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Value Access Bronze

91661NJ2360001
Expanded Bronze
EPO

Value Access Bronze is an Expanded Bronze EPO plan by Horizon Blue Cross Blue Shield of New Jersey.

IMPORTANT: You are viewing the 2022 version of Value Access Bronze 91661NJ2360001. You can enroll in this plan if you qualify for special enrollment until the end of 2022.

Locations

Value Access Bronze is offered in the following counties.

Plan Overview

This is a plan overview for 2022 version of Value Access Bronze 91661NJ2360001.
Insurer: Horizon Blue Cross Blue Shield of New Jersey
Network Type: EPO
Metal Type: Expanded Bronze
HSA Eligible?: No
Plan ID: 91661NJ2360001

Cost-Sharing Overview

Value Access Bronze offers the following cost-sharing.

Notes:

  • Some plans have separate cost-sharing for medical and drugs, while other plans offer combined cost-sharing. The cost-sharing amounts above are combined medical and drug costs unless otherwise noted.
  • You are viewing the standard version of this plan. Your costs may be lower depending on your income. Use the “get a quote” button below to see your estimated premium and out-of-pocket costs after assistance.
Ready to sign up for Value Access Bronze?

Click or call to enroll online, get a quote, or find out if you qualify for assistance.
Get Help from a licensed agent. 1-877-668-0904

Plan Features

Value Access Bronze offers the following features and referral requirements.

Wellness Program: No
Disease Program: Asthma, Heart Disease, Depression, Diabetes, Pregnancy
Notice Pregnancy: No
Referral Specialist: Yes
Specialist Requiring Referral: Any non-Primary Care Provider
Plan Exclusions:
Child Only Option?: Allows Adult and Child-Only

Network Details

The following network details will help you understand what Value Access Bronze covers when you are out of the service area or out of the country.

Out of Country Coverage: No
Out of Country Coverage Description:
Out of Service Area Coverage: No
Out of Service Area Coverage Description:
National Network: No

Additional Benefits and Cost-Sharing

Value Access Bronze includes the following benefits at the cost sharing rates listed below.

