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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.

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 generally placed into one of two tiers – OMNIA Tier 1 or Tier 2. Some members may have an OMNIA Health Plan with other tiers, like Inner Circle. Check your Plan Details for more information.

When you choose doctors, other health care professionals or hospitals designated as an OMNIA Tier 1, Inner Circle, or equivalent tier (depending on your plan), you will get the most from your benefits and pay less out of pocket. Check your Plan Details for more information.

Use the Doctor & Hospital Finder to look up the tier of your doctor, hospital or other health care profession.

OMNIA Health Plan members do not have out-of-network benefits, unless it’s for an emergency. However, if you or an eligible dependent will be outside New Jersey for at least 90 consecutive days, but no more than 180 days, you may be eligible to apply and get coverage from the local Blue Plan through the Away From Home Care Program.

Check your member ID card to see if you have an empty suitcase or a PPO-in-a-suitcase logo. If you do, this means you may be able to get care outside the state of New Jersey through the BlueCard® program.

Use the Doctor & Hospital Finder to look up your doctor, hospital or other health care professional.

On the search results page, the tier of the provider you searched for, such as “OMNIA Tier 1” or “Tier 2,” will appear on the right side under each result. 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.

When you choose doctors, other health care professionals or hospitals designated as an OMNIA Tier 1, Inner Circle, or equivalent tier (depending on your plan), you will get the most from your benefits and pay less out of pocket. Check your Plan Details for more information.

Some of the highlights of the OMNIA Health Plans are:

1. You don’t need to select a Primary Care Physician;
2. You don’t need a referral to see participating specialists;
3. Your premium is generally lower compared to other plans;
4. Depending on your specific OMNIA Health Plan, you pay less out of pocket when using doctors, hospitals and other health care professionals designated as an OMNIA Tier 1, Inner Circle or equivalent tier.

OMNIA Health Plans are offered statewide and give you the choice to get care and services from any hospital in the Horizon Hospital Network and any doctor or other health care professional in the Horizon Managed Care network. Use the Doctor & Hospital Finder to find an in-network doctor or hospital who accepts your OMNIA Health Plan.

Once you have completed your search, use the All Tiers drop-down menu at the top of the search results page to filter your results by tier. When you choose doctors, other health care professionals or hospitals designated as an OMNIA Tier 1, Inner Circle, or equivalent tier (depending on your plan), you will get the most from your benefits and pay less out of pocket. Check your Plan Details for more information.

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.