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With our OMNIA Health Plans, doctors and other health care professionals in the Horizon Managed Care Network and all hospitals in the Horizon Hospital Network are placed into one of two tiers – OMNIA Tier 1 or Tier 2. You can use the Doctor & Hospital Finder to look up the tier status for participating doctors, health care professionals and hospitals.

OMNIA Health Plan members get the most from their benefits and lower their out-of-pocket costs by using doctors, other health care professionals and hospitals designated as OMNIA Tier 1. Members can still choose to see doctors and hospitals in Tier 2, but may pay more than they would if they had chosen a health care professional designated as OMNIA Tier 1.

For more information about the services covered under your plan and how costs will vary based on if you see an OMNIA Tier 1 or Tier 2 doctor, hospital or other health care professional, many members can use our Treatment Cost Estimator.

To find out the tier of a doctor, hospital or other health care professional, use our Doctor & Hospital Finder and follow the steps below:

1. Select the type of care that you are looking for.
2. Enter the appropriate health plan and location, if applicable (the menu defaults to Your Plan when signed into your account).
3. Type your search criteria (e.g., doctor’s name), or click Browse by Category.
4. On the results page, a blue box next to the provider’s information will show if the doctor or hospital is designated as “OMNIA Tier 1” or “OMNIA Tier 2”.

Be sure to check the health care professional’s tier status for each office location. Some health care professionals may be part of more than one group practice.

Members in an OMNIA Health Plan can receive eligible care or services from any doctor or other health care professional in the Horizon Managed Care Network and any hospital in the Horizon Hospital Network. However, when members choose doctors, other health care professionals or hospitals designated as OMNIA Tier 1, they will maximize their benefits and pay less out-of-pocket.

Most OMNIA Health Plan members do not have out-of-network benefits for nonemergency care. However, if you or an eligible dependent will be outside New Jersey for at least 90 consecutive days, but no more than 365 days, you may be eligible to apply for the Away From Home Care Program.

Some Large Group members have access to BlueCard benefits. Check with your benefits administrator to see if this applies to your plan.

Some of the highlights of the OMNIA Health Plans are:

1. No requirement to select a Primary Care Physician;
2. No referrals to see participating specialists;
3. Lower premiums than comparable plans;
4. Lower copayments and deductibles (and in some cases, no deductibles), when using OMNIA Tier 1-designated doctors, hospitals and other health care professionals.

OMNIA Health Plans are offered statewide and give members the choice to use or receive care from any hospital in the Horizon Hospital Network and any doctor or other health care professional in the Horizon Managed Care Network. For OMNIA Health Plan members, participating doctors, hospitals and other health care professionals are grouped into two tiers – OMNIA Tier 1 and Tier 2. Members can use the Doctor & Hospital Finder to find participating doctors, health care professionals and hospitals and check the designated tier.