Horizon HMO, a subsidiary of Horizon Blue Cross Blue Shield of New Jersey, was one of the first HMOs available under the State Health Benefits Program (SHBP). Members may select from a network of over 13,000 providers available in all counties in New Jersey and Bucks County, Pennsylvania. Approximately, 4,000 of these providers are Primary Care Physicians (PCP). All providers participating in the Horizon HMO network are carefully selected and screened and must meet rigorous professional standards. Periodically, we review the credentials of participating providers and profile their performance to ensure that members receive the best medical care available. In addition, Horizon HMO has received full accreditation from the National Committee for Quality Assurance (NCQA).

You and Your Primary Care Physician

Your PCP will provide you with routine care, including annual physical examinations, well-child care and immunizations. There is a $5 co-payment each time you visit your PCP. You may change your PCP simply by calling Member Services. If you and your PCP determine you need to see a specialist, a referral will be issued to a participating provider. There is a $5 co-payment per specialist office visit. Your PCP will also coordinate your hospital care through our broad network of 65 New Jersey hospitals in 76 locations and you will receive 100 percent coverage.

Obstetrician/Gynecologist Coverage

Female members have direct access to participating Obstetricians/Gynecologists (OB/ Gyns) without PCP referral. This includes an annual well-woman exam and other OB/Gyn related services. There is a $5 co-payment per OB/Gyn visit. This co-payment is waived for prenatal and postnatal maternity care visits after the initial visit.

Vision Coverage

Members have direct access to a participating optometrist or ophthalmologist for an annual vision examination. There is a $5 co-payment for an annual vision examination. Additional visits require written referral from your PCP and also require a $5 co-payment per visit.

Prescription Drug Coverage

Prescription drug coverage is provided to employees whose employer does not offer a separate, prescription drug plan. Prescription drug coverage is also provided to retirees. A $5 generic drug co-payment and a $10 brand name co-payment applies at a retail pharmacy for up to a 30-day supply. Mail order is also available with a $5 generic co-payment and a $5 brand name co-payment for up to a 90-day supply.

Emergency Care

If you experience a medical emergency, please go to the nearest emergency facility immediately. You must contact us and your PCP within 48 hours. A $25 co-payment applies if you are treated and released but is waived if you are admitted to the hospital. Please note all Horizon HMO PCPs have 24-hour back up coverage in the event he/she is unavailable.

Away-From-Home Coverage

Horizon HMO covers you and your eligible family members when traveling or temporarily away from home through HMO Blue USA, a national Blue Cross Blue Shield HMO network serving over 250 major cities and all 50 states, as well as Puerto Rico. Or, if you are away from home for an extended period of time, enrollment may be granted through our Guest Membership Program in a Blue Cross Blue Shield sponsored HMO in another state.

Horizon HMO Specialty Programs/Features

Precious Additions - a prenatal education and information program that helps expectant mothers enjoy a healthy pregnancy. After the birth, the program offers home care services and encourages child immunizations.

SmartEyes - a discount program for eyeglasses and accessories through more than 6,500 Cole Vision/Pearle Vision Centers nationwide. Cole Vision outlets can be found in Sears Optical Centers, JC Penney Optical Centers, and Montgomery Ward Vision Centers. Call 1-800-424-1155 for a location near you.

Centers of Excellence - a network of regional hospitals for bone marrow, heart, lung, liver and kidney transplants, should they be necessary.

Focus Newsletter- a free subscription to our quarterly newsletter, FOCUS, which gives you health tips and benefit updates.

Health and Fitness Discount Program - discounts for weight loss, smoking cessation and stress management programs, health club memberships, and other healthy lifestyle programs.

For Additional Information

If you have questions, please call Horizon HMO Member Services at 1-800-355-BLUE (2583) during our service hours of Monday through Friday, 8:00 a.m. to 8:00 p.m. You may also access our interactive Web-Site at www.horizon-bcbsnj.com or write to us at:

Horizon Blue Cross Blue Shield of New Jersey

Horizon HMO

P.O. Box 820

Newark, New Jersey 07101-0820

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SHBP Summary Program Description - September 18, 2000