Jane Dotson
OMNIA Health Plans are health insurance plans offered by Horizon Blue Cross Blue Shield of New Jersey. The plans divide in-network hospitals into two tiers. Members who use OMNIA Tier 1 physicians and hospitals will have the lowest out-of-pocket expenses and save money compared to Tier 2 hospitals or non-participating healthcare facilities. OMNIA Tier 1 doctors and hospitals have committed to reducing healthcare costs by improving quality and coordination to enhance the patient experience.
| Characteristics | Values |
|---|---|
| Cost | Lower out-of-pocket expenses compared to Tier 2 hospitals or non-OMNIA Health Plan hospitals |
| Network | Access to 45,000 doctors and 82 hospitals across New Jersey and Pennsylvania |
| Quality | High-quality care that meets significant quality measures |
| Cost-saving | No or low deductibles |
| Premium | 15-20% lower than Horizon's broad network plans |
| Coordination | Improved coordination between providers to enhance the patient experience |
| Providers | Physicians, hospitals, and ancillary providers |
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What You'll Learn
OMNIA Tier 1 vs. Tier 2
OMNIA Health Plan is an insurance plan offered by Horizon Blue Cross Blue Shield of New Jersey. With this health plan, doctors and hospitals are grouped into two tiers: OMNIA Tier 1 and Tier 2. Both tiers are considered in-network for all OMNIA Health Plans. This means that members must get care from doctors, hospitals, and other healthcare professionals that are in-network. The only exception to this is in the case of a true medical emergency.
In-network doctors and hospitals have agreed to provide high-quality care and services to Horizon members at a lower cost. OMNIA Tier 1-designated doctors and hospitals are cheaper for members, with lower copays and deductibles, or even no deductibles at all. Members can use the Horizon Blue app or visit the Doctor & Hospital Finder online tool to find out which doctors and hospitals are participating in the network.
Members can also use the member-only tools on the secure member web portal and Horizon Blue app to access detailed information about their plan, including office visits, services rendered, and how much they owe. This allows members to get the most out of their OMNIA Health Plan and save money.
Overall, while both OMNIA Tier 1 and Tier 2 provide in-network coverage, Tier 1 offers more affordable options for members, with lower out-of-pocket costs. Members can easily find specialists in either tier using the Horizon Blue app or the online Doctor & Hospital Finder tool.
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Lower out-of-pocket expenses
OMNIA Health Plans are health insurance plans offered by Horizon Blue Cross Blue Shield of New Jersey. The plans are designed to give members more flexibility and control over their healthcare costs.
OMNIA Health Plans are divided into two tiers: Tier 1 and Tier 2. Using Tier 1 physicians, hospitals, and other healthcare providers will result in lower out-of-pocket expenses for members. Tier 1 providers have committed to reducing healthcare costs by improving quality and coordination, giving patients a better overall experience. This means that members will have no or low deductibles and will spend the least out-of-pocket when using Tier 1 providers.
In-network providers must discuss the cost-sharing implications of using Tier 1 or Tier 2 providers with patients and document this discussion in patient medical records. This transparency ensures that members are aware of the potential financial impact of their provider choices.
OMNIA Tier 1 providers have met additional criteria and are working to reduce medical costs, improve preventive care, and better control chronic health conditions. This means that members can benefit from high-quality, affordable healthcare and focus on staying healthy, rather than worrying about insurance claims or payment issues.
By choosing an OMNIA Health Plan and utilizing Tier 1 providers, members can maximize their benefits and minimize their out-of-pocket expenses, making their healthcare journey more accessible and affordable.
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In-network doctors and hospitals
OMNIA Health Plans are provided by Horizon Blue Cross Blue Shield of New Jersey. The plans divide in-network hospitals into two tiers. OMNIA Tier 1 physicians and hospitals have met additional criteria and joined Horizon in committing to reducing the cost of healthcare by improving quality and coordination to give patients a better overall experience.
