Transcription of Summary of Benefits and Coverage: What this Plan Covers ...
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Summary of Benefits and Coverage: What this Plan Covers ...
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2019 - 12/31/2019 Horizon BCBSNJ: OMNIA Silver Coverage for: All Coverage Types Plan Type: EPO (G3944/P2481)(G3945/P2481) 1 of 12 The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered health care services. NOTE: Information about the cost of this plan (called the premium) will be provided separately. This is only a Summary . For more information about your coverage, or to get a copy of the complete terms of coverage, visit Member Online Services at or by calling 1-800-355-BLUE(2583). If you do not currently have coverage with Horizon BCBSNJ you can view a sample policy here, For general definitions of common terms, such as allowed amount, balance billing, coinsurance, copayment, deductible, provider, or other underlined terms see the Glossary.
2 of 12 All copayment and coinsurance costs shown in this chart are after your deductible has been met, if a deductible applies. Common Medical Event Services You May Need OMNIA What You Will Pay Limitations, Exceptions, & Tier1 Other Important Information
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