Horizon Advantage EPO Essentials
Benefits & Coverage
| Insurance Type | ACA (Obamacare) |
| Plan Name | Horizon Advantage EPO Essentials |
| Plan ID | qhp-91661NJ2280001 |
| Plan Year | 2019 |
| Insurance Provider | Horizon Blue Cross Blue Shield of New Jersey |
| Metal Level | Catastrophic |
| Plan Type | EPO |
| Deductible | $7,900 |
| Out-of-Pocket Maximum | $7,900 |
| Plan Highlights |
Costs for Medical Care | |
|---|---|
| Primary Care Visit to Treat an Injury or Illness | No Charge after Deductible |
| Specialist Visit | No Charge after Deductible |
| Laboratory Outpatient and Professional Services | No Charge after deductible |
| X-rays and Diagnostic Imaging | No Charge after deductible |
| Deductible - Family | $15800 |
| Out-of-Pocket Maximum - Family | $15800 |
Prescription drug coverage | |
|---|---|
| Generic Drugs | No Charge after Deductible |
| Preferred Brand Drugs | No Charge after Deductible |
| Non-Preferred Brand Drugs | No Charge after Deductible |
| Specialty Drugs | No Charge after Deductible |
Access to doctors and hospitals | |
|---|---|
| Provider directory URL | Coming Soon |
Hospital services | |
|---|---|
| Emergency Room Services | No Charge after Deductible |
| Inpatient Hospital Services (e.g., Hospital Stay) | No Charge after Deductible |
| Inpatient Physician and Surgical Services | No Charge after Deductible |
Maternity | |
|---|---|
| Prenatal and Postnatal Care | No Charge after deductible |
Mental Health | |
|---|---|
| Mental/Behavioral Health Outpatient Services | No Charge after deductible |
| Mental/Behavioral Health Inpatient Services | No Charge after deductible |
Vision Coverage | |
|---|---|
| Routine Eye Exam for Children | No Charge |
| Eye Glasses for Children | No Charge |
Exclusions and Limitations | |
|---|---|
| More Included Benefits | Accidental Dental Dialysis Allergy Testing Chemotherapy Radiation Diabetes Education Prosthetic Devices Other Practitioner Office Visit (Nurse, Physician Assistant) Outpatient Facility Fee (e.g., Ambulatory Surgery Center) Outpatient Surgery Physician/Surgical Services Hospice Services Infertility Treatment Urgent Care Centers or Facilities Home Health Care Services Inpatient Physician and Surgical Services Bariatric Surgery Skilled Nursing Facility Outpatient Rehabilitation Services Habilitation Services Chiropractic Care Durable Medical Equipment Hearing Aids Imaging (CT/PET Scans, MRIs) Preventive Care/Screening/Immunization Rehabilitative Speech Therapy Rehabilitative Occupational and Rehabilitative Physical Therapy Well Baby Visits and Care Abortion for Which Public Funding is Prohibited Transplant Infusion Therapy Treatment for Temporomandibular Joint Disorders Nutritional Counseling Reconstructive Surgery |
| More Excluded Benefits | Long-Term/Custodial Nursing Home Care Private-Duty Nursing Cosmetic Surgery Routine Foot Care Acupuncture Weight Loss Programs Dental Check-Up for Children |
Catastrohpic plan frequently asked questions (FAQ)
What is the Catastrophic Plan?
Catastrophic health insurance is a type of medical coverage under the Affordable Care Act. This is a type of high-deductible health plan for people under 30 or those who qualify for a "hardship exemption."
How are Catastrophic Plans different than other Obamacare health plans?
The fundamental difference among the new Obamacare health plans is the percentage of covered medical costs paid by the health plan. There is no actuarial value associated with catastrophic plans but other Obamacare metal plans pay a higher percentage of these costs.
How much does a Catastrophic Plan cost?
The monthly premium for a Catastrophic Plan depends on the insurer from whom you purchase the plan, the number of people to be insured by the plan, your age, whether you smoke, and the region in which you live. You can use HealthPocket’s comparison tool to compare Catastrophic Plan premiums in your area.
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