ?acts sick? once his or her fever is brought down.
? Has a fever that persists for more than 24 hours in
a child younger than 2 years
? Has a fever that persists for more than 3 days
(72 hours) in a child 2 years old or older
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horizonNJhealth.com Page 4Blue Notes Issue 2, 2015
? ??? ?
?Member Services 1-877-7NJ-HEALTH
(1-877-765-4325) (TTY: 1-800-654-5505)
24 hours a day, seven days a week.
horizonNJhealth.com
Fraud, Waste and Abuse Hotline:
1-855-FRAUD20 or 1-855-372-8320
(TTY: 1-800-654-5505)
BLUE NOTES is published as a community service for the friends and patrons of
Horizon NJ Health, 210 Silvia St., West Trenton, NJ 08628. Information in
BLUE NOTES comes from a wide range of medical experts. If you have any concerns
or questions about specific content that may affect your health, please contact
your health care physician. Models may be used in photos and illustrations.
Horizon NJ Health is part of the Horizon Blue Cross Blue Shield of New Jersey enterprise,
an independent licensee of the Blue Cross and Blue Shield Association.
? 2015 Horizon Blue Cross Blue Shield of New Jersey.
Three Penn Plaza East, Newark, NJ 07105
BlueNotes
If you have asthma, there are ways to prevent an asthma attack.
Controlling your asthma triggers will help lower
symptoms and help keep your asthma from flaring up.
Common indoor asthma triggers:
? Dust and dust mites ? Animals with fur or feathers
? Food allergies ? Cold, flu and other infections
? Mold ? Cockroaches
? Strong odors ? Tobacco smoke
Common outdoor asthma triggers:
? Weather ? Pollen ? Air pollution
Know how to control your asthma triggers.
Ways to control asthma triggers indoors:
? Avoid smoking ? Clean, dust and vacuum regularly
? Keep animals out of your home
? Use pest control to keep cockroaches out of your home
? Do not use products with strong odors
Always have your asthma medications with you and be sure to
follow your asthma treatment plan. If your Primary Care Provider
(PCP) prescribes a controller medication, you must take it every
day, even when your asthma is fine. Always have your quick relief
medication on hand.
See your PCP immediately if:
? You are using your quick relief
medication more than two times
per week
? Your asthma stops you from going
to work or school
? Your asthma wakes you up at night
The Horizon NJ Health Asthma ?Breathe Easy? Program helps
members with asthma reduce their risk of asthma attacks,
relieve attacks when they occur and learn how to prevent them
Horizon NJ Health nurses can help you:
? Create a treatment plan ? Make doctor appointments
? Coordinate your asthma care ? Get asthma management supplies
? Learn about self-management
? Remember to schedule preventive care
Asthma ?Breathe Easy? is open to members of all ages.
Join by calling toll-free at 1-800-682-9094,
extension 89634 (TTY: 1-800-654-5505).
If you have a new name, address, or phone number, call
NJ FamilyCare at 1-800-701-0710 (TTY: 1-800-701-0720).
Representatives are available Monday and Thursday
from 8 a.m. to 8 p.m. and Tuesday, Wednesday and
Friday from 8 a.m. to 5 p.m.
If your NJ FamilyCare eligibility was done through your
local County Welfare Agency (CWA), then you must report
any changes to that CWA.
It is important to keep this information up to date
so you never have issues getting health care
benefits or services.
Note that this information should be changed
with NJ FamilyCare first, not Horizon NJ Health.
NJ FamilyCare will let us know about the change.
Be sure to keep your personal information up to date with your health plan.Have You Moved?
? ? ??
?
A newsletter for Horizon NJ Health Members
horizonNJhealth.com
Issue 1, 2015
MEMBER SERVICES
Our Member Services toll free
number is: 1-877-7NJ-HEALTH
(1-877-765-4325),
24 hours a day, seven days a week.
Members with speech or hearing
impairments may call TDD/TTY
toll free at 1-800-654-5505.Horizon NJ Health
210 Silvia Street
West Trenton, NJ 08628
BlueNotes
Lead Testing for Children
Lead poisoning can cause serious but preventable illness.
Children can get lead poisoning by swallowing or inhaling lead.
Screening for lead poisoning must be done for all children between the ages of 9 and 18 months
(preferably at 12 months) and again between 18 and 26 months (preferably at 24 months).
If the test result is not normal, your doctor will recommend testing often and a Horizon NJ Health nurse
will help you until the level is in the normal range.
Lead can be found in:
? Homes built before 1978
? Drinking water from lead pipes and solder in plumbing
? Some soil, spices, imported candies, makeup,
folk medicine, stained glass and batteries
? Some children?s toys and jewelry made in China
All it takes is a simple blood test
to find out if your child has
lead poisoning.
Children who have lead poisoning may not show symptoms until they get older.
Take your child to his or her primary care provider to be tested.
horizonNJhealth.com Page 2Blue Notes Issue 1, 2015
Needing an Advance Directive
Your Doctor
Can Help You
Determine
Where to
Get Care
Are you pregnant?
Call the Mom?s GEMS program
24/7 Nurse hotline with your
questions or concerns.
Toll-free: 1-877-765-4325
(TTY: 1-800-654-5505)
You have the
right to decide
what kind of
medical care
you want or do
not want to get.
An advance directive is a document that helps you
to decide what type of care you would like if you
become too sick to speak or decide for yourself. You
can put that decision into writing or you can name
someone else who understands what you want.
Now, while you are healthy, is the time to think
about an advance directive. Your doctor can help
you make one. Talk to him or her about your
care options.
There are three kinds of advance directives in
New Jersey:
? A proxy directive means you can name a person
(18 years old or older) to make your health care
choices when you no longer can.
? An instruction directive tells your desires/
instructions for care.
? A combined directive names a person and
gives instructions for care.
The State of New Jersey has more information
online at www.state.nj.us/health/advancedirective.
Your doctor?s office can provide most of the basic
health care you need. Sometimes, your doctor
may send you to another doctor, center or lab
to have certain services done.
Unless you have a referral from your doctor, you
should not go to a hospital for non-urgent care,
such as routine testing. If your doctor says you
need to go somewhere else for a special service,
be sure to ask him or her where you should go.
The goal of the Horizon NJ Health Quality
Improvement Program is to help you live
a healthier life.
We focus on your health and the care you get when
you see a doctor. We want to make sure you are
satisfied with your care and the services you get.
The goals of the program are to make sure that:
? We are making it easy for you to get good health care.
? You have doctors available to you and that you get
the best care.
? You are happy with Horizon NJ Health and your doctors.
? We are obeying the laws and standards set for
Horizon NJ Health by the state of New Jersey and
accrediting groups.
If you would like more information about our
Quality Improvement Program, visit our website,
www.horizonNJhealth.com, or call
1-800-682-9094 (TTY: 1-800-654-5505)
and ask for the Quality department.
Focus on Quality
horizonNJhealth.com Page 3Blue Notes Issue 1, 2015
Healthy Food Choices
A healthy diet is very important
to your health.
We?re Here to Help You
Did you know that Horizon NJ Health Member Services
representatives are available to help you at
any time of day, any day of the week?
Eating too much and choosing unhealthy
foods that are high in fat, sugar and salt can
lead to many serious conditions like high
blood pressure and high cholesterol and
becoming overweight. It is important to
control your portion sizes and choose foods
that are high in protein and fiber and full of
vitamins and nutrients.
Here are some tips for making the best
food choices:
? Eat at least five servings of fruit and vegetables
a day.
? Choose whole grains like brown rice and wheat
bread instead of white rice and white bread.
? Choose nonfat or low-fat dairy products like
milk, yogurt and cheese.
? Bake or grill meat instead of frying it, and
choose lean proteins like chicken and fish.
? Pick snacks high in fiber and protein that will
keep you feeling full, such as unsalted nuts,
popcorn without butter, veggie sticks with
hummus, and all-fruit smoothies.
? Drink lots of water to help fill you up.
? Read nutrition labels so you are aware of how
many calories and how much fat, sugar and salt
are in the foods you choose.
? Be a good role model for
children ? teach them how
to make healthy food
choices and show them how
tasty healthy food can be.
Our staff is ready to help you get the most out of your
Horizon NJ Health membership, 24 hours a day, seven
days a week, including holidays. Any time you have a
question about your benefits, how Horizon NJ Health works,
or how to get the care you need, give us a call.
We also have 24-hour translation services available at
no cost. These translators know many languages,
including sign language.
We can also arrange for a translator to talk over the phone
with you and your doctor during your visit to the doctor.
The translator will make sure your doctor knows what you are
saying and you know what the doctor is saying.
You can call Member Services toll-free at 1-877-7NJ-HEALTH
(1-877-765-4325). Speech- and hearing-impaired members
can call us toll-free at 1-800-654-5505.
horizonNJhealth.com Page 4Blue Notes Issue 1, 2015
? ??? ?
?Member Services 1-877-7NJ-HEALTH
(1-877-765-4325) (TTY: 1-800-654-5505)
24 hours a day, seven days a week.
horizonNJhealth.com
Fraud, Waste and Abuse Hotline:
1-855-FRAUD20 or 1-855-372-8320
(TTY: 1-800-654-5505)
BLUE NOTES is published as a community service for the friends and patrons of
Horizon NJ Health, 210 Silvia St., West Trenton, NJ 08628. Information in
BLUE NOTES comes from a wide range of medical experts. If you have any concerns
or questions about specific content that may affect your health, please contact
your health care physician. Models may be used in photos and illustrations.
Horizon NJ Health is part of the Horizon Blue Cross Blue Shield of New Jersey enterprise,
an independent licensee of the Blue Cross and Blue Shield Association.
? 2015 Horizon Blue Cross Blue Shield of New Jersey.
Three Penn Plaza East, Newark, NJ 07105
Visit the Dentist Twice a Year
Taking care of your teeth and gums is
important to your body?s overall health.
You should visit your dentist at least twice a year for
a checkup and cleaning. Most people do not know when
cavities are in their teeth or their gums are not healthy.
Dentists can find signs of dental disease, which can lead
to problems in other parts of your body, too.
It is also important for children to visit the dentist.
Visits should start when a child turns 1 year old or when the
first tooth can be seen.
You can go for a checkup and cleaning every six months, and
more often if you have special health care needs. Make sure
that you complete the treatment your dentist recommends.
You do not need a referral from your primary care provider or pre-approval from Horizon
NJ Health for routine dental care, such as cleanings, fillings and X-rays.
Schedule an appointment with your dentist today. If you do not have a dentist or need help
making an appointment, Member Services can help you.
