What is Horizon advantage EPO?

Asked by: Nasir Powlowski Jr.  |  Last update: February 11, 2022
Score: 4.9/5 (40 votes)

Horizon Advantage EPO provides integrated medical and pharmacy benefits, including wellness and emergency care. In New Jersey, members have access to all doctors, specialists and hospitals that participate in Horizon's Managed Care Network.

What is a horizon EPO plan?

The Horizon Advantage EPO plans provide integrated medical and pharmacy benefits, including wellness and emergency care. Although members are not required to select a Primary Care Physician (PCP), there are lower out-of-pocket costs when care is coordinated through a PCP.

What is EPO advantage?

An exclusive provider organization, or EPO, is a health insurance plan that only allows you to get health care services from doctors, hospitals, and other care providers who are within your network. Your insurance will not cover any costs you get from going to someone outside of that network.

Does an EPO need a referral?

Most EPOs will not require you to get a referral from a primary care healthcare provider before seeing a specialist. This makes it easier to see a specialist since you're making the decision yourself, but you need to be very careful that you're seeing only specialists that are in-network with your EPO.

What is Horizon Blue Card?

The BlueCard® Program links participating physicians, facilities and other health care professionals and independent Blue Cross and/or Blue Shield Plans, across the country and abroad, with a single electronic network for claims processing and reimbursement.

Horizon Silver Advantage EPO

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Is Horizon Omnia a good plan?

We recommend buying the lowest priced plan with a good network, the Horizon Omnia Bronze H.S.A. This way they can cover their employees with the lowest possible premium, but give them good benefits by reimbursing the employees as the claims are incurred.

What is Horizon PPO?

Horizon PPO gives members referral-free access to many health care services and programs, including preventive care benefits, emergency medical care and a number of value-added programs. For in-network care, there are no claim forms to file and virtually no paperwork.

Is it better to have an EPO or PPO?

A PPO offers more flexibility with limited coverage or reimbursement for out-of-network providers. An EPO is more restrictive, with less coverage or reimbursement for out-of-network providers. For budget-friendly members, the cost of an EPO is typically lower than a PPO.

What is the deductible for EPO?

Participating: $250 per individual / $500 per family calendar year brand-name drug deductible. Non-Participating: Not Covered There are no other specific deductibles.

Is an EPO like a PPO?

A PPO (or “preferred provider organization”) is a health plan with a “preferred” network of providers in your area. ... An EPO (or “exclusive provider organization”) is a bit like a hybrid of an HMO and a PPO. EPOs generally offer a little more flexibility than an HMO and are generally a bit less pricey than a PPO.

What is Anthem Blue Cross EPO?

An EPO is a sort of hybrid plan that offers some of the flexibility of a Preferred Provider Organization (PPO) plan and the cost savings of a Health Maintenance Organization (HMO) plan. ... The Anthem Blue Cross Silver EPO A plan even offers no deductible on prescription drug benefits.

What is Anthem Blue Connection EPO?


Blue Connection is a health plan option designed to specifically meet the evolving health care needs of our employer groups in the San Francisco Bay area. You can expect to see members later this year.

Is Blue Cross Blue Shield an EPO?

Welcome to Blue Shield's Exclusive Provider Organization (EPO) Plan. ... Blue Shield of California has a statewide network of physician members and contracted hospitals known as Preferred Providers.

Does horizon advantage EPO require referrals?

What makes an EPO plan different from a PPO? ... Generally, an EPO does not pay for any services from out-of-network providers and facilities except in emergency or urgent care situations, which is similar to an HMO. Unlike an HMO, EPO participants are not usually required to have a primary care physician or referrals.

What is an EPO plan vs HMO?

An Exclusive Provider Organization (EPO) is a lesser-known plan type. Like HMOs, EPOs cover only in-network care, but networks are generally larger than for HMOs. They may or may not require referrals from a primary care physician. Premiums are higher than HMOs, but lower than PPOs.

What is Horizon Managed Care?

Welcome to Horizon HMO! Your Horizon HMO plan provides you with access to safe and effective care through many programs and services and a large network of participating physicians, facilities and other health care professionals. Other Horizon HMO features include: ... Emergency medical care coverage.

What is an HRA EPO?

Health reimbursement arrangements, or HRAs, allow your employer to flow money to you for qualified medical expenses. Basically, these are dollars your employer earmarks just for health-related expenses.

What is an EPO account?

EPO stands for "Exclusive Provider Organization" plan. As a member of an EPO, you can use the doctors and hospitals within the EPO network, but cannot go outside the network for care. There are no out-of-network benefits.

What is one advantage of an HMO over a traditional PPO plan?

HMO plans typically have lower monthly premiums. You can also expect to pay less out of pocket. PPOs tend to have higher monthly premiums in exchange for the flexibility to use providers both in and out of network without a referral. Out-of-pocket medical costs can also run higher with a PPO plan.

What does it mean 10 coinsurance after deductible?

Coinsurance is an additional cost that some health care plans require policy holders to pay after the deductible is met. ... For instance, with 10 percent coinsurance and a $2,000 deductible, you would owe $2,800 on a $10,000 operation – $2,000 for the deductible and then $800 for the coinsurance on the remaining $8000.

Can you get a PPO through marketplace?

Yes. Any plan shown in the Marketplace includes these essential health benefits. This is true for all plan categories (all “metal levels,” including Catastrophic plans) and all plan types (like HMO and PPO).

What is difference between EPO and PPO anthem?

A PPO plan gives you more flexibility than an EPO by allowing you to attend out-of-network providers. On the other hand, an EPO will typically have lower monthly premiums than a PPO. But, if you're considering an EPO, you should check approved in-network providers in your area before you decide.

What does Horizon Family grins cover?

The Horizon Family Grins Plan offers the same quality pediatric coverage as Horizon Young Grins, along with dental coverage for parents or guardians. Horizon Family Grins Plus adds out-of-network coverage for members over the age of 19. Each plan offers coverage for cosmetic orthodontia as well.

Do doctors prefer HMO or PPO?

PPOs Usually Win on Choice and Flexibility

If flexibility and choice are important to you, a PPO plan could be the better choice. Unlike most HMO health plans, you won't likely need to select a primary care physician, and you won't usually need a referral from that physician to see a specialist.

Does horizon Omnia have out-of-network benefits?

There are no out-of-network benefits except in cases of medical emergencies. Features of our OMNIA Health Plans: Primary Care Physicians (PCPs) are not required.