OMNIA Tier 1 doctors and hospitals provide high-quality care and meet significant quality measures. They also offer no or low deductibles, and patients will spend the least out-of-pocket. When members use OMNIA Tier 1 providers, they will have the lowest out-of-pocket expenses and save money compared to care received at Tier 2 hospitals or healthcare facilities that do not participate in OMNIA Health Plans.
OMNIA Health Plan members will maximize their benefits and have lower out-of-pocket costs when they use physicians, ancillary providers, hospitals, or other healthcare professionals designated as OMNIA Tier 1. Members will pay less out of their pocket for care when they use OMNIA Tier 1 physicians, other healthcare professionals, hospitals, and ancillary providers.
In-network providers must discuss the cost-sharing implications of using OMNIA Tier 1 or Tier 2 providers with patients, retain documentation of the discussion in patient medical records, and make it available to Horizon within 10 business days upon request.
CentraState Healthcare System is an example of a Tier 1 hospital for all Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ) OMNIA health plan members in its service area. While most doctors at CentraState are members of their Healthcare Partners Physician Health Organization (PHO), some doctors may not be and may not participate in the same insurance plans or OMNIA Tiers. Patients are encouraged to check their physicians' insurance participation and OMNIA Tier status in advance of receiving services.
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CentraState Healthcare System
OMNIA Health Plans are offered by Horizon Blue Cross Blue Shield of New Jersey. These plans give enrolled members the flexibility to use any hospital within their Horizon Hospital Network and any physician or healthcare professional within their Horizon Managed Care Network. OMNIA Health Plan members will have lower out-of-pocket costs when they use Tier 1 physicians, hospitals, and other healthcare providers.
While most doctors at CentraState are members of their Healthcare Partners Physician Health Organization (PHO), some doctors may not be and may not participate in the same insurance plans or OMNIA Tier as CentraState Medical Center. Therefore, patients are encouraged to check their physicians' insurance participation and OMNIA Tier status in advance of receiving services at CentraState Medical Center. Patients can do so by visiting CentraState's website or using the Horizon Blue app.
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OMNIA Health Alliance
OMNIA Health Plans are a product of Horizon Blue Cross Blue Shield of New Jersey. The plans are built around the OMNIA Health Alliance, a partnership that brought Horizon together with leading health systems and physician groups to work together for patients.
The OMNIA Health Alliance aims to reduce medical costs, improve preventive care, and better control chronic health conditions. It rewards doctors and hospitals for providing better care, not just more care. The Alliance includes 45,000 doctors and 82 hospitals across New Jersey and Pennsylvania.
OMNIA Health Plans are designed to give members flexibility and control over their out-of-pocket costs. Members can use any hospital in the Horizon Hospital Network and any physician or other healthcare professional in the Horizon Managed Care Network.
OMNIA Health Plans are divided into two tiers. Members who use OMNIA Tier 1 physicians and hospitals will have lower out-of-pocket expenses and save more money compared to Tier 2. Tier 1 providers have committed to reducing healthcare costs by improving quality and coordination, giving patients a better overall experience.
To check if a doctor or hospital is Tier 1 or Tier 2, members can use the Horizon Blue app or visit the Horizon website.
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Frequently asked questions
Omnia Tier 1 is a health insurance plan offered by Horizon Blue Cross Blue Shield of New Jersey. It allows members to save money and have lower out-of-pocket expenses when receiving care from Tier 1 hospitals and physicians.
Omnia Tier 1 health plans give enrolled members the flexibility to use any hospital or physician within the Horizon Hospital Network and Horizon Managed Care Network. Members will pay lower out-of-pocket costs and have lower deductibles when using Tier 1 physicians and hospitals, as they have committed to reducing healthcare costs by improving quality and coordination.
You can check if your doctor is an Omnia Tier 1 provider by using the Horizon Blue app or visiting their website. Additionally, members can also use the Doctor & Hospital Finder tool to check the tier status of their physician or hospital for Omnia Health Plans.
