and healthy travel experiences with Blue365 a program for members of participating Blue Cross and Blue Shield Companies. Described as: "Get up to $150 back when you join an eligible gym or participate in a virtual fitness app and work out regularly. You are leaving this website/app (site). Go to the nearest hospital in an emergency. To ensure you have the best experience, we recommend using the latest versions of these supported browsers below. This website is operated by Horizon Blue Cross Blue Shield of New Jersey and is not New Jerseys Health Insurance Marketplace. External links open in new windows to websites Blue Cross and Blue Shield of Louisiana does not control. To see all available Qualified Health Plan options, go to the New Jersey Health Insurance Marketplace at Get Covered NJ. The Illinois Long Term Care Ombudsman Program, An appointment with another health care provider, One (1) eye exam every 12 months per member, Every two (2) years for member age 21 and older, Replaced "as needed" for members under 21, Additional reimbursement toward a pair of upgraded eyeglass frames, Cosmetic surgery or treatment that are not medically necessary, Procedures that are still being tested or experimental, Drugs and supplies without a prescription, Services in an emergency room for health issues that are not emergencies. Get Reimbursed in Three Easy Steps1 1. As a Blue Cross Community Health Plans member, you have access to medical, dental, vision, behavioral health, prescription drug coverage and more. 24/7 Nurseline: If you have questions, our nurses have answers. Qualified for Fitness Reimbursement: Blue Cross will reimburse your membership fees for up to three consecutive months (of one individual or family membership) or, alternatively . They are passionate about serving our members. The Blue Cross and Blue Shield name and symbols are registered marks of the Blue Cross Blue Shield Association. It is not the intention of Peloton to provide specific reimbursement advice, but rather to provide users with information to better understand general reimbursement policies and procedures. One option is Adobe Reader which has a built-in reader. 1-877-860-2837 Designed for older adults, Silver&Fit members can join a fitness facility for as low as $25 per year and meet new people at social events like trips to the zoo or museum at no cost. Box 1609. However, the reimbursement only applies to certain Blue Cross companies and plans, so you'll need to log into your Blue Cross . Health and wellness deals that work for your lifestyle. Plan coverage may vary. As a Blue Cross Community Health Plans member, you have access to medical, dental, vision, behavioral health, prescription drug coverage and more. Take advantage of a 15% discount on healthy food deliveries. Additional workplace benefits . See the BCCHP Blue KitSM or MLTSS Blue KitSM for details on benefits and services. Choose . Depending on the plan you choose, Excellus BCBS offers different incentive programs to keep you healthy. Most PDF readers are a free download. Newark, NJ 07101-1609. You can also enroll by phone by calling (888) 242-2060, Monday through Friday, 8 a.m.- 8 p.m., Eastern Time. Blue Cross and Blue Shield of Illinois, aDivision of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. This website does not display all Qualified Health Plans available through Get Covered NJ.To see all available Qualified Health Plan options, go to the New Jersey Health Insurance Marketplace at Get Covered NJ.. Products and services are provided by Horizon Blue . This approval is called "prior authorization." *Services must be medically necessary. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. We will also reimburse fees paid for exercise classes taken at a qualified fitness facility (e.g., yoga, Pilates, spinning). All Rights Reserved. Health savings accounts Health reimbursement accounts. Power 2022 award information, visit jdpower.com/awards. Products and services are provided by Horizon Blue Cross Blue Shield of New Jersey, Horizon Insurance Company, Horizon Healthcare of New Jersey, Braven Health, and/or Horizon Healthcare Dental, Inc., each an independent licensee of the Blue Cross Blue Shield Association. Blue Cross has developed reimbursement policies to provide ready access to coding and reimbursement information, subject to all terms of the Provider Service Agreement as well as changes, updates and other requirements of coding rules and guidelines. Ease stress from COVID-19 with free virtual programs for 90 days. Blue Cross Blue Shield does reimburse some members for their gym membership and some group fitness classes like yoga, pilates, spin, and more. to check your benefits booklet or speak to your benefits administrator to determine if this benefit applies to your coverage . Like going out for a run, working around the yard, even taking the stairs. Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association. The Braven Health name and symbols are service marks of Braven Health. Peace of mind when you need it. Some services need approval from your health plan before you get treated. The total reimbursement depends on your specific plan and eligibility. Excellus BCBS members have access to specially trained professionals who can provide support and education for members with chronic or complex health conditions or answers to more general health questions 24 hours a day. In addition, some sites may require you to agree to their terms of use and privacy policy. P.O. The call is free. To view this file, you may need to install a PDF reader program. To learn more about Prior Authorizations, visit the Prior Authorization page. Our members have access to the HealthwiseKnowledgebase, which features thousands of consumer-friendly pieces of content about medical conditions, symptoms, tests, and treatments. The $400 reimbursement and any amounts paid out-of-pocket for health club reimbursement do not count toward your maximum out . 100% of hospitals and 99% of doctors in our area accept our plans. Blue Cross and Blue Shield is one of the most trusted names in the world. This website does not display all Qualified Health Plans available through Get Covered NJ. You are not required to obtain a prior authorization for standard non-emergency transportation services. You are leaving the Horizon Blue Cross Blue Shield of New Jersey website. We have been providing health care coverage for more than 80 years and will be there for you when you need us. Yes, under certain circumstances, a Prior Authorization is required for non-covered benefits. Horizon Blue Cross Blue Shield of New Jersey. We have been providing health care coverage for more than 80 years and will be there for you when you need us. Please note that these forms are to be used by Federal Employee Program Members only, Referral Requirements for Services Not Related to COVID-19, Pre-Certification/Prior Authorization requirements for Post-Acute Facility Admissions, Telemedicine Cost Share Waiver for Non-COVID-19-Related Services to End, Telemedicine Cost Share Waiver for Non-COVID-19-Related Services to End for Self-Insured Health Plans, Submitting Pharmacy Claims for COVID-19 Vaccinations, Reminder: Select one method for COVID-19 and Influenza Testing, Antibody testing: FDA and CDC do not recommend use to determine immunity, June 2021 Updates: COVID-19 treatment cost share waiver, Reminder: Use correct codes when evaluating for COVID-19, Submitting claims for COVID-19 vaccines delivered in non-traditional medical settings, For Essential Workers, COVID-19 Treatment Covered Under Workers Compensation Benefits, COVID-19 vaccine administration reimbursement at UCCs, COVID-19 vaccines will be covered at 100%, Reminder to use specific codes when evaluating for COVID-19, COVID-19 Update: Telemedicine Reimbursement Policy Addenda, Join a Horizon BCBSNJ or Horizon NJ Health Network (Physicians and Other Healthcare Professionals ), Join the Horizon BCBSNJ Network (Ancillary Providers), Join the Horizon NJ Health Network (Ancillary Providers), Blue Cross and Blue Shield of Minnesota: New PA requirement for Nusinersen (Spinraza), Blue Cross Blue Shield of Massachusetts: BCBSMA High Tech Radiology and Sleep UM Programs, Arkansas BlueCross BlueShield: AIM Medical Oncology Program to be Implemented for Tyson Foods Enrollees, Arkansas BlueCross BlueShield: Six specialty medications to need prior approval beginning April 2018, Blue Cross Blue Shield of Massachusetts: Radiology and Sleep Apnea Program Expansion, Blue Cross Blue Shield of Minnesota: Implementation of a Medical Drug Exclusions List, BlueCard Medical Policy/Pre-Certification Info, Braven Health Electronic Data Interchange (EDI), Horizon BCBSNJ Electronic Data Interchange (EDI), Cardiology Imaging Program Provider Questions and Answers, Medical Information Requirements for Programs Administered by eviCore, Medical Necessity Determination (MND) Review of Molecular and Genomic Diagnostic Testing Services Frequently Asked Questions, Molecular and Genomic Testing Procedure Codes, Musculoskeletal Program for Pain Management Services, Radiation Therapy Program Questions and Answers, Cardiology & Radiology Imaging Procedure Codes, Codes Considered Inclusive to an Imaging Service, Maternal Fetal Medicine Evaluation Coding, Radiology/Imaging Guidelines for Emergency Room Preliminary Reads (Wet Reads), Radiology/Imaging Program Guidelines for Use of Modifier 59, Correct Coding Rules Bank for Radiology, Cardiology and Ultrasound Services, Code Pairs Added to this List Effective January 1, 2022, Code Pairs Removed from this List Effective December 31, 2021, Code Bundling Rules for Radiology, Cardiology and Ultrasound Services, Prior Authorization/Pre-Service Registration, Medical Injectables Program Provider Questions and Answers, Specialty Pharmaceuticals for Office Administration, Medicare Advantage Network Plans Overview, Braven Health℠ Plans(Medicare Advantage), New Jersey Infection Prevention Partnership, Remote Patient Monitoring for COPD Provided by HGE Health, How Risk Adjustment Benefits You and Your Patients, Referral Process Using the Interactive