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Horizon BCBSNJ: Omnia Platinum Plan Highlights
What is the overall deductible?
· 0$ for OMNIA Tier 1 providers.
· $1,000 Individual or $2,000 Family for Tier 2 providers
What is the out-of-pocket limit for this plan?
· For Health/Pharmacy OMNIA Tier 1 providers $1,900 Individual/ $3,800 Family
· For Health/Pharmacy OMNIA Tier 2 providers $3,000 Individual/$6,000 Family
Do you need a referral to see a specialist?
Common Medical Events – Tier One Providers
Primary care visit to treat an injury or an illness: $10.00 Copayment per visit
Specialist visit: $15.00 Copayment per visit
Preventive care/screening/immunization: NO CHARGE
Diagnostic test (x-ray, blood work): NO CHARGE for Office, Independent, Laboratory, Outpatient Hospital
Imaging (CT/PET scans, MRIs): $15.00 Copayment per visit for Outpatient Facility
If you need drugs to treat your illness or condition – Tier 1 Provider
Generic Drugs: $5.00 Copayment/Retail
Preferred Brand Drugs: $15.00 Copayment/Retail
Non-preferred brand drugs: $30.00 Copayment/Retail
Specialty drugs: $30.00 Copayment/Retail
If you have outpatient surgery – Tier 1 Provider
Facility fee (e.g., ambulatory surgery center): $150.00 Copayment per visit for Ambulatory Surgical Center, Outpatient Hospital
Physician/surgeon fees: No charge for Ambulatory Surgical Center, Outpatient Hospital
If you need medical attention – Tier 1 Provider
Emergency room care: $100 Copayment per visit for Outpatient Hospital
Emergency medical transportation: NO CHARGE
Urgent Care: $30.00 Copayment
If you have a hospital stay – Tier 1 Provider
Facility Fee (e.g., hospital room): $300.00 Copayment per day for Inpatient Hospital
If you need mental health, behavioral health, or substance abuse services – Tier 1 Provider
Outpatient Services: NO CHARGE for Outpatient Hospital
Inpatient Services: $300 Copayment per day for Inpatient Hospital
(Subject to change at plan renewal time WITHOUT notice)