MEDICAL & PRESCRIPTION DRUGS

Elect a medical plan administered by Horizon Blue Cross Blue Shield of New Jersey

Patient Care Medical Group is thrilled to be able to offer the same level of medical benefits to employees for the March 1, 2023 – February 29, 2023 plan year. Horizon Blue Cross Blue Shield of New Jersey will continue to administer your Medical and Prescription Drug plan.

WHO IS ELIGIBLE?

Employees and their dependents (spouse and children) are eligible upon date of hire.

POS Platinum 22 Plan

The POS Platinum 22 Medical Plan offers the flexibility of receiving care from in-network and out-of-network providers. However, utilizing in-network providers will maximize your medical benefit. Under this plan, you may utilize the Direct Access Blue Card Network.

There is no separate deductible for pharmacy coverage.

The table below provides a brief overview of the POS Platinum 22 Plan. Please refer to the carrier benefit summary for specific coverage details

In-Network
Network
Direct Access Blue Card
Annual In-Network Deductible (Plan Year)
Individual / Family
$0 / $0
Annual In-Network Out of Pocket Maximum
Individual / Family
$3,750 / $7,500
Annual Out-of-Network Deductible
Individual / Family
$1,500 / $3,000
Annual Out-of-Network Out of Pocket Maximum
Individual / Family
$6,000 / $12,000
Coinsurance (What the plan pays)
100%
Office Visits
Wellness Visits (Preventive Care)
Covered 100%
Primary Care Visit
$20 copay
Specialist Visit
$40 copay
Urgent Care
$75 copay
Hospital Services
Emergency Room
$100 (Waived if admitted)
Inpatient Services
$250/day, $1,250 max per admission
(Pre-authorization required)
Outpatient Services
$150 ambulatory service center or outpatient surgery facility
Prescription (Retail / Mail Order)
Generic
$10 / $20
Preferred Brand
$25 / $50
Non-Preferred Brand
$50 / $100

TO LEARN MORE ABOUT PATIENT CARE MEDICAL GROUP'S MEDICAL PLAN

For questions and additional information, please contact/visit PCMG's Human Resources Department or the Graham Company Service Line. More information can also be found on the Horizon Blue Cross Blue Shield of New Jersey website.

Horizon BCBSNJ Website

HOW TO LOCATE A PROVIDER

Visit the Online Doctor & Hospital Finder at HorizonBlue.com/doctorfinder and:

  • Sign in to your Horizon account or continue as a guest.
  • Select the type of health care professional you are looking for.
  • Next, select POS from the Choose a Plan to Start dropdown menu.
  • Narrow your search by using one of the filters. You can filter by distance from your selected location, gender, language spoken and more
  • Use the Doctor Affiliation filter to get a list of all the participating health care professionals that are part of a group practice or enter the name of a hospital for all the doctors who can care for you at the facility.

Remember, you pay less out of pocket when you get health services from providers that are in-network for your Horizon BCBSNJ health plan, even when you have out-of-network benefits.

HORIZON MEMBER RESOURCES

Horizon Blue Cross Blue Shield of NJ offers an array of tools and services to help members maximize their benefits. Some examples of these tools/services are listed below:

  • 24/7 Nurse Line
  • My Health Manager
  • Identity Protection Services
  • Personal Health Assistant
  • Treatment Cost Estimator

Please click below to view the full list of tools and services offered by Horizon.

LIST OF TOOLS AND SERVICES

TELEMEDICINE

Access to healthcare is now even easier with Horizon CareOnline

When your primary doctor isn't available, Horizon CareOnline is available 24/7/365 for treatment of acute conditions.

Horizon CareOnline

When you need to see a doctor - anytime day or night - simply sign into HorizonBlue.com or through the Horizon Blue app. As a Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) member, you have 24/7 access to U.S. board-certified doctors via video and phone from the comfort of your home.

You and your dependents can avoid unnecessary visits to the Emergency Room and/or Urgent Care and long waits for doctor appointments by utilizing Horizon CareOnline.

CareOnline Video
More About CareOnline

The doctor will provide a diagnoses and advice for many common medical conditions such as:

  • Colds and flu
  • Fever
  • Skin irritations
  • Abdominal pain
  • Sinusitis

You can also see behavioral health specialists by appointment from 7 a.m. to 11 p.m., for conditions such as:

  • Anxiety
  • Attention deficit/hyperactivity disorder (ADHD)
  • Bipolar disorder
  • Depression

Dental & Vision

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