Horizon Blue Cross Blue Shield of New Jersey - OMNIA Silver Value
Primary Care Visit
$45 Copay
100% Coinsurance
Specialist Visit
50% Coinsurance after deductible
100% Coinsurance
Other Practitioner Office Visit (Nurse, Physician Assistant)
50% Coinsurance after deductible
100% Coinsurance
Preventive Care/Screening/Immunization
No Charge
100% Coinsurance
Laboratory Outpatient and Professional Services
50% Coinsurance after deductible
100% Coinsurance
X-rays and Diagnostic Imaging
50% Coinsurance after deductible
100% Coinsurance
Imaging (CT/PET scans, MRIs)
50% Coinsurance after deductible
100% Coinsurance
Generic Drugs
50% Coinsurance after deductible
100% Coinsurance
Preferred Brand Drugs
50% Coinsurance after deductible
100% Coinsurance
Non-Preferred Brand Drugs
50% Coinsurance after deductible
100% Coinsurance
Specialty drugs
50% Coinsurance after deductible
100% Coinsurance
Outpatient Facility Fee
50% Coinsurance after deductible
100% Coinsurance
Outpatient Surgery Physician/Surgical Services
50% Coinsurance after deductible
100% Coinsurance
Emergency Room Services
$100 Copay with deductible
50% Coinsurance after deductible
50% Coinsurance after deductible
100% Coinsurance
Emergency Transportation/Ambulance
50% Coinsurance after deductible
100% Coinsurance
Urgent Care
50% Coinsurance after deductible
100% Coinsurance
Inpatient Hospital Services
50% Coinsurance after deductible
100% Coinsurance
Inpatient Physician and Surgical Services
50% Coinsurance after deductible
100% Coinsurance
Mental/Behavioral Health Outpatient Services
50% Coinsurance after deductible
100% Coinsurance
Mental/Behavioral Health Inpatient Services
50% Coinsurance after deductible
100% Coinsurance
Substance Abuse Disorder Outpatient Services
50% Coinsurance after deductible
100% Coinsurance
Substance Abuse Disorder Inpatient Services
50% Coinsurance after deductible
100% Coinsurance
Prenatal and postnatal care
50% Coinsurance after deductible
100% Coinsurance
Delivery and All Inpatient Services for Maternity Care
50% Coinsurance after deductible
100% Coinsurance
Home Healthcare Services
$20 Copay
100% Coinsurance
Outpatient Rehabilitation Services
50% Coinsurance after deductible
100% Coinsurance
Habilitation Services
50% Coinsurance after deductible
100% Coinsurance
Skilled Nursing Facility
50% Coinsurance after deductible
100% Coinsurance
Durable Medical Equipment
No Charge
100% Coinsurance
Hospice Services
50% Coinsurance after deductible
100% Coinsurance
Chiropractic Care
$30 Copay
100% Coinsurance
Acupuncture
Not covered
Not covered
Rehabilitative Speech Therapy
50% Coinsurance after deductible
100% Coinsurance
Rehabilitative Occupational and Rehabilitative Physical Therapy
50% Coinsurance after deductible
100% Coinsurance
Well Baby Visits and Care
No Charge
100% Coinsurance
Allergy Testing
50% Coinsurance after deductible
100% Coinsurance
Diabetes Education
50% Coinsurance after deductible
100% Coinsurance
Nutritional Counseling
50% Coinsurance after deductible
100% Coinsurance
Eye Exam for Children
No Charge
100% Coinsurance
Eye Glasses for Children
No Charge
100% Coinsurance
Accidental Dental
50% Coinsurance after deductible
100% Coinsurance
Basic Dental Care (Adult)
Not covered
Not covered
Basic Dental Care (Child)
Not covered
Not covered
Dental Check Up (Child)
Not covered
Not covered
Major Dental Care (Adult)
Not covered
Not covered
Major Dental Care (Child)
Not covered
Not covered
Orthodontia (Adult)
Not covered
Not covered
Orthodontia (Child)
Not covered
Not covered
Routine Dental Services (Adult)
Not covered
Not covered