Remember:
A hospital Emergency Room (ER) is not the best
place to go for dental pain or infection, because
the ER is not set up to provide full dental care like
a dental office. If you have a dental emergency,
contact your dentist or call Horizon NJ Health at
1-877-7NJ-HEALTH (1-877-765-4325) for help
finding one in your area.
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.KMG?WU?QP?(CEGDQQMv>ViL????V?????????? ??
BlueNotes
? ? ??
?
People in New Jersey are starting to
suffer the effects of a respiratory virus
known as Enterovirus D68, or EV-D68.
A newsletter for Horizon NJ Health Members
horizonNJhealth.com
Issue 4, 2014
MEMBER SERVICES
Our Member Services toll free
number is: 1-877-7NJ-HEALTH
(1-877-765-4325),
24 hours a day, seven days a week.
Members with speech or hearing
impairments may call TDD/TTY
toll free at 1-800-654-5505.Horizon NJ Health
210 Silvia Street
West Trenton, NJ 08628
Help Protect Yourself
and Loved Ones
Against Enterovirus
People who have EV-D68 have mild to
severe respiratory symptoms, and some
infections can be serious.
Mild symptoms are runny nose, sneezing, cough,
body and muscle aches, and sometimes fever.
Severe symptoms include difficulty breathing
and worsening asthma symptoms.
EV-D68 is spread through close contact with
infected people. The virus can spread when an
infected person coughs or sneezes. You can
also become infected by touching things with
the virus on them then touching your mouth,
nose or eyes.
Most people who get the virus will not need
treatment. Those with serious illness may need
to go to the hospital.
How can you keep from getting EV-D68?
? Wash your hands with soap and water for 20 seconds,
especially after changing diapers. Don?t rely on hand
sanitizer because it does not work against EV-D68.
? Don?t touch your ? or a child?s ? eyes, nose or mouth
with unwashed hands.
? When you cough or sneeze, do it into a tissue and
throw it out right away.
? Avoid kissing, hugging and sharing cups or utensils
with people who are sick.
? Keep often-used surfaces such as toys and doorknobs
clean and disinfected, especially if someone is sick.
? If you are sick, stay home!
? Keep up with your shots
(vaccines). It is important
to get a flu shot if you are
elderly, young or have a
chronic illness. This can
help protect you against
other infections and more
severe illness if you are
infected with EV-D68 at
the same time as the flu.
BlueNotes
horizonNJhealth.com Page 2Blue Notes Issue 4, 2014
When to Take Antibiotics
Everyone Needs an Annual Exam
Did you know that
antibiotics do not fight
viral infections like colds, flu,
most sore throats and some
cases of bronchitis?
Taking antibiotics when
they are not needed
may cause you more harm than good.
When antibiotics do not work, it can
cause longer-lasting illnesses, more
doctor visits or extended hospital stays,
the need for stronger medicine, and
life-threatening illness.
Here are some simple things you should
and should not do to help your medicine
be effective:
Do:
n Talk with your doctor about the right use
of antibiotics.
n Take antibiotics exactly as the doctor tells you.
Keep taking the medicine even if you feel better.
n Make sure your children take medicine
as prescribed.
Do NOT:
n Take an antibiotic (unless instructed by
your doctor) for a viral infection like:
? Colds or flu
? Most coughs and bronchitis
? Sore throats not caused by strep
? Runny noses
n Demand antibiotics when a doctor says they
are not needed.
n Skip medication doses, save it for later use,
or let anyone else use it.
n Use alcohol. Alcohol may prevent antibiotics
from being effective.
You do not have to be sick
to go to the doctor.
It is a good idea to make an appoint-
ment with your Primary Care Provider
(PCP) at least once a year for a checkup.
This visit is a great time to talk to
your doctor about any health concerns
you have and get important health
readings like blood pressure and
cholesterol. Your doctor can also tell
you about other screenings you might
need based on your age, health history
and other risk factors.
Regular checkups help stop health problems before they
start. They also help find problems early when your chances
of a cure are much better. Having a relationship with your
PCP will also keep you from having to go to the emergency
room for things that are not emergencies.
Children need routine visits, too. It is important for
children to get well care, immunizations, eye exams,
dental exams and lead screenings to maintain good health.
If you or your child have not visited your PCP in a while,
call to make an appointment today. If you do not know
who your PCP is, look on your Horizon NJ Health ID card ?
his or her name and phone number are on the front.
If you would like to change your PCP, call Horizon NJ Health
Member Services at 1-877-765-4325. TTY: 1-800-654-5505.
Prior Approval for Medical Services
Horizon NJ Health has a Utilization Management department that
works with your providers to help make sure you get all the services you
need. If your doctor thinks you need a service that requires prior approval
(or preauthorization) from Horizon NJ Health, he or she will contact us to
get approval for you.
As a Horizon NJ Health member, you have a right to appeal Horizon
NJ Health?s preauthorization decision about your service. To do this,
please call Member Services at 1-877-7NJ-HEALTH (1-877-765-4325),
TTY: 1-800-654-5505. Detailed information about how to appeal a
decision is also in your Horizon NJ Health Member Handbook.
horizonNJhealth.com Page 3Blue Notes Issue 4, 2014
Did You Get
your Flu Shot?
It is not too late. Although
October and November are the
best times to get your shot, you
can still get a flu shot through the
winter. Call your doctor today.
It is most important for these people
to get their seasonal flu shot:
? Pregnant women
? Children over 6 months of age and
young adults
? People who live with or care for children
younger than 6 months of age
? People with chronic disease such as
asthma, diabetes, heart disease,
kidney or liver disease and cancer
Being pregnant is
such an exciting time!
Taking care of yourself
while you are pregnant
can give your baby a
great start at life.
The Horizon NJ Health
GEMS program can help.
GEMS means ?Getting
Early Maternity Services.?
Joining our program will help you with:
? Getting visits with an obstetrician/gynecologist
(OB/GYN) doctor: you should start getting care
during your first trimester (first 14 weeks)
of pregnancy.
? Access to specialists: These are other doctors
who can care for you during your pregnancy,
including your dentist.
? Care and Case Management: Our case managers
can speak with you 24 hours a day, seven days
a week to answer your questions.
? Transportation: Some members can get help to
and from doctor appointments. Call your GEMS
case manager or LogistiCare at 1-866-527-9933
(TTY: 1-866-288-3133) to learn more.
? Nutrition advice: Learn more about healthy eating
that can help you and your baby grow.
? Breastfeeding: Breastfeeding is the healthiest choice
for your baby. Call WIC at 1-866-44NJWIC
(1-866-446-5942) or your GEMS case manager for
information and help.
? Nurse visits: In some cases, a nurse may be able to
visit you to answer questions about your baby?s care.
? Health care for your baby during his or her first
60 days of life.
It is important to care for yourself after your baby
is born as well. Our GEMS team will help
you schedule your postpartum doctor appoint-
ment. This checkup should be within 21 and
56 days of your baby?s birth date.
The sooner your sign up for the GEMS program,
the better your chances are of having a healthy,
full-term baby. Call the Horizon NJ Health GEMS
Prenatal Program toll-free at 1-800-682-9094
(TTY: 1-800-654-5505) and ask for the
GEMS department.
horizonNJhealth.com Page 4Blue Notes Issue 4, 2014
? ??? ?
?Member Services 1-877-7NJ-HEALTH
(1-877-765-4325) (TTY: 1-800-654-5505)
24 hours a day, seven days a week.
horizonNJhealth.com
Fraud, Waste and Abuse Hotline:
1-855-FRAUD20 or 1-855-372-8320
(TTY: 1-800-654-5505)
BLUE NOTES is published as a community service for the friends and patrons of
Horizon NJ Health, 210 Silvia St., West Trenton, NJ 08628. Information in
BLUE NOTES comes from a wide range of medical experts. If you have any concerns
or questions about specific content that may affect your health, please contact
your health care physician. Models may be used in photos and illustrations.
Horizon NJ Health is part of the Horizon Blue Cross Blue Shield of New Jersey enterprise,
an independent licensee of the Blue Cross and Blue Shield Association.
? 2014 Horizon Blue Cross Blue Shield of New Jersey.
Three Penn Plaza East, Newark, NJ 07105
Keeping Your Children at a Healthy Weight
Gaining too much weight is a
very serious health problem
for children, teens and adults.
It is especially important to help keep your children
at a healthy weight to help prevent serious health
problems as they get older. Carrying extra weight
can put your child at risk of:
? Heart disease, high blood pressure, diabetes and
problems breathing and sleeping
? Being depressed or sad
More children are becoming overweight. If your child is overweight, the best way reach a healthy
weight is to be more active and eat healthy food. Have your family work as a ?team? to help:
? Buy healthier foods like fruit, vegetables, lean meat (like chicken and fish), whole grains
(like brown rice and whole-wheat bread), and low-fat dairy (like milk, cheese and yogurt).
? Involve your child in planning and making meals so they can learn about good nutrition.
? Read nutrition labels and control portion sizes.
? Limit snacking times. Monitor what your child eats at school.
? Take part in community or school activity programs.
? Be active as a family, like taking a walk or bike ride
together every night.
? Limit time spent being inactive, such as watching TV
and playing video games.
? Reward your child with things other than food.
? Give your child praise so he/she is encouraged
to stay on a healthy path.
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.KMG?WU?QP?(CEGDQQMv>ViL????V?????????? ??
BlueNotes
horizonNJhealth.com
Changes Ahead for Those who Get Long-Term Care
Our Member Services toll free
number is: 1-877-7NJ-HEALTH
(1-877-765-4325),
24 hours a day, seven days a week.
Members with speech or hearing
impairments may call TDD/TTY
toll free at 1-800-654-5505.
MEMBER SERVICES
Horizon NJ Health
210 Silvia Street
West Trenton, NJ 08628
A newsletter for Horizon NJ Health Members Issue 2, 2014
Horizon NJ Health will start to
provide Managed Long-Term
Services and Supports (MLTSS),
which are home- and community-
based services that are now
managed by the Medicaid
program. The MLTSS program
will keep all of your services
under one program to make
things easier for you.
MLTSS benefits include assisted living, community, residential, mental health, and substance
abuse services, as well as wellness and recovery programs. It also affects people in these
Medicaid programs:
? AIDS Community Care Alternatives Program (ACCAP)
? Community Resources for People with Disabilities (CRPD)
? Global Options for Long-Term Care (GO)
? Traumatic Brain Injury (TBI)
If you currently get these services, you do not have to do anything for this change.
The services will be moved under Horizon NJ Health automatically.
Horizon NJ Health looks forward to providing your MLTSS starting in July 2014.
BlueNotes
horizonNJhealth.com Page 2Blue Notes Issue 2, 2014
Care/Case/Disease
Management Programs
Complex Case Management
Horizon NJ Health offers a holistic approach
to help manage all your health care needs
and will assist to coordinate services.
