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CentraState Now in OMNIA Tier 1

CentraState Now in OMNIA Tier 12022-09-18T13:02:52-04:00

CentraState Healthcare System is now designated a Tier 1 hospital for all Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ) OMNIA health plan members in its service area, effective April 1, 2020.

For more information on what this means for OMNIA members, please read the Q&A below.

OMNIA Q&A

With the OMNIA Health Plan, in-network hospitals are divided into two tiers. When you receive care from an OMNIA Tier 1 hospital, like CentraState, you will save money and have the lowest out of pocket expense. With the OMNIA Health Plan, in-network hospitals are divided into two tiers. When you receive care from an OMNIA Tier 1 hospital, like CentraState, you will have the lowest out-of-pocket expenses and save money in comparison to care received at Tier 2 hospitals or at healthcare facilities that do not participate in OMNIA Health Plans.

In general, OMNIA Health Plan premiums are 15 to 20 percent lower than Horizon’s broad network plans. OMNIA members who receive care from Tier 1 hospitals and providers save more money through lower out-of-pocket costs. When members receive care at CentraState, they will have no or low deductibles, and they will spend the least out-of-pocket. To determine just how much you can save or ask member-specific questions, contact Horizon Blue Cross Blue Shield at 1-800-355-BLUE (2583).

The doctors who are integral in delivering your care at CentraState may be members of contracted groups, or independent professionals (i.e., “independent contractors”) who are not employed by CentraState, but who have certain privileges to perform medical services at CentraState Medical Center. This may include pathologists, radiologists, anesthesiologists, cardiologists and other specialists.

All members of CentraState’s Healthcare Partners Physician Health Organization (PHO) are OMNIA Tier 1 providers. Visit our Physician Finder and select the CentraState Healthcare Partners box to find a PHO physician near you.

While most doctors at CentraState are members of our PHO, some doctors may not be and may not participate in the same insurance plans, or at the same OMNIA Tier as CentraState Medical Center does. We encourage all patients to check their physicians’ insurance participation and OMNIA Tier status in advance of receiving services at CentraState Medical Center.

You may also click here for a list of the physician groups CentraState Medical Center contracts with and information for checking their insurance participation and OMNIA Health Plan Tier.

Additionally, you can search all in-network doctors, and other healthcare professionals using the Horizon Blue app or visiting their website here.  The physician profile will show OMNIA Tier 1 or Tier 2.

OMNIA members can take advantage of the same Horizon Managed Care Network used by other plans, which requires all Horizon in-network doctors to provide high-quality care and meet significant quality measures.

OMNIA Tier 1 physicians and hospitals, however, have met additional criteria and joined Horizon in committing to reduce the cost of healthcare by improving quality and coordination to give our patients a better overall experience.

In fact, CentraState is currently partnering with Horizon to work together on behalf of our patients in various value-based care initiatives, which focus on better care, not just more care.

CentraState will remain a Tier 2 hospital until 3/31/2020 and benefits will be administered at this cost-sharing level for members until its OMNIA Tier 1 Status officially begins on 4/1/2020.

At CentraState, our goal is for you to focus on getting healthy, not on insurance claims or payment hassles. For information regarding your bill and post-billing payment arrangements, please call 732-294-7065.

Important terms:

  • Co-pay: The amount your insurance plans requires you to pay for each medical visit to an in-network hospital. Co-pay amounts are listed on your Horizon BlueCross BlueShield of NJ member ID cards.
  • Co-insurance: The percentage of a covered charge that Horizon BlueCross BlueShield of NJ pays. For example, if your plan has 80 percent coinsurance, you are responsible for 20 percent of covered charges.
  • Deductible: The amount you must pay each year before benefits are paid by your insurance company.
  • EOB: Explanation of Benefits. A form provided by your insurance company which specifies your benefits and breaks down the insurance payment and your out-of-pocket expenses.

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