Member ID card reference guideAt the time of service• Ask the member for all insurance cards, including his or her Health Benefits Identification Card

(HBID), Medicare and/or commercial coverage cards. The HBID can be used by members to access services covered by Fee-For-Service, which are not covered by Horizon NJ Health.

• Primary Care Provider: Check your panel listing to ensure the member is assigned to your office. If a member does not appear on your panel listing, verify eligibility through Navinet.net or 1-800-682-9091.

• Specialist: Verify that the member has a valid referral. Check member eligibility through NaviNet.net or 1-800-682-9091.

• Collect the copayment, if applicable.

NJ FamilyCare

Managed Long Term Services & Supports (MLTSS)

Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP)

Products are provided by Horizon NJ Health. Communications are issued by Horizon Blue Cross Blue Shield of New Jersey in its capacity as administrator of programs and provider relations for all its companies. Both are independent licensees of the Blue Cross and Blue Shield Association. The Blue Cross® and Blue Shield® names and symbols are registered marks of the Blue Cross and Blue Shield Association. The Horizon® name and symbols are registered marks of Horizon Blue Cross Blue Shield of New Jersey. © 2019 Horizon Blue Cross Blue Shield of New Jersey, Three Penn Plaza East, Newark, New Jersey 07105. EC003861

horizonNJhealth.com

Members: See your benefit booklet for covered services.Possession of this card does not guarantee eligibility for benefits.

PROVIDERS MUST NOT BILL MEDICARE.

MA HMO products are provided by Horizon Healthcare of New Jersey, Inc., an independent licensee of the Blue Cross and Blue Shield Association.Insured by Horizon Healthcare of New Jersey, Inc. In case of an emergency, dial 911 or go to the nearest emergency room. Prior authorization is not required for emergency services.

AN INDEPENDENT COMPANY ADMINISTERING PHARMACY BENEFITS.

Horizon NJ TotalCare(HMO SNP)

MEMBER NAME

FIRST NAME LAST NAME

MEMBER ID NUMBER

YKU12345678

PCP:PHONE:OFFICE VISIT:SPECIALISTEMERGENCY ROOM:

LAST NAME, FIRST NAME

$0$0$0

EFFECTIVE DATE

BC/BS PLAN CODE

ISSUER (80840)

RxBIN 016499

RxPCN DSNPPRI

RxGrp RXHRZN

RxID 12345678 CMS-H8298-001

01/01/2017

S 280/780

Member Services:Pharmacy Services:Prior Authorization:Dental Services:Behavioral Health:TTY/TDD:24/7 Nurse Line: Lab Services in NJ:Provider Services:Emergency Services:Submit medical claims to: Horizon NJ TotalCare Claims Processing DepartmentPO Box 24080Newark, NJ 07101-0406Submit Rx claims to: Prime Therapeutics LLC PO Box 20970 Lehigh Valley, PA 18002-0970

1-800-543-56561-855-457-13461-888-621-58941-800-543-56561-800-543-5656

7111-800-711-5952 1-800-631-5250 1-855-955-5590

911

HorizonBlue.com/Medicare

Members: See your benefit booklet for covered services.Possession of this card does not guarantee eligibility for benefits.

PROVIDERS MUST NOT BILL MEDICARE.

MA HMO products are provided by Horizon Healthcare of New Jersey, Inc., an independent licensee of the Blue Cross and Blue Shield Association.Insured by Horizon Healthcare of New Jersey, Inc. In case of an emergency, dial 911 or go to the nearest emergency room. Prior authorization is not required for emergency services.

AN INDEPENDENT COMPANY ADMINISTERING PHARMACY BENEFITS.

Horizon NJ TotalCare(HMO SNP)

MEMBER NAME

FIRST NAME LAST NAME

MEMBER ID NUMBER

YKU12345678

PCP:PHONE:OFFICE VISIT:SPECIALISTEMERGENCY ROOM:

LAST NAME, FIRST NAME

$0$0$0

EFFECTIVE DATE

BC/BS PLAN CODE

ISSUER (80840)

RxBIN 016499

RxPCN DSNPPRI

RxGrp RXHRZN

RxID 12345678 CMS-H8298-001

01/01/2017

S 280/780

Member Services:Pharmacy Services:Prior Authorization:Dental Services:Behavioral Health:TTY/TDD:24/7 Nurse Line: Lab Services in NJ:Provider Services:Emergency Services:Submit medical claims to: Horizon NJ TotalCare Claims Processing DepartmentPO Box 24080Newark, NJ 07101-0406Submit Rx claims to: Prime Therapeutics LLC PO Box 20970 Lehigh Valley, PA 18002-0970

1-800-543-56561-855-457-13461-888-621-58941-800-543-56561-800-543-5656

7111-800-711-5952 1-800-631-5250 1-855-955-5590

911

HorizonBlue.com/Medicare