Our Care Management Programs teach members
how to manage their disease. Members get
educational information, access to resources and
phone calls from Horizon NJ Health nurses to help
them reach their personal program goals.
Horizon NJ Health provides support and education
for the following disease management programs
but is not limited to:
? Congestive heart failure (CHF)
? Chronic obstructive pulmonary disease (COPD)
? Diabetes
? High blood pressure (hypertension)
? Asthma
Members may receive outreach, to
participate in care management by:
? Your PCP?s suggestion
? Self referral
If you would like to enroll in
a care management program,
please call Horizon NJ Health
toll free at 1-800-682-9094,
extension 89634
(TTY: 1-800-654-5505).
All members are
entitled to care
management and
can disenroll from
care management
at any time.
Horizon NJ Health has staff dedicated
to help members who have had a
major health event or diagnosis.
If you need these complex case management
services, our nurses and care managers can help
you get the care you need and guide you through
the health care system.
Our goal is to help the member get as healthy as
possible as quickly as possible. We can help find
the best facility for treatment and share information
about extra resources that may be available.
Each member under our complex care management
program will receive a personal care management
plan with performance goals, resources and
benefits. We help the member carry out the plan,
monitoring the member?s progress and following up
with phone calls to help address any issues.
We use many sources of information to find
members who may need help: when your doctor
sends us his bill, if you take certain medications, if
you have been to the emergency room or admitted
to the hospital, or your doctor asks us to help you.
Please call Horizon NJ Health at 1-800-682-9094,
extension 89634 if you would like help
(TTY: 1-800-654-5505).
horizonNJhealth.com Page 3Blue Notes Issue 2, 2014
Complex Case Management
Horizon NJ Health would like to let you
know about recent changes to our drug
formulary list. The changes found in
the list on the right will be added to
our drug formulary list on the Horizon
NJ Health website, horizonNJhealth.com.
If you would like a paper copy of the
drug formulary list, please call Member
Services toll-free at 1-877-765-4325
(TTY: 1-800-654-5505), 24 hours a day,
seven days a week, and ask for one.
Please talk with your primary care
provider (PCP) about these changes.
If your PCP decides that, for medical
reasons, you must take a drug that is
not on the formulary list or needs
pre-approval, including a brand name
medication exception, he or she can
call us and ask for special permission
(prior authorization) for you to get
the drug.
Formulary Change
Description
Brand (Generic)
Drug Name
Alternatives
(if Applicable)
Not Covered Oruvail (ketoprofen ER)
Motrin (ibuprofen), Naprosyn
(naproxen), Lodine (etodolac),
Daypro (oxaprozin), Relafen
(nabumetone), Voltaren
(diclofenac), Mobic (Meloxicam)
Not Covered Lidex (fluocinonide) solution
Aristocort A (triamcinolone),
Kenalog (triamcinolone),
Topicort (desoximetasone)
Not Covered
Diprolene (betametha-
sone dipropionate
augmented) ointment
Temovate/Temovate E/Clobex
(clobetasol), Ultravate
(halobetasol propionate),
Diprosone (betamethasone
dipropionate) ointment
Covered
Diprosone (betametha-
sone dipropionate)
ointment
Covered Vitafol-One (prenatal vitamin)
Covered Sirturo (bedaquiline)
Covered Cystaran (cysteamine)
Covered Tecfidera (dimethyl fumarate)
Covered
Abilify Maintena
(aripiprazole)
9LVLW?WKH?+RUL]RQ?1-?+HDOWK?ZHEVLWH?WR?Q??.GCTP?CDQWV?QWT?OGODGT?RTQITCOUQ??6HDUFK?WKH?3URYLGHU?'LUHFWRU\Q??/HDUQ?KRZ?WR?DFFHVV?\RXU?EHQHILWVQ??5HYLHZ?WKH?0HPEHU?5LJKWV?DQG?5HVSRQVLELOLWLHVQ??$QG?PRUH
,I?\RX?ZRXOG?OLNH?D?SULQWHG?FRS\?RI?DQ\?PDWHULDO?IRXQG?RQ?RXU?ZHEVLWH??SOHDVH?FDOO?0HPEHU?6HUYLFHV?WROO?IUHH?DW???????0,?*'#.6*?
????????????????:H?DUH?DYDLODEOH????KRXUV?D?GD\????GD\V?D?ZHHN?3HRSOH?ZLWK?KHDULQJ?RU?VSHHFK?GLIILFXOWLHV?FDQ?FDOO?RXU?7''?77<?VHUYLFH?DW????????????????
YYY?JQTK\QP0,JGCNVJ?EQOYYY?JQTK\QP0,JGCNVJ?EQOYour PCP may call the Horizon NJ Health Pharmacy Department at 1-800-682-9094 to request a prior authorization. A pharmacy representative is available 24 hours a day, seven days a week.
Formulary
Changes
horizonNJhealth.com Page 4Blue Notes Issue 2, 2014
Did you know that Horizon NJ Health covers
many over-the-counter (OTC) products with
a prescription?
Examples of different OTC classes are listed below:
If, for medical reasons, you cannot switch to an OTC
alternative, please contact the Pharmacy department
at 1-800-682-9094, extension 81014, to request prior
authorization. Office hours are Monday through
Friday from 8 a.m. and 6 p.m. and Saturday from
9 a.m. to 4:30 p.m. A pharmacist is available 24 hours
a day, seven days a week.
The drug formulary is available on the Horizon
NJ Health website, horizonNJhealth.com, or
you can call Member Services at 1-877-765-4325
TTY: 1-800-654-5505) for a copy of the formulary
guide.
Over the Counter (OTC)
Product Availability
Common
Symptom
Preferred OTC Medications
[Brand Tradenames]
Allergies
Generic OTC Loratadine [Claritin](Tablets or
Syrup), Loratadine Oral-Disintegrating Tablets
(Alavert), Loratadine-D [Claritin-D]
OTC Cetirizine [Zyrtec](Tablets, Chewable
Tablets or Syrup), Cetirizine ?D [Zyrtec-D]
OTC Fexofenadine [Allegra Allergy],
Fexofenadine ?D [Allegra-D]
Heartburn Prilosec OTC, Zegerid OTC, Prevacid 24HR
Vaginal
Anti-Fungals
Generic OTC Clotrimazole [Gyne-Lotrimin,
Mycelex] or OTC Miconazole [Monistat ] or
Tioconazole [Vagistat-1] Vaginal products
Cold Sores Abreva
Allergies
(Eye Drops)
Zaditor OTC, Alaway, Generic Naphcon-A,
Opcon-A
Cough and Cold Most products, including Robitussin, Pediacare, Dimetapp, Mucinex
Lice OTC Permethrin [Nix]
At Horizon
NJ Health,
we care about
the treatment
you get from
your doctors.
We want to make
sure you get the
very best care.
If you are not happy with any health care
service you get, or you feel you were not
treated well, you can call Member
Services toll free at 1-877-765-4325
(TTY: 1-800-654-5505), 24 hours a day,
seven days a week.
You could also send a letter to:
Horizon NJ Health
Attn: Member Complaints
200 Stevens Drive
Philadelphia, PA 19113-1570
We will look into your complaint. You will
receive an answer from Horizon NJ Health.
? If your complaint is an emergency,
we will look into it right away.
? If your complaint is about urgent care,
you will get a response within 48 hours.
? If you submit a complaint by mail, we will
try to contact you by telephone within
24 hours of receiving your complaint.
If your complaint is not resolved within five
business days, you will get a written notice
about the outcome within 30 calendar days
from when we receive your complaint.
For more information about complaints,
please refer to your Horizon NJ Health
Member Handbook.
If You Have a Complaint
horizonNJhealth.com Page 5Blue Notes Issue 2, 2014
How to Get Mental Health Care
If you are having overwhelming feelings
of sadness, anxiety or depression or
are struggling with substance abuse,
there are resources to help.
Horizon NJ Health provides mental health benefits
for members of the Division of Developmental
Disabilities (DDD). DDD members can call
Horizon Behavioral Health toll free at 1-877-695-5612
(TTY: 1-800-508-6975) for more information.
All other Horizon NJ Health members can get
mental health and/or substance abuse services
through the NJ FamilyCare program.
You do not need a referral from your PCP to
see a mental health or substance abuse provider.
If you think you or a family member needs help with
a mental health or substance abuse problem, call
your primary care provider or the New Jersey Divi-
sion of Mental Health Services at 1-800-382-6717
(TTY: 1-877-294-4356) during business hours.
For after-hours service, call NJ Mental Health Cares
toll-free at 1-866-202-4357 (TTY: 1-877-294-4356).
To get services for children younger than 18 years
old, call the Children?s System of Care at
1-877-652-7624 (TTY: 1-866-896-6975). You can also
call Horizon NJ Health Member Services for help at
1-877-765-4325 (TTY: 1-800-654-5505).
Horizon NJ Health cares about
your total well-being.
You deserve the best health care. As a member of
Horizon NJ Health, you have a partner who will help you
get the care you need. Horizon NJ Health will treat you
with respect and there are certain rights you can expect
from Horizon NJ Health. There are also responsibilities
that Horizon NJ Health expects from you.
To learn more about your rights and responsibilities as
a Horizon NJ Health member, you can view the full list in
your Member Handbook. The rights and responsibilities
are also posted on our website at horizonNJhealth.com.
From the home page, click Member Support, then
Resources, then How Horizon NJ Health Works.
Member Rights & Responsibilities
horizonNJhealth.com Page 6Blue Notes Issue 2, 2014
Member Services 1-877-7NJ-HEALTH
(1-877-765-4325) (TTY: 1-800-654-5505)
24 hours a day, seven days a week.
horizonNJhealth.com
Fraud, Waste and Abuse Hotline:
1-855-FRAUD20 or 1-855-372-8320
(TTY: 1-800-654-5505)
BLUE NOTES is published as a community service for the friends and patrons of
Horizon NJ Health, 210 Silvia St., West Trenton, NJ 08628. Information in
BLUE NOTES comes from a wide range of medical experts. If you have any concerns
or questions about specific content that may affect your health, please contact
your health care physician. Models may be used in photos and illustrations.
Horizon NJ Health is part of the Horizon Blue Cross Blue Shield of New Jersey enterprise,
an independent licensee of the Blue Cross and Blue Shield Association.
? 2014 Horizon Blue Cross Blue Shield of New Jersey.
Three Penn Plaza East, Newark, NJ 07105
BlueNotes
How to Find a Doctor
Using the Online
Provider Directory
It is easy to find a doctor
to fit your needs using our
online provider directory.
To use the directory,
go to our website at
horizonNJhealth.com.
