Premium, Plan Benefits and Network are the 3 major components that make up a health plan. Each carrier has multiple networks of providers & hospitals. When choosing a health plan, it is important to consider the network of doctors and hospitals included in the health plan. If your doctor is not In-Network, then you will not have any coverage. Also, some networks are limited to NJ-only access or may have some regional access or national access.
Horizon BCBS of NJ:
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OMNIA: NJ, PA, DE access
2) Advantage EPO: NJ, PA, DE access, some plans allow for Blue Card PPO rider
3) Direct Access: NJ access with blue card
* OMNIA and Advantage EPO networks are available in the Individual Market
* OMNIA, Advantage EPO and Direct Access networks are available in the Small Group / Employer Market
Amerihealth of NJ:
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1) AmeriHealth Advantage: Network includes: AtlantiCare, Cape Regional Medical Center, Cooper University, Deborah Heart and Lung Center, Hackensack Meridian, and RWJBarnabas. Learn more. Tier 2 providers are available through the AmeriHealth New Jersey Local Value network. View Tiered Facilities.
2) AmeriHealth Hospital Advantage: Lower out-of-pocket costs for hospital and facility services. Tier 2 providers are available through the AmeriHealth New Jersey Local Value network. View Tiered Facilities.
3) Preferred Regional: One of the largest networks of doctors, hospitals, and labs in the state of New Jersey. Member get access to New Jersey, Delaware, and Southeastern Pennsylvania.
4) Local Value: represents 82% of the NJ-based
Regional Preferred network. NJ-only access.
5) National Network: Available through the Multiplan PHCS National Network for services obtained outside of the Regional Preferred service area. Not available in the Individual Market.
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1) Qualcare network in NJ with access to NY: Mt Sinai network, Montefiore and Long Island Health network
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3) Garden State Network - NJ access only
4) Metro Network - NY plans
MEDICARE: Supplement Plans
* 100% of hospitals in America accept medicare supplements
* Estimated 93% to 95% of doctors in America accept medicare supplements
MEDICARE: Advantage Plans
* Limited to the insurance carriers network of doctors & hospitals.
* May include out-of-state coverage.
* MAPD's either have state, regional or national access networks
* Some MAPD's have out of network benefits.
Christopher S. Kudryk
KBenefits insurance services provide solutions for small business owners and individuals in New Jersey & New York. Contact KBenefits today and see how we can benefit you.
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