Voice Response System, Effective use of the Interactive Voice Response System, Surgical and Implantable Device Management Program, About the Surgical and Implantable Device Management Program, Surgical and Implantable Device Management Program for Cardiac Surgeries Frequently Asked Questions Updated: March 25, 2021, Surgical and Implantable Device Management Program Orthopedic Services Frequently Asked Questions, Using Out-of-Network Providers in Surgical Services, Eligible Laboratory Procedures Rendered by a Practice, CMS Audits to Validate Directory Information, Initiating Demographic Updates: Participating Providers, Supporting Documentation Requirements for Practice-level Demographic Updates, Supporting Documentation Requirements for Practitioner Demographic Updates, Supporting Documentation for Ancillary Provider Demographic Updates, Initiating Demographic Updates: Nonparticipating Providers, Time Limits for Filing Inquiries/Complaints, Appeals of Non-Utilization Management Determinations, Appeals of Utilization Management/Medical Management Determinations, Appeals of Post Service Medical Necessity Determinations, Allowable Practice Locations for Pathologists, Appointment Availability Access Standards for Primary Care-Type Providers, ObGyns, Specialists and Behavioral Health Providers, Credentialing and Recredentialing Policy for Ancillary and Managed Long Term Support Service (MLTSS) Providers, Credentialing and Recredentialing Policy for Participating Physicians and Healthcare Professionals, Diagnostic Imaging Privileging by Participating Provider Practice Specialty, EDI and NaviNet Claims Submission Requirement, Material Adverse Change (MAC) Notification Policy, Outlier Audit Programs: Post Payment and Pre-Payment, Physician and Healthcare Professional Counseling and Termination Policy - Professional Competency, Participation Status in Products that Utilize Tiering and/or Subset of an Existing Horizon Network, Practitioner Office Site Quality and Medical/Behavioral Health Record Keeping Standards, Provider Outlier Program Frequently Asked Questions, SHBP/SEHBP Inpatient Readmission Reimbursement, Standards for All Types of Medical and Dental Diagnostic Radiology and Imaging Facilities, Use of Horizon Hospital Network Performance Data, Add-on Payment for COVID-19 Diagnostic Testing Run on High Throughput Technology (U0005), Ambulatory Electrocardiographic Monitoring, Bariatric Surgery Billed With Hiatal Hernia Repair, Billing Guidelines for Maternity Services, Cardiovascular Implant Device Monitoring Services, Claims Requiring Additional Documentation, Continuous Positive Airway Pressure or Bi-level Positive airway Pressure (CPAP/BiPAP) Supplies, COVID-19 Testing and Testing Related Services, Daily Management of Epidural or Subarachnoid Continuous Drug Administration, Daily Maximum Units for Surgical Pathology and Microscopic Examination, Distinct Procedural Service Modifiers (59, XE, XP, XS, XU), Duplicate Claim Logic for Independent Laboratory Services, Evaluation and Management Services with Chiropractic Manipulative Treatment, Evaluation and Management Services with Osteopathic Manipulative Treatment, Evaluation and Management Services billed with Global Radiology, Stress Test, Stress Echo, Myocardial Profusion Imaging, Frequency of Care Coordination Services and ESRD Procedures, Horizon Fee Schedule Updates based on Third Party Sources, Hospital Non-Patient Laboratory Services Sample Fees, Laser Treatment of Psoriasis or Parapsoriasis, Medicare Advantage Hospital Sequestration Reimbursement, Mutually and Non-Mutually Exclusive NCCI Supplemental Edits, Outpatient Facility Code Edits: Bundling and Revenue Codes, Lab codes when billed with other services, Outpatient Laboratory Claims: Referring Practitioner Required, Physician Extenders Non-Surgical Services, Pre-Payment Documentation Requests: Facility Claims, Post Payment Documentation Requests: Facility Claims, Pulmonary Diagnostic Procedures when billed with E&M Codes, Reimbursement and Billing Guidelines for Anesthesia Claims, Removal of Impacted Cerumen Requiring Instrumentation, Screening and Diagnostic Mammography & 3D Tomosynthesis, Telemedicine Services Reimbursement Policy: Temporary Addendum for Horizon BCBSNJ Commercial/ASO plans and products, Telemedicine Services Reimbursement Policy: Temporary Addendum for Horizon Medicare Advantage, Urinalysis with Evaluation and Management (E&M) Services, Prior Authorization Procedure Search Tool, Consumer Assessment of Healthcare Providers and Systems (CAHPS), Focusing on Your Horizon and Braven Health Patients Experience: Tools to Help You, Discussion Checklist for CAHPS and HOS Surveys, HEDIS Measure Guidelines for Behavioral Health Providers, Follow-Up Care for Children Prescribed ADHD Medication (ADD), Antidepressant Medication Management (AMM), Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM), Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics (APP), Follow-Up After Emergency Department Visit for Substance Use (FUA), Follow-Up After Hospitalization for Mental Illness (FUH), Follow-Up After High-Intensity Care for Substance Use Disorder (FUI), Follow-Up After Emergency Department Visit for Mental Illness (FUM), Initiation and Engagement of Substance Use Disorder Dependence Treatment (IET), Adherence to Antipsychotic Medications for Individuals with Schizophrenia (SAA), Diabetes Screening for People with Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications (SSD), HEDIS Measurement Year (MY) 2022 Provider Tips for Optimizing HEDIS Results, Adherence to Antipsychotic Medications for Individuals With Schizophrenia (SAA), Adults Access to Preventive/Ambulatory Health Services (AAP), Antibiotic Utilization for Respiratory Conditions (AXR), Appropriate Testing for Children with Pharyngitis (CWP), Appropriate Treatment for Upper Respiratory Infection (URI), Avoidance of Antibiotic Treatment for Acute Bronchitis/ Bronchiolitis (AAB), Blood Pressure Control for Patients With Diabetes (BPD), Cardiovascular Monitoring for People With Cardiovascular Disease and Schizophrenia (SMC), Child and Adolescent Well-Care Visits (WCV), Deprescribing of Benzodiazepines in Older Adults (DBO), Diabetes Monitoring for People With Diabetes and Schizophrenia (SMD), Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications (SSD), Eye Exam for Patients With Diabetes (EED), Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence (FUA), Follow-Up After High- Intensity Care for Substance Use Disorder (FUI), Hemoglobin A1c Control for Patients With Diabetes (HBD), Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment (IET), Kidney Health Evaluation for Patients with Diabetes (KED), Osteoporosis Management in Women Who Had a Fracture (OMW), Osteoporosis Screening in Older Women (OSW), Persistence of Beta- Blocker Treatment After a Heart Attack (PBH), Pharmacotherapy Management of COPD Exacerbation (PCE), Statin Therapy for Patients with Cardiovascular Disease (SPC), Statin Therapy for Patients with Diabetes (SPD), Use of Imaging Studies for Low Back Pain (LBP), Use of Opioids from Multiple Providers (UOP), Use of Spirometry Testing in the Assessment and Diagnosis of COPD (SPR), Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC), Well-Child Visits in the First 30 Months of Life (W30), Policies, Procedures and General Guidelines, Programs Administered by eviCore healthcare, Participating Physician and Other Health Care Professional Office Manual, Behavioral Health Network Specialist Assignments, Eligibility and Benefits Cost Share Estimator, Womens Health Results and Recognition Program, Provider Guidelines: Non-Standard (Medical Record) Supplemental Data for HEDIS Gap Closure, How to Submit Supplemental Data to Horizon, Health Outcomes Survey: How You Can Drive Results, Radiation Therapy Medical Necessity Determination, Treat Knee, Back, and Hip Pain with Orthotic Device that Helps Avoid Invasive Procedures, Horizon Neighbors in Health Program Supports Struggling Families, Bariatric Surgery Value-Based Program Helps Members with Weight Loss, Dental Providers Benefit from Dedicated Horizon Liaisons, Connecting with parents on the importance of early childhood health screenings and vaccinations, Episodes of Care Program Gives Cancer Patients the Care They Need, HealthSphere gives a behavioral health provider the full patient view, Home-Delivered Meals Help Braven Health℠ Patients, Horizon Neighbors in Health Program Helps At-Risk Members in Camden, How a value-based primary care provider helps the New Jersey Vaccination Program, Improving Health Equity through Increased Access to Prenatal Care Across New Jersey, Making Pathways in Innovating and Advancing Maternal Health, Pharmacy Collaboration leads to better patient outcomes and cost savings, Providing Innovative Cancer Care - Expanding Episodes of Care, Telehealth after COVID-19 Many doctors agree it's here to stay, Value-based care -- transforming health care with better collaboration and improved health outcomes, When planning, collaboration and crisis merge - a medical practice's successful response to COVID-19, Applicable Products:Commercial PPO/EPO &Exchange POS/EPO, Applicable Products: Commercial HMO & POS, Claims Payment Policies and Other Information. This new site may be offered by a vendor or an independent third party. Our Estimate Medical Costs tool provides cost estimates for common treatments and procedures. Enroll and pay the $29 initiation fee and $29 monthly membership fee* (Note: Payment is made online when you enroll. Our reimbursement process is quick, easy, and online. Our Customer Care teams live and work in your community. Easy Enrollment. With the ExerciseRewards Program subscribers and their spouse or domestic partner can receive up to $600 a year to help pay for their fitness facility memberships. Get paid for working out. What you must pay when you get these services: For eligible items under Fitness Benefit, you pay any balance in excess of the $400 limit. Sign in to MyBlue and check your plan details. They are passionate about serving our members.

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