Click Need a Doctor on the
right side of your screen.
From this page, you can
search for primary doctors,
specialists, hospitals, dentists, pharmacies and other
health care services.
The best way to narrow your search is to click on
the Advanced Physician Search link. If you know the
name of the provider you are looking for, enter his
or her last name in the Last Name field. Or, to see a
list of providers in your area, enter your ZIP code in
the ZIP Code field. There is a large list of specialties
to choose from ? pick the specialty you need from
the drop-down menu.
To search a larger or smaller region, you can define
your search by filling any of these fields: city, county,
state, and search radius. If you prefer a male or
female provider or someone who speaks a different
language, you can search using these fields, too.
On the right side of your screen, you can narrow
your search by checking any of the boxes that are
important to you, such as wheelchair accessible
offices.
Using all of these search features can help you
find the best provider for you. If you have any
questions about using the provider directory or
choosing a doctor, you can call Member Services at
1-877-765-4325 (TTY: 1-800-654-5505).
As a Horizon NJ Health member,
you have access to the largest network
of Medicaid doctors in the state.
Follow us on Twitter
twitter.com/HorizonNJHealth
@HorizonNJHealth
Like us on Facebook
facebook.com/HorizonNJH
Blue NotesISSUE 3, 2019
Your health care needs
are important to us.
Horizon NJ Health wants to make sure you have the information you need to take care of your health.
Our specially-trained Member Services Representatives are here to help you understand your benefits.
If you have any questions, please call Member Services at 1-800-682-9090 (TTY 711), 24 hours a day,
seven days a week.
In this issue
Breast pumps available at no cost ............................................ 2
Reminder: get your flu shot ..................................................... 3
You may be eligible for Horizon NJ TotalCare (HMO D-SNP) ... 3
What you need to know about prostate cancer ....................... 4
Changes to management of the Horizon
Behavioral Health Program ....................................................... 4
Teens and vaping: what you should know................................ 5
Renew it or lose it! ................................................................. 6
How to choose a Personal Representative .............................. 6
Our commitment to quality ...................................................... 6
Children?s health....................................................................... 7
Changes to covered medicines ................................................ 9
Managing your medication ......................................................10
A reminder about lab services ................................................10
Member rights and responsibilities .........................................10
Online member support ..........................................................10
Nutrition and your health ........................................................11
NJ Peer Recovery ...................................................................11
Do you want to get your high school diploma?
We can help. ...........................................................................12
Information about your provider ..............................................12
Look out for health insurance fraud .........................................13
Notice of Nondiscrimination ....................................................14
Please visit our website to learn more about all the programs available to you.
Breast pumps available at no cost
Are you pregnant or a new mom and plan to breastfeed your
infant? If so, you are eligible for a breast pump at no cost to you.
You can get a breast pump up to 30 days before your due date
and up to 56 days after your baby is delivered.
Follow the steps below to get your breast pump:
1. Get a breast pump prescription from your Ob/Gyn.
? Fill the prescription for a breast pump at any Horizon
NJ Health participating Durable Medical Equipment (DME)
supplier. To find a DME provider:
- Search our Doctor & Hospital Finder
at horizonNJhealth.com/findadoctor.
- Select Horizon NJ Health then choose Other
Healthcare Services. Enter Durable Medical Equipment
Supplier in the search bar.
? Call Member Services at 1-800-682-9090.
? Contact your Mom?s GEMS Care Manager.
? TTY callers can use 711.
There are two types
of breast pumps covered
with a prescription:
? Manual: Covered for
each pregnancy
? Standard electric*:
Covered once every
three years
Rental of a hospital-grade
electric breast pump must
be requested through prior
authorization and will be
approved if considered
medically necessary.
2*As identified by NJ FamilyCare contract.
You may be eligible for Horizon NJ TotalCare (HMO D-SNP)
3
If you are eligible for both Medicaid and Medicare, you can get all your health care benefits
under one convenient plan. With Horizon NJ TotalCare (HMO D-SNP), you can receive
benefits and services at no cost to you.
Horizon NJ TotalCare (HMO D-SNP) includes:
Reminder: get your flu shot
Myth: The flu shot can give me the flu.
Truth: The flu shot does not cause the flu. The
shot is not an active form of the virus and is not
infectious. Some people may have a mild reaction
to the flu shot, like muscle soreness where the shot
was given or mild cold symptoms. The shot takes
1 to 2 weeks to protect you from the flu. If you get
sick after getting the flu shot, you may have come
in contact with a virus before you got the shot.
Myth: It?s better to get the
flu than a flu shot.
Truth: The flu is a serious disease, especially
for older adults and people with chronic health
conditions, like asthma or diabetes. The flu can
put you in the hospital and it can be deadly.
Getting the flu shot is your best protection against
the flu and also protects the people around you.
Myth: I don?t need to get a flu shot every year.
Truth: The flu virus changes every year. Getting
a flu shot every year will help you stay protected
from the most dangerous strains. Your immune
system also declines over time, so getting a flu
shot every year will protect you.
Myth: The flu shot doesn?t work.
Truth: The flu shot works differently for everyone
and does not protect you from all strains of the flu.
If you do get the flu, getting a flu shot can lessen
your symptoms, which will reduce your risk for
a hospital stay and death.
The best way to prevent the flu
is to get a flu shot every year.
If you have not received your flu shot, you can get one at no cost from your doctor or local
participating pharmacy. Influenza (flu) is a contagious respiratory disease that can put you in the
hospital or cause death in serious cases.
Are you trying to decide if the flu shot is right for you? Here are answers to the most common
myths about flu shots.
To learn more, call 1-888-328-5736 (TTY 711), 24 hours a day, seven days a week,
or visit HorizonBlue.com/TotalCare.
? $0 premiums
? $0 copays
? No referrals
? $0 deductibles
? $245 per quarter to purchase
health items from our catalog
? An additional $250 per quarter
on a prepaid Over-the-Counter (OTC)
Benefit Card to purchase eligible health
care products from retail stores like
Walmart or CVS
? And more!
What you need to know
about prostate cancer
4
Risk factors
? Race ? African American men are 70% more likely to develop
prostate cancer than Caucasian or Hispanic men.
? Age ? 60% of prostate cancers are diagnosed in men over age 65.
? Family history ? Men with an immediate family member, such as
a father or brother who had it, are twice as likely to develop
prostate cancer.
Who should get screened?
Screening recommendations are different for each man. Talk to your
doctor to discuss your personal risk for prostate cancer and whether
or not you should get screened.
Women ? have the men in your life been screened?
Like many women, you may be the one scheduling appointments
for your family and keeping them on track with their health. Talk to
the men in your life about their risk and encourage them to talk with
their doctor about screening options.
Source: American Cancer Society, cancer.org
Changes to
management
of the Horizon
Behavioral
Health Program
On or about
January 1, 2020,
Horizon NJ Health will
move the administrative
and clinical management
of the Horizon Behavioral
HealthSM Program,
behavioral health
services and benefits,
from Beacon Health
Options (formerly
ValueOptions) to Horizon
NJ Health?s internal
operations.
This change does not
impact your plan benefits
and services.
? You will continue
to have access to
behavioral health
services according to
your plan.
? There will be no
changes to the network
of behavioral health
care professionals that
participate with
your plan.
? You can still use the
phone numbers that
you currently use to
access behavioral
health care benefits
and services.
Prostate cancer is the most common
(non-skin) cancer among American men.
1 in 9 men will be diagnosed
in their lifetime.
174,650 new cases diagnosed each year.
If found early, prostate cancer is one
of the most treatable kinds of cancer.
THE STATS
Teens and vaping: what you should know
Vaping, or smoking electronic cigarettes (e-cigs, JUUL, etc.),
is dangerous for everyone, but especially for teens and
adolescents. E-cigarettes contain liquid nicotine, which is highly
addictive and can harm adolescents? developing brains. Many
of these liquids are flavored to appeal to teens, but they have
toxic chemicals that can harm both the person vaping
and others around them.
As of October 2019, 1,080 confirmed or probable cases
of lung illness associated with the use of e-cigarette products
have been reported to the Centers for Disease Control
and Prevention (CDC) from 48 states. The CDC, U.S. Food
and Drug Administration (FDA) and state and local health
departments are investigating these severe cases.
Why is vaping harmful to the body?
? E-cigarette vapor has toxic and cancer-causing ingredients
like formaldehyde, heavy metals and diacetyl.
? Nicotine in the vapor can harm the lungs, increase the
risk of a heart attack and affect the impulse control part
of the brain that is still developing in adolescents.
E-CIGARETTES
are addictive and are not
a safe alternative
to regular cigarettes.
Source: CDC
5
The CDC reports
that while 2.8% of adults
use e-cigs, almost 21%
of high schoolers vape.
For more information about vaping and tips for how to talk to your teen about
the dangers of e-cigarettes, visit cdc.gov/tobacco.
Our
commitment
to quality
Horizon NJ Health?s
Quality Improvement
(QI) program works
with members and
providers to improve
the quality of care and
services you receive.
Our QI program ensures
these services continue
to be appropriate,
necessary and
properly administered.
We monitor areas
that affect the care
our members get,
like access to care,
screenings and member
satisfaction. For more
information about
Horizon NJ Health?s
QI program and its
progress toward
goals, visit
horizonNJhealth.com/
quality, or call
Member Services at
1-800-682-9090 (TTY 711)
and ask for the Quality
Department.
Renew it or lose it!
In order to be a Horizon NJ Health member, you must renew your
NJ FamilyCare coverage on time EVERY year. Call NJ FamilyCare at
1-800-701-0710 (TTY 1-800-701-0720) to find out your renewal date
or to ask for a renewal form.
What you need to know:
? If you don?t renew your NJ FamilyCare eligibility, you might have to
start over as a new applicant, and the approval process will take longer.
? The renewal process for members who are Aged, Blind and
Disabled is different and requires different updates.
? Keep your contact information updated so NJ FamilyCare can reach you.
What you need to do:
? Open and respond to all mail from your County Welfare Agency
(CWA) or your eligibility-determining agency.
? Contact your case worker at your CWA or call NJ FamilyCare at
1-800-701-0710 (TTY 1-800-701-0720). If you need the information
for your local CWA, please call the Managed Care hotline at
1-800-356-1561 (TTY 711) or visit state.nj.us/humanservices/dmahs/
clients/medicaid/payment/NJ_County_Welfare_Agencies.pdf.
? Pay your premiums on time, in you have one.
For questions, please call Member Services at 1-800-682-9090
(TTY 711), 24 hours a day, seven days a week.
E-CIGARETTES
are addictive and are not
a safe alternative
to regular cigarettes.
