All Claims for these specific prefixes are to be mailed to the address indicated. In addition, any inquires, complaints or appeals should be directed to the addresses.
BlueCard is a collection of programs and policies that enable Blue Cross Blue shield (BCBS) members to receive health care services while travelling to, or living in, another plan’s services area. It links participating providers and BCBS plans across the country through a single, electronic network.
The Exclusive Provider Organization Network (EPO) allows for savings by providing members with hassle-free coverage with a selection of participating providers with no out-of-network options.
HMO program where selection of a Primary Care Physician (PCP) and referrals for speciality care are required. There are no benefits for out-of-network services, except in emergency situations. This program is offered to customers in the Consumer market and to small and large sized groups.
Medigap is coverage that supplements Medicare and is offered to individuals age 65 and over. It is also available to the disabled individuals under age 65. All insurance companies must offer 10 federal Government designed Medigap Policies (Plan A through Plan J) as part of selection.
Group plans or accounts with participants living through the United States, as well as internationally. These members are eligible for claims processing through Horizon BCBSNJ and BlueCard Program.
The Point-of-Services (POS) program is a managed care program with flexibility to choose care in and out-of-network. The member receives the highest level of benefits with a primary care physician (PCP) manages his\her care. The member can opt to bypass the PCP and receive the lower level (out-of-network) of benefits.
A Traditional program is a fee-for-service health plan with the freedom to select any doctor and hospital. Patients can reduce their out-of-pocket costs by using doctors and hospitals that participate with Horizon BCBSNJ or through the BlueCard program. The plan is made up of a basic coverage and the deductible and coinsurance applies to supplemental services.