KBenefits Insurance Services
Insurance - Medicare - Retirement

 Carrier Networks

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: 
Find a Doctor

1)   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
Find a doctor in the network
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.

 

Oscar Insurance: 
Find a Doctor

1)  Qualcare network in NJ with access to NY:  Mt Sinai network, Montefiore and Long Island Health network
 

Oxford
Find a Doctor
1)   Freedom

2)   Liberty
3)  Garden State Network - NJ access only
4)   Metro Network - NY plans

 

Qualcare/APEHP:

1)  Qualcare:  Find a NJ Doctor
2)  CIGNA OA POS PLUS national access:  Find a Out-of-State Doctor
2)  Community Care Network - NJ access only:  :  Find a NJ Doctor

 

EWA:  CIGNA and United Healthcare networks:
Elite:         https://eliteenroll.com

Premier:  https://premierenroll.com

 

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.

 

 

 

KBenefits, LLC
Christopher S. Kudryk

Call:  732-333-1976
Fax:   732-444-5971
chris@kbenefits.com

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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