6
How to choose a Personal
Representative
All Horizon NJ Health members have the right to choose a Personal
Representative ? someone you choose to work with us on your
behalf to handle your health care and benefits. If you have a Personal
Representative, you will still have all your rights. Your Personal
Representative stands in for you when you don?t feel well enough to
manage your health care benefits on your own. They can handle all
phone calls and written communications about your benefits.
To appoint a Personal Representative:
? Download a Request for Personal Representative Form
at horizonNJhealth.com/personalrep.
? Mail your completed form to the address provided.
Your Personal Representative can be your spouse, child, other relative,
family friend, lawyer or someone chosen by the court. You can also
change your Personal Representative at any time.
The CDC reports
that while 2.8% of adults
use e-cigs, almost 21%
of high schoolers vape.
7
Your child?s health and well-being are important to us. If you have any issues that prevent you
from getting your child the care he or she needs, please call the Horizon Healthy Journey line at
1-844-754-2451 (TTY 711), Monday through Friday, from 8:30 a.m. to 5 p.m., Eastern Time (ET).
Children?s health
Bully prevention
Bullying is a type of youth violence that occurs
throughout the United States. It can happen
to children of all ages and can even happen online
(cyberbullying).
4 ways help prevent bullying
1. Help kids understand bullying ? talk about what
bullying is, how to stand up to it safely, why it is
unacceptable and know how to get help.
2. Keep the lines of communication open ? check
in with kids often, listen to their concerns,
know their friends and ask about school.
3. Encourage kids to do what they love ? special
activities, hobbies and interests can boost
confidence and help kids make friends.
4. Model how to treat others ? set an example
of how to act with kindness and respect.
Vaccine myths
Keeping your children up to date with vaccines is a vital part of protecting them against serious
diseases. There are a few myths that prevent people from vaccinating, but we are here to let you
know why they are not true.
Myth Truth
Vaccines cause autism
Although the cause of autism has not been found, autism can be seen in
children well before they receive the measles, mumps and rubella (MMR) vaccine.
Recent research shows proof that autism develops in utero (when a baby is
developing during pregnancy).*
Infant immune systems
can?t handle so many vaccines
Babies can handle several vaccinations in one day because of the number
of antibodies present in their blood.
Vaccines cost extra
There are no costs for vaccines. They are covered under your child?s
NJ FamilyCare benefits.
Common types of bullying
Physical hitting, kicking, punching, spitting, tripping, pushing
Verbal
teasing, name calling,
innapropriate sexual comments,
or verbal or written threats
Social excluding someone, spreading rumors, making embarrassing comments
*For more information, visit CDC.gov/vaccines/parents/FAQs.html.
Source: stopbullying.gov
students reported being
high school
in the last year.
1 in 5
bullied at school
8
Health risk behaviors
Your child?s doctor should screen for and talk to
your child about health-risk behaviors at his or her
annual wellness visit. Health-risk behaviors can
lead to illness and death among youth and adults.1
These behaviors include:
? Tobacco use
? Alcohol and drug use
? Unsafe sexual behavior
? Depression
Confidentiality is key
? Preteens/teens are more likely to discuss
health-risk behaviors if they believe their
care is confidential.2
? We recommend offering your child the
opportunity to speak privately with his or
her doctor. If it makes you more comfortable,
you can ask for a nurse to be in the room.
Lead testing and prevention
Lead poisoning can cause serious problems to a
child?s development, behavior, hearing and learning.
Children 6 years old and younger are most at risk
because their brain is developing rapidly.
Lead poising can be prevented
A simple blood test can be done in the doctor?s office
to check your child?s lead levels. Children should be
tested when they are 12 months old, and again at
24 months old.
Lead can be found in:
? Drinking water from lead pipes
? Homes built before 1978 and paint that
is chipping/peeling
? Some imported pottery, spices and candies
? Some toys and jewelry made outside the United
States, including in China and Mexico
ANY CHILD BETWEEN
2 and 6
years of age
who has never been
tested for lead should be
tested right away.
31.5% of preteens/teens
feel sad or hopeless1
39.5% of preteens/teens
have engaged in sexual intercourse1
28.9% of preteens/teens
have tried cigarette smoking1
15.5% of preteens/teens
had his or her first drink of alcohol
before 13 years of age1
Sources:
1. nccd.cdc.gov/youthonline/App/Default.aspx
2. umhs-adolescenthealth.org
high school
9
Changes to covered medicines
We want to let you know about the recent changes to our formulary list, also called preferred
drug list (see box). The changes found in this list will be added to our Drug Formulary list at
horizonNJhealth.com/covered_drugs. This list includes an explanation and listing of step therapy,
quantity/age limitations and drugs that require prior authorization (approval).
Please talk with your Primary Care Provider (PCP) about these changes. If your PCP decides that,
for medical reasons, you must take a drug that is not on the formulary list or needs pre-approval,
including a brand name medication exception, he or she can call us and ask for special permission
(prior authorization) for you to get the drug. Please note that Horizon NJ Health?s maximum days?
supply limit is 30 days.
Drug Name Recommendation Alternatives
Aimovig (erenumab-aooe) Covered N/A
Apokyn (apomorphine) Not Covered Levodopa or Carbidopa/Levodopa
Apriso (mesalamine) Not Covered Generic Lialda
Cablivi (caplacizumab-yhdp) Covered N/A
Femring (estradiol) Not Covered Climara, Estradiol patch
Firdapse (amifampridine) Covered N/A
Gynazole (butoconzaole) Not Covered Clotrimazole, Miconazole, Terconazole
Indocin (indomethacin) suspension Not Covered Ibuprofen suspension
Lialda (mesalamine) Covered N/A
Lotrimin (clotrimazole) solution Not Covered
Over-The-Counter alternative (e.g. Lotrimin AF [clotrimazole], Monistat [miconazole],
Micatin [miconazole], Lamisil AT), Ketoconazole, Spectazole (econazole) cream
Lyrica (pregablin) capsules Covered N/A
Metrolotion (metronidazole) Not Covered Metrocream, Metrogel
Nucala (mepolizumab) Not Covered Fasenra
Phenergan VC with codeine
(promethazine/phenylephrine/codeine)
Not Covered Promethazine with Codeine and Sudafed PE or Sudafed
Plexion (sulfacetamide sodium-sulfur)
suspension
Not Covered Generic Plexion Cleansing Emulsion 10-5% (sodium sulfacetamide/sulfur 10-5% emulsion)
Timoptic XE (timolol) gel Not Covered Generic Timoptic (timolol solution)
Zyrtec (cetirizine) chewable Not Covered Over-The-Counter Cetirizine tabs, syrup; Over-The-Counter Loratadine tabs/syrup
Over-the-counter (OTC) and herbal medicines are
medicines you can buy without a prescription from
your doctor. These medicines can help you feel better
by treating or preventing health problems like allergies,
constipation, cough and cold, heartburn and many more.
While you don?t need a prescription from your doctor to get these
medicines, it is very important to let your doctor and pharmacist
know all OTC and herbal medicines you are currently taking.
These medicines may cause side effects when taken with the
medicines your doctor prescribes. They can also cause other
medicines to act differently than intended. If you see more than one
doctor or fill prescriptions at more than one pharmacy, it?s important
to tell everyone involved in your care about all the medicines you are
taking, including OTC and herbal medicines.
We encourage you to use Laboratory Corporation of America?
Holdings (LabCorp) when getting laboratory services. LabCorp is your
laboratory services provider.
You can visit horizonNJhealth.com/findadoctor to find a
LabCorp location near you. Select Other HealthCare Services from
the dropdown menu, then type Laboratory in the Service Type
dropdown menu.
LabCorp also offers online appointment scheduling for all New Jersey
Patient Service Centers. Visit labcorp.com/PSC to find a location.
Walk-in patients are welcome.
You can use LabCorp Patient, an online service, to download and
print your test results on your own. Register at patient.labcorp.com.
LabCorp will give your test results to your doctor before posting them
to your online account.
Managing your medication
A reminder about lab services
10
Member
rights and
responsibilities
As a Horizon NJ Health
member, you have
rights, responsibilities
and choices in the
care you get. Your
member rights and
responsibilities can be
found in your Horizon
NJ Health Member
Handbook or at
horizonNJhealth.com/
memberrights.
Take all medicines ? OTC and prescription ?
exactly as the label says to make sure they are working
the best way they can to treat your condition.
Online
member
support
Once you register
and sign in at
horizonNJhealth.com,
you have access to
your plan information
24 hours a day,
seven days a week.
You can easily:
? Change your PCP
? Request a new
member ID card
? Find tools for
healthy living
? And much more
Font=Avenir next
bold and medium
Eating the right food is an important part of your overall health
and wellness. What we eat can affect our energy, sleep and weight.
Eating a balanced diet is the best way to ensure you are getting
the vitamins and nutrients you need for your body.
Build your healthy meal:
? Each meal should have foods from at least three different
food groups.
? Each snack should have foods from at least two different food groups.
? Choose whole grains like brown rice or quinoa.
? Choose dairy products that are low fat.
? Choose lean protein like fish or poultry.
Eating meals with foods from different groups will help decrease portion size and keep you satisfied
until your next meal. To learn more about the five food groups and the daily recommendations
for children and adults, please visit choosemyplate.gov.
Are you struggling with an opioid addiction or other substances?
Are you in recovery and need support? NJ Peer Recovery will listen,
help and offer hope. NJ Peer Recovery is a peer-support line providing
confidential, accessible and responsive telephonic support. You can
connect to trained NJ Peer Recovery Support Specialists by phone who
will provide emotional and informational support. You will be connected
with someone who knows your struggles and has been in your shoes.
The specially-trained representatives know wellness and recovery
principles and will share their experience with you ? since they?ve been
through their own addiction and recovery. They will support you with
overall wellness, including physical, emotional and mental health.
NJ Peer Recovery offers:
? Support seven days a week from 8 a.m. to 8 p.m., ET
? Help with a personal wellness and recovery plan
? Relapse and overdose prevention tools
? Access to recovery, wellness and treatment resources
Nutrition and your health
NJ Peer Recovery
11
If you or someone you love is struggling with addiction, call 1-833-422-2765 (TTY 711)
to connect with a Peer Support Specialist and start getting help today.
Do you want to get your high
school diploma? We can help.
12
* Services will be provided when needed. Not all members
will receive these services.
** Limited to three attempts.
Horizon Neighbors in Health: Education Works can help you get
your high school diploma. You will get a custom plan that fits your life,
to help you study for and get your diploma ? all at no cost to you!
To enroll in Horizon Neighbors in Health: Education Works,
you must:
? Be a current Horizon NJ Health member
? Have a valid photo ID card, such as driver?s license or state ID card
? Be 18 years of age or older
? Not have a high school diploma or equivalent
? Not be enrolled in an accredited high school
Getting a high school diploma can open doors to better job opportunities.