Service In-Network
Copay / Coinsurance
Out-of-Network
Copay / Coinsurance
Limits and Explanation
Diabetes Education
Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: Yes All member cost sharing varies based upon Place of Service. Please refer to plan documents for additional information.Additional EHB Benefit
Inpatient Hospital Services (e.g., Hospital Stay)
Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: Yes
Mental/Behavioral Health Inpatient Services
Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: Yes
Dialysis
Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: Yes All member cost sharing varies based upon Place of Service. Please refer to plan documents for additional information.Other Law/Regulation
Specialty Drugs
Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: Yes Please refer to your drug guide for information regarding different tiers of drug coverage and applicable prior authorization, medical necessity review, and dispensing limits.Other Law/Regulation
Laboratory Outpatient and Professional Services
Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: Yes All member cost sharing varies based upon Place of Service. Please refer to plan documents for additional information.Other Law/Regulation
Substance Abuse Disorder Outpatient Services
Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: Yes For the first 180 days per plan year of inpatient and outpatient stay, treatment of substance use disorders must be provided when determined to be medically necessary by the member’s licensed physician, psychologist or psychiatrist without any prior authorization or other prospective utilization management requirements.
Orthodontia – Child
Not Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: No Dental Only Plan Available
Weight Loss Programs
Not Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: No
Basic Dental Care – Child
Not Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: No Dental Only Plan Available
Transplant
Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: Yes All member cost sharing varies based upon Place of Service. Please refer to plan documents for additional information.Other Law/Regulation
Routine Eye Exam (Adult)
Not Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: No Routine eye examinations – including eye examinations with a refraction – is not covered. Preventive eye screenings as part of preventive services is covered.Not EHB
Acupuncture
Not Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: No Acupuncture is covered when used as an alternative to anesthesia.
X-rays and Diagnostic Imaging
Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: Yes All member cost sharing varies based upon Place of Service. Please refer to plan documents for additional information.Other Law/Regulation
Prenatal and Postnatal Care
Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: Yes
Delivery and All Inpatient Services for Maternity Care
Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: Yes
Routine Eye Exam for Children
Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: Yes1 Visit(s) per Year Other Law/Regulation
Orthodontia – Adult
Not Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: No
Long-Term/Custodial Nursing Home Care
Not Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: No
Well Baby Visits and Care
Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: Yes Additional EHB Benefit
Allergy Testing
Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: Yes All member cost sharing varies based upon Place of Service. Please refer to plan documents for additional information.Additional EHB Benefit
Major Dental Care – Adult
Not Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: No
Infusion Therapy
Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: Yes All member cost sharing varies based upon Place of Service. Please refer to plan documents for additional information.Other Law/Regulation
Rehabilitative Speech Therapy
Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: Yes30 Visit(s) per Year All member cost sharing varies based upon Place of Service. Please refer to plan documents for additional information.Additional EHB Benefit
Hearing Aids
Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: Yes Age 15 or Under. Purchase of one hearing aid for each hearing-impaired ear every 24-monthsOther Law/Regulation
Dental Check-Up for Children
Not Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: No Dental Only Plan Available
Substance Abuse Disorder Inpatient Services
Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: Yes For the first 180 days per plan year of inpatient and outpatient stay, treatment of substance use disorders must be provided when determined to be medically necessary by the member’s licensed physician, psychologist or psychiatrist without any prior authorization or other prospective utilization management requirements.
Preferred Brand Drugs
Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: Yes Please refer to your drug guide for information regarding different tiers of drug coverage and applicable prior authorization, medical necessity review, and dispensing limits.Other Law/Regulation
Emergency Room Services
Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: Yes $100 copay is waived if admitted within 24hrs
Urgent Care Centers or Facilities
Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: Yes
Imaging (CT/PET Scans, MRIs)
Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: Yes All member cost sharing varies based upon Place of Service. Please refer to plan documents for additional information.Other Law/Regulation
Outpatient Surgery Physician/Surgical Services
Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: Yes
Generic Drugs
Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: Yes Please refer to your drug guide for information regarding different tiers of drug coverage and applicable prior authorization, medical necessity review, and dispensing limits.Other Law/Regulation
Hospice Services
Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: Yes All member cost sharing varies based upon Place of Service. Please refer to plan documents for additional information.Other Law/Regulation
Specialist Visit
Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: Yes
Cosmetic Surgery
Not Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: No
Bariatric Surgery
Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: Yes All member cost sharing varies based upon Place of Service. Please refer to plan documents for additional information.Other Law/Regulation
Prosthetic Devices
Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: Yes All member cost sharing varies based upon Place of Service. Please refer to plan documents for additional information.Other Law/Regulation
Non-Preferred Brand Drugs
Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: Yes Please refer to your drug guide for information regarding different tiers of drug coverage and applicable prior authorization, medical necessity review, and dispensing limits.Other Law/Regulation
Infertility Treatment
Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: Yes Limited to artificial insemination. All member cost sharing varies based upon Place of Service. Please refer to plan documents for additional information.Other Law/Regulation
Private-Duty Nursing
Not Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: No The Private Duty Nursing benefit is only covered as part of a Home Health Care plan.Not EHB
Skilled Nursing Facility
Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: Yes Please refer to plan documents for additional information.Other Law/Regulation
Eye Glasses for Children
Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: Yes1 Item(s) per Year Please refer to Plan Brochure for limits and exclusions.Other Law/Regulation
Major Dental Care – Child
Not Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: No Dental Only Plan Available
Routine Foot Care
Not Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: No
Primary Care Visit to Treat an Injury or Illness
Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: Yes
Other Practitioner Office Visit (Nurse, Physician Assistant)
Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: Yes All member cost sharing varies based upon Place of Service. Please refer to plan documents for additional information.Other Law/Regulation
Radiation
Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: Yes All member cost sharing varies based upon Place of Service. Please refer to plan documents for additional information.Other Law/Regulation
Treatment for Temporomandibular Joint Disorders
Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: Yes All member cost sharing varies based upon Place of Service. Please refer to plan documents for additional information.Other Law/Regulation
Emergency Transportation/Ambulance
Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: Yes
Rehabilitative Occupational and Rehabilitative Physical Therapy
Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: Yes30 Visit(s) per Year All member cost sharing varies based upon Place of Service. Please refer to plan documents for additional information.Other Law/Regulation
Outpatient Rehabilitation Services
Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: Yes30 Visit(s) per Year
Routine Dental Services (Adult)
Not Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: No
Basic Dental Care – Adult
Not Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: No
Durable Medical Equipment
Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: Yes All member cost sharing varies based upon Place of Service. Please refer to plan documents for additional information.Other Law/Regulation
Mental/Behavioral Health Outpatient Services
Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: Yes
Nutritional Counseling
Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: Yes All member cost sharing varies based upon Place of Service. Please refer to plan documents for additional information.Other Law/Regulation
Habilitation Services
Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: Yes30 Visit(s) per Year Habilitation services are subject to the limits applicable to rehabilitation services, other therapies, services and supplies. 30-visit limit does not apply to the treatment of autism or other developmental disabilities. See Explanation. All member cost sharing varies based upon Place of Service. Please refer to plan documents for additional information.Other Law/Regulation
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: Yes
Abortion for Which Public Funding is Prohibited
Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: Yes All member cost sharing varies based upon Place of Service. Please refer to plan documents for additional information.Other Law/Regulation
Accidental Dental
Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: Yes All member cost sharing varies based upon Place of Service. Please refer to plan documents for additional information.Other Law/Regulation
Chemotherapy
Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: Yes All member cost sharing varies based upon Place of Service. Please refer to plan documents for additional information.Other Law/Regulation
Preventive Care/Screening/Immunization
Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: Yes
Chiropractic Care
Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: Yes30 Visit(s) per Year All member cost sharing varies based upon Place of Service. Please refer to plan documents for additional information.Other Law/Regulation
Inpatient Physician and Surgical Services
Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: Yes
Home Health Care Services
Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: Yes The Private Duty Nursing benefit is only covered as part of a Home Health Care plan. Please refer to plan documents for additional information.Other Law/Regulation
Reconstructive Surgery
Covered
Excluded from In-Network MOOP: NoExcluded from Out-of-Network MOOP: Yes Horizon BCBSNJ covers reconstructive breast Surgery, Surgery to restore and achieve symmetry between the two breasts and the cost of prostheses following a mastectomy on one breast or both breasts.Other Law/Regulation

Free Preventive Services

There is no copayment or coinsurance for any of the following Value Access Bronze preventive services. This is true even if you haven’t met your yearly deductible.

Please note, these services are free only when delivered by a doctor or other provider in your plan’s network.

Ready to sign up for Value Access Bronze?

Click or call to enroll online, get a quote, or find out if you qualify for assistance.
Get Help from a licensed agent. 1-877-668-0904

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