What Is Horizon BCBS?
Horizon Blue Cross Blue Shield of New Jersey is a nonprofit health services organization best known for its managed care and traditional insurance plans for individuals and employers. The Newark, N.J.-based organization provides health insurance coverage to more than 3 million people throughout the Garden State.
Horizon BCBSNJ dates to 1932, when Associated Hospitals of Essex County, Inc. formed a multi-hospital prepayment insurance plan. The company later became the nation’s first Blue Cross Plan.
For the third year in a row, Horizon BCBSNJ received the J.D. Power Award for the highest member satisfaction among commercial health plans in New Jersey for 2022. The study was fielded from January to April 2022 among commercial HMO, PPO, and point of service (POS) plan members.
Horizon BCBS Plan Types
Horizon BCBSNJ strives to cover as many people as possible via its wide variety of plans. All Horizon plans cover behavioral health treatment, though there are variations regarding which services and how much is covered.
The types of plans that Horizon BCBSNJ offer include:
- BlueCard PPO. The nation’s preeminent Blue Cross and Blue Shield Preferred Provider Program, BlueCard PPO allows members to see any provider they want, even those out of network. Still, coverage is greater for those seeing in-network healthcare providers.
- EPO (Exclusive Provider Organization). EPOs allow members to receive full benefits if they stay in-network. Horizon’s EPO network is the same as that in the BlueCard PPO plan.
- Horizon Direct Access. Direct Access plans offer members referral-free access to many healthcare services and programs, as well as one of the largest provider networks in the U.S.
- Horizon HMO. Health maintenance organizations (HMOs) require some out-of-pocket payments from their members. Also, these plans are less flexible since members must get specialist referrals from their primary care provider.
- Horizon POS (Point of Service). Horizon’s POS plan lets members choose their own medical service providers. POS plans cover medical emergency screening exams, which are performed in a hospital ER to determine whether a medical emergency exists.
- OMNIA Health Plans. Horizon’s OMNIA health plans include a variety of plan types. These plans have lower premiums and do not require members to seek referrals for specialized treatment services, so long as the providers are in-network.
- Traditional Indemnity. Indemnity health plans are fee-for-service (FFS) plans. FFS plans are a traditional type of insurance in which the organization will either pay the medical provider directly or reimburse the policyholder once they have filed an insurance claim for each covered medical expense.
Does Horizon BCBS Cover Mental Health Treatment?
As required by the Affordable Care Act, behavioral and mental health treatments are considered essential benefits. Therefore, all health plans must cover these treatments. Covered mental health benefits include counseling and therapy as well as inpatient mental health and addiction treatment.
In recent years, Horizon BCBSNJ has taken a leadership role in mental health coverage for its members, prioritizing the integration of behavioral health into primary care. In November 2022, the nonprofit launched NovaWell—a behavioral health integration service designed to empower health plans and health systems—accelerated behavioral health integration into their existing operations.
NovaWell utilizes data analysis to direct members to mental health services when needed and identify gaps in healthcare. NovaWell representatives point out that integrating mental health into members’ primary healthcare can reduce medical expenses.
Horizon BCBSNJ has also turned to technology for care services. In July 2022, the nonprofit struck a deal with digital mental health company Valera Health to expand its remote health services to members.
Overall, Horizon BCBSNJ has grown its mental health network by 40% since 2018. Horizon can cover and connect members to the following:
- Providers and facilities specializing in mental health
- Individual and group counseling
- Crisis intervention and mental health treatment
- Autism care management services
- Online wellness and self-directed therapy tools
- Virtual doctor and therapy visits
- Treatment programs for substance use disorder
Certain behavioral health services may require prior authorization. Fortunately, Horizon representatives often work with members and their families to get them the treatment and support they need.
Does Horizon BCBS Cover Dual Diagnosis Treatment?
When someone is living with an untreated mental health disorder, the risk of developing a substance use disorder increases. Numerous studies suggest that common mental health disorders like depression, anxiety, bipolar, and post-traumatic stress disorder (PTSD) can contribute to a person’s tendency to use and abuse alcohol and drugs.
When someone has both a mental health disorder and a co-occurring substance use disorder, they are known as dual diagnosis cases. Consistent with its commitment to helping its members recover from addiction and mental health disorders, virtually all dual diagnosis treatments are covered under Horizon BCBSNJ plans.