For more information, call 1-800-682-9094 x52076 (TTY 711),
Monday through Friday, 9 a.m. to 5 p.m.,ET, or email
EducationWorks@HorizonBlue.com.
? Connect you to groups in your area
to help you study
? Give you telephone coaching throughout
the process to help you stay on track
? Work with you one-on-one to understand your
situation and remove any barriers that are preventing
you from getting your diploma, such as transportation
to the testing center or childcare during the test*
? Pay the pre-test and test fees**
Horizon Neighbors in Health: Education Works will:
Information
about your
provider
Information about
your provider,
including your PCP
and specialist, can be
found when you search
our Online Doctor
& Hospital Finder at
horizonNJhealth.com/
findadoctor. There you
can see:
? Provider?s name,
office location
and phone number
? Specialty
? Professional
qualifications
? Languages spoken
To find additional
information regarding
a provider, including
the medical school
attended and residency
completion, visit one of
the following websites:
NJ Division of
Consumer Affairs:
njconsumeraffairs.gov
American Board of
Medical Specialties:
abms.org
13
Look out for health insurance fraud
Health insurance fraud affects everyone. You can help identify and prevent it.
Some common types of health insurance fraud schemes are:
? Billing for services that did not happen
? Faking a patient?s diagnosis to justify a test, surgery or other procedure
that is not medically necessary
? Claiming non-covered treatment are medically-necessary procedures
? Performing medically-unnecessary procedures to get a payment
? Billing for a higher level of service to get a higher payment
? Kickbacks or bribes
? Changing claims or prescriptions
Horizon NJ Health always verifies member information over the phone before talking to you about
your benefits or services. This is an important step we take to protect your information and guard
against fraud. To report health insurance fraud, call 1-855-FRAUD20 (1-855-372-8320) (TTY 711).
Here?s what you can do:
ALWAYS
? Review anything you get in the mail from Horizon NJ Health, a doctor or other
health care providers.
? Ask for a copy of everything you sign.
? Be suspicious of anyone giving free tests or screenings in exchange for your
member ID card number.
NEVER
? Give your health insurance ID card number to anyone except your doctor, clinic,
hospital or other health care provider.
? Give your health insurance ID card number to anyone who calls you without you
asking and offers you free goods or services (durable medical equipment or medication).
? Let anyone borrow or use your health insurance ID card or number.
? Ask your doctor or health care provider for treatment or care you do not need.
? Sign your name to a blank form.
? Share your medical records or medical information with anyone except your doctor,
clinic, hospital or other health care provider.
Notice of Nondiscrimination
14
Notice of Nondiscrimination
086-19-100 CMC0008179C (0719) An Independent Licensee of the Blue Cross and Blue Shield Association.
Horizon NJ Health complies with applicable Federal civil rights laws and does not discriminate against nor does it
exclude people or treat them differently on the basis of race, color, gender, national origin, age, disability, pregnancy,
gender identity, sex, sexual orientation or health status in the administration of the plan, including enrollment and benefit
determinations. Horizon NJ Health provides free aids and services to people with disabilities (e.g. qualified language
interpreters and information in other formats) and to those whose primary language is not English (e.g. information in
other languages) to communicate effectively with us.
Contacting Member Services
Call Member Services at 1-844-498-9393 (TTY 711) or the phone number on the back of your member ID card, if
you need the free aids and services noted above and for all other Member Services issues.
Filing a Section 1557 Grievance
If you believe that Horizon NJ Health has failed to provide the free communication aids and services or discriminated
against you for one of the reasons described above, you can file a discrimination complaint also known as a Section 1557
Grievance. Horizon NJ Health?s Civil Rights Coordinator can be reached by calling the Member Services number on the
back of your member ID card or by writing to:
Horizon NJ Health
Civil Rights Coordinator
PO Box 10194
Newark, NJ 07101
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights
Complaint Portal, online at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail at U.S. Department of Health and
Human Services, 200 Independence Avenue, SW, Room 509F, HHH Building, Washington, D.C. 20201 or by phone
at 1-800-368-1019 or 1-800-537-7697 (TDD). OCR Complaint forms are available at
www.hhs.gov/ocr/office/file/index.html.
Language assistance
Si habla espa?ol, tiene a su disposici?n servicios gratuitos de asistencia ling??stica. Llame al 1-844-498-9393 (TTY 711).
?????????????????????????????? 1-844-498-9393?TTY 711?.
??: ???? ????? ??, ?? ?? ???? ??? ???? ? ????.
1-844-498-9393 (TTY 711)??? ??? ????.
ATEN??O: Se fala portugu?s, encontram-se dispon?veis servi?os lingu?sticos, gr?tis. Ligue para 1-844-498-9393
(TTY 711).
UWAGA: Je?eli m?wisz po polsku, mo?esz skorzysta? z bezp?atnej pomocy j?zykowej. Zadzwo? pod numer
1-844-498-9393 (TTY 711).
ATTENZIONE: In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare
il numero 1-844-498-9393 (TTY 711).
?????? ??????? ???????? ????? ??? ?????? ???? ????? ??? ??? :?????? ???? ???? .??????? ??1-844-498-9393 ?????? ???? ???? ???)711.(
PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang
bayad. Tumawag sa 1-844-498-9393 (TTY 711).
????????: ???? ?? ???????? ?? ??????? ?????, ?? ??? ???????? ?????????? ?????? ????????. ???????
1-844-498-9393 (???????? 711).
ATANSYON: Si w pale Krey?l Ayisyen, gen s?vis ?d pou lang ki disponib gratis pou ou. Rele 1-844-498-9393 (TTY
711).
CH? ?: N?u b?n n?i Ti?ng Vi?t, c? c?c d?ch v? h? tr? ng?n ng? mi?n ph? d?nh cho b?n. G?i s? 1-844-498-9393
(TTY 711).
ATTENTION : Si vous parlez fran?ais, des services d'aide linguistique vous sont propos?s gratuitement. Appelez le
1-844-498-9393 (ATS 711).
???? ??? ? ??? ?????? ??? ??? ????? ?? ??? ?? ???? ?? ?? ?? ???? ????? ???? ?? ??? :??????
1-844-498-9393 (TTY 711).
Blue Notes
Member Services 1-800-682-9090 (TTY 711) 24 hours a day, seven days a week. horizonNJhealth.com
BLUE NOTES is published for members of Horizon NJ Health, 1700 American Blvd., Pennington, NJ 08534. Information in
BLUE NOTES comes from a wide range of medical experts. If you have any concerns or questions about specific content
that may affect your health, please contact your health care physician. Models may be used in photos and illustrations.
Horizon NJ TotalCare (HMO D-SNP) is an HMO Medicare Advantage Dual Eligible Special Needs plan with a Medicare
contract and a contract with the State of New Jersey Medicaid Program. Enrollment in Horizon NJ TotalCare (HMO D-SNP)
depends on contract renewal. Products are provided by Horizon NJ Health. Communications are issued by Horizon Blue
Cross Blue Shield of New Jersey in its capacity as administrator of programs and provider relations for all its companies.
Both are independent licensees of the Blue Cross and Blue Shield Association.
The Blue Cross? and Blue Shield? names and symbols are registered marks of the Blue Cross and Blue Shield Association.
The Horizon? name and symbols are registered marks of Horizon Blue Cross Blue Shield of New Jersey.
? 2019 Horizon Blue Cross Blue Shield of New Jersey. Three Penn Plaza East, Newark, New Jersey 07105.
Y0090_H8298_EC004611_M 086-19-134
Blue Notes
horizonNJhealth.com
Issue 1, 2020
2
In this issue
We?re here for you ?????????????????????????????????????????????????????????????????? 2
Member rights and responsibilities ???????????????????????????????????????? 2
Helping you get the most from your plan ?????????????????????????????? 3
Have you scheduled your annual wellness exam? ?????????????????? 4
Don?t lose your health insurance for you and your family ?????? 4
First aid for seizures ???????????????????????????????????????????????????????????????? 5
Get the facts on aspiration pneumonia ?????????????????????????????????? 5
Sign up at horizonNJhealth.com ??????????????????????????????????????????? 6
Horizon NJ TotalCare (HMO D-SNP):
All your benefits in one plan ??????????????????????????????????????????????????? 6
We are committed to your health care needs ???????????????????????? 7
Preventing bedsores ??????????????????????????????????????????????????????????????? 8
Our commitment to quality ???????????????????????????????????????????????????? 8
Support from Care Managers ????????????????????????????????????????????????? 8
Recovery support for those who need it ??????????????????????????????? 9
Community events ?????????????????????????????????????????????????????????????????? 9
Taking steps to prevent falls ????????????????????????????????????????????????? 10
Changes to covered medicines ?????????????????????????????????????????????11
Taking your medicines as prescribed ????????????????????????????????????12
New generics ?????????????????????????????????????????????????????????????????????????12
Caring for a loved one with a cognitive impairment ?????????????13
Notice of Nondiscrimination ??????????????????????????????????????????????????14
Your health care needs are important to us? Our specially-trained
Member Services Representatives are here to help you understand your
benefits. If you have any questions, please call Member Services at
1-800-682-9090 (TTY 711), 24 hours a day, seven days a week.
We?re here for you
As the novel coronavirus (COVID-19) has become a global concern, Horizon NJ Health
continues to respond to this public health issue to provide the information and services
you need. We understand that you may feel uneasy, and we want you to know that
we?re working hard for our members to help you get the care you need. Your health
and well-being are our top priorities.
You can get the latest COVID-19 information from these credible resources:
? World Health Organization (WHO): who.int
? Centers for Disease Control and Prevention (CDC): cdc.gov
? National Institutes of Health (NIH): nih.gov
? New Jersey Department of Health: nj.gov/health
? New Jersey COVID-19 Information Hub: covid19.nj.gov
Here are 3 ways to get care:
1. Call before you go. It is important to call your doctor or other health care facility before
you go there. When you call, inform them of your concerns, and they will give you further
directions. Your doctor may offer virtual visits, or telemedicine, via video, chat or phone
instead of in-office visits.
2. Get answers any time of day. Call our 24/7 Nurse Line at 1-800-711-5952 (TTY 711).
This gives you access to licensed nurses who can answer your health questions.
3. Is it an emergency? Always call 911 if you are experiencing a medical emergency.
For answers to frequently asked questions about novel coronavirus and related coverage,
please visit horizonNJhealth.com/coronavirus. Member Services is here for you at
1-800-682-9090 (TTY 711), 24 hours a day, seven days a week.
