In-Network...Out-of-Network...Emergencies! Page 5 of 7
In-Network:
New Jersey offers HMO and EPO health plans. HMO & EPO health plans have In-Network-only benefits. You must go to a
participating In-Network provider or hospital to be covered. Be sure your provider or hospital accepts your plan's network. Use the carrier's online "Find A Doctor" tool.
* Every carrier network is different.
* Each carrier has multiple networks & tiers.
Out-of-Network:
PPO & POS plans have both in-network and out-of-network access to benefits. If your provider doesn't accept your health plan
in-network, you would submit the claim out-of-network. The Individual market doesn't offer PPO or POS plans
- EPO/HMO plans: "In-Network" access only
- PPO/POS plans: "In & Out-of-Network" access
Out-of-State:
When seeking services outside of New Jersey, be sure your provider is a participating provider. Only Horizon's OMNIA Gold offers access to New
York and nationwide coverage. All other health plans in the NJ marketplace have NJ access and limited regional coverage.
- Horizon OMNIA plans: NJ, PA & DE access
- Amerihealth Advantage T2: PA access (T2)
- Oscar: Access Staten Island & Long Island
- Aetna Whole Health: NJ access only
- Wellcare/AmBetter: NJ access only
- United Healthcare: NJ access only
EMERGENCY - ALWAYS COVERED:
In the event of a true emergency, you are covered In-Network. An example of a life-threatening emergency::
- Heart attack
- Severe breathing problem
- Severe bleeding
- Stroke
- Convulsions
- Severe burns
- Gunshot or knife wounds
- Unconsciousness
- Immediate and imminent threat to life or loss of life
Print