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Plan Details

Horizon NJ TotalCare (HMO D-SNP)

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MONTHLY PREMIUM

$0.00

ENROLL
BENEFIT TYPE IN NETWORK BENEFIT
Referrals
Referrals No
PCP Required
PCP Required Yes
Annual Medical Deductible
Annual Medical Deductible No
Maximum Out-of-Pocket Responsibility
Maximum Out-of-Pocket Responsibility $0, you will have no cost sharing responsibility for services.
Hospital Care
Hospital Care

Inpatient
$0 Copay
Except in an emergency, your doctor must tell the plan that you are going to be admitted to the hospital.
Authorization rules may apply.

Outpatient
$0 Copay
Authorization rules may apply.

Doctor Visits
Doctor Visits

$0 Copay

Authorization rules may apply.

Emergency Care
Emergency Care $0 Copay
Coverage is limited to $60,000 worldwide when you are temporarily outside of the United States and its territories.
Urgently Needed Services
Urgently Needed Services $0 Copay
Coverage is limited to $60,000 worldwide when you are temporarily outside of the United States and its territories.
Diagnostic Services/ Labs/ Imaging
Diagnostic Services/ Labs/ Imaging

$0 Copay

Authorization rules may apply.

Covers
  • Lab services
  • Diagnostic procedures and tests
  • X-rays
  • Diagnostic radiology services (other than X-rays)
  • Therapeutic radiology services
Hearing Services
Hearing Services

$0 Copay
Authorization rules may apply.

The plan covers:
  • Routine hearing exams, diagnostic hearing exams and balance exams, otologic and hearing aid examinations prior to prescribing hearing aids.
  • Exams for the purpose of fitting hearing aids, follow-up exams and adjustments, and repairs after warranty expiration.
  • Hearing aids, as well as associated accessories and supplies, are covered.

Covered for services rendered beyond Medicare Part B limits.


Dental Services
Dental Services

$0 Copay
Authorization rules may apply.

Covered care includes (but is not limited to):
  • Diagnostic (X-rays and exams)
  • Preventive (cleanings and fluoride treatments)
  • Restorative (crowns, silver or tooth-colored fillings)
  • Endodontics (root canals)
  • Periodontal (gum treatments/therapies)
  • Prosthetics (dentures and fixed bridges)
  • Oral and maxillofacial surgical (extractions)
  • Adjunctive services
Vision Services
Vision Services

$0 Copay

Covered services include:
  • Outpatient physician services for the diagnosis and treatment of disease and injury to the eye.
  • Annual diabetic retinal exam
  • Glaucoma screening
  • Macular degeneration screening
  • Routine eye examinations
  • Optometrist services and optical appliances, including artificial eyes, low vision devices, vision training devices, and intraocular lenses.
  • Replacement lenses and frames (or contact lenses), covered once every 24 months for beneficiaries age 19 through 59, and once per year for those 18 years of age or younger and those 60 years of age or older.

Optometrist services and optical appliances must be obtained at a participating Davis Vision Provider.

Mental Health Services
Mental Health Services In-network
$0 Copay
Skilled Nursing Facility (SNF)
Skilled Nursing Facility (SNF) $0 Copay
Authorization rules may apply.
Covers Nursing Facility services and Nursing Facility.
Ambulance
Ambulance $0 Copay
Authorization rules may apply.
Prescription Drug Coverage
Prescription Drug Coverage $0 Copay , Coinsurance , and Deductible for all covered prescription drugs
Over-the-Counter Personal Health Items
Over-the-Counter Personal Health Items OTC (Over-the-Counter) Benefit Card

Every three (3) months you will receive a $390 credit (up to $1,560 annually) that will allow you to purchase personal health and food items without a prescription from our participating retailers. Examples of these personal items are first aid kits, folding canes, denture creams and more. The quarterly credit will not carry over from quarter to quarter or from year to year. All orders must be placed using the plan’s approved OTC Benefit Card at participating retailers or online at NationsOTC.com.

*Eligibility criteria applies for Healthy Foods.

OTC (Over-the-Counter) Catalog

Every three (3) months you will receive a $250 credit (up to $1,000 annually) that will allow you to purchase personal health items without a prescription from our OTC catalog. Examples of these personal items are first aid kits, folding canes, denture creams and more. The quarterly credit will not carry over from quarter to quarter or from year to year. All orders must be placed using the plan’s approved vendor and all orders will be delivered through the mail.

Orders can be placed through the phone at 1-855-345-4759 and online at HorizonBlueOTC.com.

Fitness Program
Fitness Program

The no-cost Silver&Fit® Program

  • Access to a network of over 15,000 participating fitness centers or select YMCAs
  • Digital fitness program with home fitness tools, including digital workout videos
  • Telephone-based Healthy Aging coaching for a broad range of areas, including nutritional and fitness coaching
The Silver&Fit program is provided by American Specialty Health, Inc., a subsidiary of American Specialty Health Incorporated (ASH). Silver&Fit is a registered trademark of ASH and used with permission herein. participating facilities and fitness chains may vary by location and are subject to change.
Foot Care (podiatry services)
Foot Care (podiatry services) $0 Copay
Covers routine exams and medically necessary podiatric services, as well as therapeutic shoes or inserts for those with severe diabetic foot disease, and exams to fit those shoes or inserts.
Home Health Care
Home Health Care $0 Copay
Authorization rules may apply.
Hospice
Hospice $0 Copay
Authorization rules may apply.
Nurse Line
Nurse Line Enables you to speak with a registered nurse, toll free 24 hours a day to assist with health-related questions and concerns. Please call 1-800-711-5952 to contact the 24/7 Nurse Line.
Outpatient Surgery
Outpatient Surgery $0 Copay
Authorization rules may apply.
Telehealth
Telehealth $0 Copay
Horizon CareOnline℠: is a telemedicine service that allows members to see a licensed, board-certified CareOnline Network doctor without an appointment via phone, video or chat, seven days a week, using a mobile device or web-enabled computer, for urgently needed services and behavioral health.
Nursing Facility Care
Nursing Facility Care $0 Copay
Authorization rules may apply.
Personal Care Assistance Services
Personal Care Assistance Services $0 Copay
Post Hospital Discharge Meals - Home Delivered
Post Hospital Discharge Meals - Home Delivered After an inpatient hospital discharge to your home, you may be eligible to receive up to 28 nutritious meals over a 14 day period. Meals must be coordinated by your Care Manager and must be consistent with the established treatment of your illness.

Find In-Network Doctors

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