As a Horizon NJ Health member, you have rights, responsibilities and choices in
the care you get. Your member rights and responsibilities can be found in your
Horizon NJ Health Member Handbook or at horizonNJhealth.com/memberrights.
Member rights and responsibilities
Seeing your Primary Care Provider (PCP) for an
annual wellness exam is important, even if you
feel healthy and well. Annual wellness exams
help your PCP find and treat any possible health
issues early, before they become serious. During
times of outbreaks, such as measles or the more
recent COVID-19, ask your doctor when it would
be best for you to schedule your annual exam.
There are no copays for
annual exams ? they are part
of your covered benefits.
At your annual wellness visit, your doctor will:
? Check your weight and blood pressure
? Measure your body mass index (BMI)
? Examine you for physical signs of health
issues
? Let you know if you need any screenings,
immunizations or labwork, based on your
age and other risk factors
Your PCP?s name and phone number are on
your Horizon NJ Health member ID card. If you
need to change your PCP, log in to the secure
member web portal at horizonNJhealth.com,
or call 1-800-682-9090 (TTY 711).
Keep your coverage ? DO NOT miss your time to renew. All NJ FamilyCare members
must renew their coverage on time, each year. If you miss your deadline or have unpaid
NJ FamilyCare premium bills, you risk losing health coverage for you and your family.
NJ FamilyCare may send you a preprinted form or a blank application to fill out. They may also
ask you to confirm your family size. It is important to respond to any written request as soon as
possible so there is no disruption in your coverage.
To renew your coverage, contact NJ FamilyCare at 1-800-701-0710 (TTY 1-800-701-0720) or
your local County Welfare Agency (CWA).
3 4
Have you scheduled your annual wellness exam?
Don?t lose your health insurance
for you and your family
Bring a list of any health questions or concerns with you to
your annual wellness exam so you don?t forget to discuss them
with your doctor?
Helping you get the
most from your plan
Our promise is to give you the
best possible experience with your
Horizon NJ Health plan. To keep
that promise, we are working hard
to offer you exceptional programs, care
management and member services that go
beyond normal NJ FamilyCare plans. Follow
these tips to get the most from your plan:
1. Build a relationship with your
Primary Care Provider
The right care starts with your Primary Care
Provider (PCP). Your PCP should:
? Listen carefully to your health concerns
? Help you get access to a specialist
? Explain things in a clear and
understandable way
? Talk to you about any medications you
are taking
If you need to change your PCP for any
reason, please call Member Services at
1-800-682-9090 (TTY 711).
2. Let us help you coordinate all of your
health care needs
Our Care Management team can help you
understand your benefits so you can get the
care you need. They can help you:
? Manage chronic conditions such as diabetes
or high blood pressure
? Arrange other resources or services you
may need
Our Care Management team is available
Monday through Friday, from 8 a.m. to 5 p.m.,
Eastern Time (ET). Please call 1-800-682-9094
x89634 (TTY 711).
3. Schedule your wellness visits and
health screenings
Life moves fast, and it can be easy to lose track
of time. That?s why we will send you important
reminders for upcoming appointments or
vaccines, like your annual flu shot. The flu
vaccine is your best protection from the flu.
Preventive care can save your life.
4. Get appointments with your doctor
quickly and easily
Your time is valuable. If you are on time for your
appointment, you should not have to wait too
long to see your doctor. Things to remember:
? When making your appointment, ask to
be the first one seen that day.
? Call us if you need help getting an
appointment with a specialist.
? Ask your doctor?s office to let you know
if they are running late.
Visit horizonNJhealth.com/bonustips for
bonus tips and to learn more about what you
get with your plan!
5
First aid for seizures
Get the facts on aspiration pneumonia
Do you know how to care for someone who is having a seizure?
A seizure can happen quickly, and there are important first aid steps to follow in order to
keep a person safe until the seizure stops. A seizure usually lasts for only a few minutes.
Aspiration pneumonia happens when food, saliva, liquids or vomit are breathed into the lungs
instead of being swallowed into the stomach. The elderly, people with dementia, stroke survivors
and people with conditions like Parkinson?s disease, multiple sclerosis and cerebral palsy often
have trouble swallowing and are at a higher risk of getting aspiration pneumonia.
If someone is having a seizure, you should:
? Check for a medical bracelet.
? Ease the person onto the floor.
? Gently turn the person onto his or her side.
? Clear the area of anything hard or sharp.
? Place something soft under the person?s
head.
? Loosen tight clothing around the neck.
? Time the seizure. Call 911 if the seizure
lasts longer than five minutes.
? Stay with the person until the seizure ends.
? Remain calm.
Signs/symptoms of aspiration
pneumonia may include:
? Confusion
? Feeling very tired
? Fever, chills or chest pain
? Hoarse voice after swallowing
? Raised breathing rate
? Shortness of breath
? Wet coughing after eating
Ways to prevent aspiration pneumonia:
? Avoid medicines that cause drowsiness.
? Eat slowly and take small bites.
? Practice exercises to strengthen throat
muscles.
? See a speech pathologist or swallow
therapist.
? Sit upright while eating.
? Use proper oral hygiene.
Sources: MedlinePlus, medlineplus.gov
6
As a Horizon NJ Health member, you have access to our secure member web portal. Once
you sign up, you have access to your plan information 24 hours a day, seven days a week.
You can use the portal to:
? Change your PCP
? Request a new member ID card
? Enroll in one of our Disease Management
programs
? Find tools for healthy living
? And much more
Sign up at
horizonNJhealth.com
Horizon NJ TotalCare (HMO D-SNP):
All your benefits in one plan
If you are eligible for both Medicare and Medicaid, you may be eligible for Horizon NJ TotalCare
(HMO D-SNP). This plan combines all covered Medicare and Medicaid health care benefits into
one easy-to-use, no-cost plan. Horizon NJ TotalCare (HMO D-SNP) includes:
? $0 copays
? $0 premiums
? No referrals
? A $0 gym membership or home fitness
program with FitnessCoach?
? $300 per quarter on an Over-the-Counter
(OTC) Benefit Card to spend on health
items at participating retail stores
? $250 per quarter to spend on personal
items from our catalog
For more information, call 1-888-328-5736 (TTY 711),
24 hours a day, seven days a week, or visit
HorizonBlue.com/TotalCare.
Additional
Benefits
$0 Cost
for Benefits
Dedicated
Care Manager
$0 Copay
for Prescription
Drugs
No Referrals
Needed
One ID Card
Horizon NJ TotalCare
(HMO D-SNP)
You should NEVER:
? Put anything in the person?s mouth?
? Hold the person down or try to stop
their movements? Sources: American Epilepsy Society, aesnet.org,
cdc.gov/epilepsy/about/first-aid.htm
7 8
Preventing bedsores
Bedsores are open wounds found on the skin.
They are common among older adults and
people with disabilities. Bedsores are caused by
long periods of pressure on the skin against a
hard surface, such as a bed, chair or wheelchair.
They are often found on bony areas of the
body such as the hips, back, heels, ankles and
buttocks.
Symptoms of bedsores can include:
? Changes in skin color
? Open sores
? Swelling of the skin
? Skin feeling cooler or warmer to the touch
What you can do to help prevent
bedsores:
? Change your body position at least
every two hours
? Change wet clothing/diapers often
? Check your whole body every day for
signs of sores
? Drink plenty of fluids
? Keep your skin clean and dry
? Pay attention to bony areas of the body
? Use mild soaps and moisturizers
? Use pillows and pads to reduce pressure
on bony areas of the body
Support from Care Managers
Care Managers work closely with our members who were transitioned from
Nursing Facilities, to assess their needs on an ongoing basis and maintain a
Plan of Care. The Care Manager will identify a member?s goals, arrange care and
support, and provide information about local resources to help him or her live as
independently as possible. They will also help members with housing, education
and employment, when applicable, so the member can be self-sufficient.
Our commitment to quality
Horizon NJ Health?s Quality Improvement (QI) program works with members and providers to
improve the quality of care and services you receive. Our QI program ensures these services
continue to be appropriate, necessary and properly administered. We monitor areas that
affect the care our members get, like access to care, screenings and member satisfaction.
For more information about Horizon NJ Health?s QI program and its progress toward goals,
visit horizonNJhealth.com/quality, or call Member Services at 1-800-682-9090 (TTY 711)
and ask for the Quality Department.
We have programs and resources to help you get and stay healthy ? and there is no cost to participate.
You have access as part of your membership with us. Let us help you achieve your best you!
Care Management
A dedicated team of Care Managers will help you schedule your doctors? visits, coordinate
services and provide resources to help you manage your chronic condition.
? Diabetes ? Chronic obstructive pulmonary disease (COPD)
? Congestive heart failure (CHF) ? Hypertension
? Asthma ? HIV/AIDS
For questions or to enroll, call 1-800-682-9094 x89634 (TTY 711), Monday through Friday,
8 a.m. to 5 p.m.
Mom?s GEMS
A prenatal program to help you get the proper care, support and education for a healthy
pregnancy. For questions or to enroll, call 1-800-682-9090 (TTY 711), 24 hours a day, seven days
a week.
Horizon Healthy Journey
A program that sends you reminders and gives you information about preventive health
screenings and services through all stages of life. For questions or more information, call
1-844-754-2451 (TTY 711), Monday through Friday, 8:30 a.m. to 5 p.m.
Neighbors in Health: Education Works
A custom program that fits your life to help you study for and get your high school equivalency
diploma, or GED. For more information, call 1-800-682-9094 x52076 (TTY 711), Monday through
Friday, 9 a.m. to 5 p.m., or email EducationWorks@HorizonBlue.com.
To stay current on all of our programs targeted at improving your health, please visit
horizonNJhealth.com to learn more.
We are committed to
your health care needs
109
Taking steps to prevent falls
Falls are the most common cause of injury in older adults, but the good news is
that they can be prevented. There are easy steps you can take to prevent falls and
stay independent.
You may be more likely to fall if you:
? Are overweight ? Have impaired vision or hearing
? Drink alcohol ? Have low levels of vitamin D
? Have arthritis (joint swelling) ? Take drugs that make you drowsy
? Have dementia
Talk to your doctor today about your risk for falls and ask about taking vitamin D supplements
to improve bone, muscle and nerve health.
Have your eyes checked
at least once a year.5
Assess your home safety. Keep floors clear,
and install grab bars in stairwells and the bathroom.4
Exercise at home or in the gym,
such as yoga and regular stretching.2
Speak to your doctor about your medications and
any changes you feel in your strength or balance.1
3 Ask for help with carrying groceries and home/yard maintenance.
Here?s
what you
can do:
Source: cdc.gov
If you are living with a substance use disorder or are in recovery, you can get help from someone
who has been there. With NJ Peer Recovery, support is just a phone call away.
A Peer Support Specialist is waiting to help you:
? Build your plan for better health and recovery
? Discover relapse and overdose prevention tools
? Find resources to help in your recovery and treatment
Call 1-833-422-2765 (TTY 711), 8 a.m. to 8 p.m.,
seven days a week to connect with a Peer
Support Specialist and start getting help today?
Font=Avenir next
bold and medium
Community events
At Horizon NJ Health, we want to help keep
the people of our state healthy and well. Our
health representatives ? we call them ?Team NJ?
? participate in various community health events
throughout New Jersey every year. Team NJ
offers fun and educational programs and
services to all New Jersey residents at no-cost.
Please call us at 1-609-947-5013 (TTY 711) or
email elvin_santiago@HorizonBlue.com to
inquire about an event near you.
Recovery support for those who need it
11
Following your doctor?s orders for taking your medicines (medication adherence)
is important for managing a medical condition, recovering from illness, and
maintaining your health and well-being.
Tips on taking your medication the right way and safely:
? Take your medication at the same time every day.
? Try taking your medications with a daily routine, like brushing teeth or eating breakfast.
Check to see if you should take your medication on a full or empty stomach.
? Use a pill box or holder to keep track of correct dose and times.
? Refill your pill container at the same time each week, if you use one.
? Buy timer caps for your pill bottles and set them to go off when your dose is due. If your
pill box has a timer function, use it.
? Be sure to bring enough of your medication, plus a few days extra when you are travelling.
? If you are flying, keep your medication in your carry-on bag in case your luggage is lost.
? Set reminders when you are getting low on medications.
? Be sure to see your doctor regularly.
If you have any questions about your medication, please talk to your doctor or pharmacist.
Source: fda.gov/drugs/special-features/why-you-need-take-your-medications-prescribed-or-instructed
Changes to covered medicines
12
New generics
Horizon NJ Health is committed to providing the most up-to-date information regarding new
generics that are available, and we encourage using generic products prior to using brand name
products, when appropriate. Generic drugs are the same as brand name drugs in quality, strength,
purity and stability, as required by the Food and Drug Administration.
The following generic drug is currently on the market or expected to be on the market within the
next three (3) months.
Generic name Brand Name
Pregabalin Lyrica
Taking your medicines
as prescribed
There are recent changes to our formulary list, also called a preferred drug list (see box).
The changes found in this list will be added to our Drug Formulary list at
horizonNJhealth.com/covered_drugs. This list includes an explanation and listing of
step therapy, quantity/age limitations and drugs that require prior authorization (approval).
Here is a list of recent changes:
Covered Change Description Brand (Generic) Drug Name Alternatives (if applicable)
Covered Diacomit (stiripental) ?
Covered Kanjinti (trastuzumab-anns) ?
Covered Mvasi (bevacizumab-awwb) ?
Covered Nuvigil (armodafinil) ?
Covered Ruzurgi (amifampridine) ?
Covered Symjepi (epinephrine) ?
Covered Turalio (pexidartinib) ?
Covered Vyndamax (tafamidis) ?
Covered Vyndaqel (tafamidis meglumine) ?
Covered Xpovio (selinexor) ?
Not Covered Alinia (nitazoxanide) metronidazole, tinidazole
Not Covered Alocril (nedocromil) Cromolyn, Ketotifen, Patanol
Not Covered Avastin (bevacizumab) Mvasi
Not Covered Axid (nizatadine) solution Ranitidine syrup
Not Covered Betopic-S (betaxolol) Betaxolol solution, Timolol solution, Levobunolol, Carteolol
Not Covered Canasa Suppository (mesalamine) rectal mesalamine
Not Covered Cimduo (lamivudine/tenofovir disoproxil) generic Epivir + generic Viread
Not Covered Dificid (fidaxomicin) vancomycin capsules
Not Covered Herceptin (trastuzumab) Kanjinti
Not Covered Ovide (malathion) Permetherin or Pyrethrin therapy
Not Covered Promethazine/DM Syrup (promethazine/dextromethorphan)
Delsym with an antihistamine,
Robitussin with an antihistamine,
dextromethorphan/chlorpheniramine,
dextromethorphan/doxylamine
Not Covered sfRowasa (mesalamine) rectal mesalamine
Not Covered Trexall (methotrexate) methotrexate tablets
Please talk with your PCP about these changes. If your PCP decides that, for medical reasons, you
must take a drug that is not on the formulary list or needs pre-approval, including a brand name
medication exception, he or she can call us and ask for special permission (prior authorization) for
you to get the drug. Please note that Horizon NJ Health?s maximum days? supply limit is 30 days.
14
Notice of Nondiscrimination Notice of Nondiscrimination
086-19-100 CMC0008179C (0719) An Independent Licensee of the Blue Cross and Blue Shield Association.
Horizon NJ Health complies with applicable Federal civil rights laws and does not discriminate against nor does it
exclude people or treat them differently on the basis of race, color, gender, national origin, age, disability, pregnancy,
gender identity, sex, sexual orientation or health status in the administration of the plan, including enrollment and benefit
determinations. Horizon NJ Health provides free aids and services to people with disabilities (e.g. qualified language
interpreters and information in other formats) and to those whose primary language is not English (e.g. information in
other languages) to communicate effectively with us.
Contacting Member Services
Call Member Services at 1-844-498-9393 (TTY 711) or the phone number on the back of your member ID card, if
you need the free aids and services noted above and for all other Member Services issues.
Filing a Section 1557 Grievance
If you believe that Horizon NJ Health has failed to provide the free communication aids and services or discriminated
against you for one of the reasons described above, you can file a discrimination complaint also known as a Section 1557
Grievance. Horizon NJ Health?s Civil Rights Coordinator can be reached by calling the Member Services number on the
back of your member ID card or by writing to:
Horizon NJ Health
Civil Rights Coordinator
PO Box 10194
Newark, NJ 07101
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights
Complaint Portal, online at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail at U.S. Department of Health and
Human Services, 200 Independence Avenue, SW, Room 509F, HHH Building, Washington, D.C. 20201 or by phone
at 1-800-368-1019 or 1-800-537-7697 (TDD). OCR Complaint forms are available at
www.hhs.gov/ocr/office/file/index.html.
Language assistance
Si habla espa?ol, tiene a su disposici?n servicios gratuitos de asistencia ling??stica. Llame al 1-844-498-9393 (TTY 711).
?????????????????????????????? 1-844-498-9393?TTY 711?.
??: ???? ????? ??, ?? ?? ???? ??? ???? ? ????.
1-844-498-9393 (TTY 711)??? ??? ????.
ATEN??O: Se fala portugu?s, encontram-se dispon?veis servi?os lingu?sticos, gr?tis. Ligue para 1-844-498-9393
(TTY 711).
UWAGA: Je?eli m?wisz po polsku, mo?esz skorzysta? z bezp?atnej pomocy j?zykowej. Zadzwo? pod numer
1-844-498-9393 (TTY 711).
ATTENZIONE: In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare
il numero 1-844-498-9393 (TTY 711).
?????? ??????? ???????? ????? ??? ?????? ???? ????? ??? ??? :?????? ???? ???? .??????? ??1-844-498-9393 ?????? ???? ???? ???)711.(
PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang
bayad. Tumawag sa 1-844-498-9393 (TTY 711).
????????: ???? ?? ???????? ?? ??????? ?????, ?? ??? ???????? ?????????? ?????? ????????. ???????
1-844-498-9393 (???????? 711).
ATANSYON: Si w pale Krey?l Ayisyen, gen s?vis ?d pou lang ki disponib gratis pou ou. Rele 1-844-498-9393 (TTY
711).
CH? ?: N?u b?n n?i Ti?ng Vi?t, c? c?c d?ch v? h? tr? ng?n ng? mi?n ph? d?nh cho b?n. G?i s? 1-844-498-9393
(TTY 711).
ATTENTION : Si vous parlez fran?ais, des services d'aide linguistique vous sont propos?s gratuitement. Appelez le
1-844-498-9393 (ATS 711).
???? ??? ? ??? ?????? ??? ??? ????? ?? ??? ?? ???? ?? ?? ?? ???? ????? ???? ?? ??? :??????
1-844-498-9393 (TTY 711).
13
Caring for a loved one with a cognitive impairment (decline in memory or thinking skills) can be
challenging. Even having a simple conversation can be difficult. Cognitive impairment in older
adults can be caused by medication side effects, illness, depression and dementia. Alzheimer?s
disease is the most common type of dementia. Cognitive impairment caused by medication side
effects and depression can be reversed with treatment. Others, such as Alzheimer?s disease,
cannot be reversed, but it can be treated for a period of time.
Individuals with cognitive impairment may experience:
? Aggressive or impulsive behaviors ? Memory problems
? Fixation on/repetition of an idea or activity ? Paranoia (suspicion or mistrust of people)
? Incontinence (trouble holding urine or bowels) ? Poor judgment
? Lack of motivation ? Wandering
It can be helpful to ask your loved one just one question at a time and use simple language. For
example, instead of asking ?Would you like to come in and sit down and have a snack?? use
simple statements such as ?Sit down here? and ?Here?s a snack for you.?
Wandering and poor judgement could lead to dangerous situations and the need for 24-hour
supervision. Use the resources below to know who to contact in your community in case of an
emergency.
Resources
? Family Caregiver Alliance:
caregiver.org/caring-adults-cognitive-and-memory-impairment
? Alzheimer?s Association: alz.org
Caring for a loved one with
a cognitive impairment
Blue Notes
Member Services 1-800-682-9090 (TTY 711) 24 hours a day, seven days a week. horizonNJhealth.com
BLUE NOTES is published for members of Horizon NJ Health, 1700 American Blvd., Pennington, NJ 08534. Information in
BLUE NOTES comes from a wide range of medical experts. If you have any concerns or questions about specific content that
may affect your health, please contact your health care physician. Models may be used in photos and illustrations.
Horizon NJ TotalCare (HMO D-SNP) is an HMO Medicare Advantage Dual Eligible Special Needs plan with a Medicare contract
and a contract with the State of New Jersey Medicaid Program. Enrollment in Horizon NJ TotalCare (HMO D-SNP) depends on
contract renewal. Products are provided by Horizon NJ Health. Communications are issued by Horizon Blue Cross Blue Shield
of New Jersey in its capacity as administrator of programs and provider relations for all its companies. Both are independent
licensees of the Blue Cross and Blue Shield Association. The Blue Cross? and Blue Shield? names and symbols are registered
marks of the Blue Cross and Blue Shield Association. The Horizon? name and symbols are registered marks of Horizon
Blue Cross Blue Shield of New Jersey. ? 2020 Horizon Blue Cross Blue Shield of New Jersey.
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