Member Newsletters
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A newsletter for Horizon NJ Health Members
horizonNJhealth.com
Issue 4, 2015
MEMBER SERVICES
Our Member Services toll free
number is: 1-877-7NJ-HEALTH
(1-877-765-4325),
24 hours a day, seven days a week.
Members with speech or hearing
impairments may call TDD/TTY
toll free at 711.Horizon NJ Health
210 Silvia Street
West Trenton, NJ 08628
BlueNotes
MEMBER SERVICES
Horizon NJ Health Online Member Portal
To register to use Horizon
NJ Health?s member portal, visit our
website at horizonnjhealth.com.
From the home page, click
Member Support, then Resources,
then Member Online Services.
We encourage you to sign up for the
online member portal as soon as possible.
We hope you find this self-service tool
to be a useful resource for managing
your health plan!
Horizon NJ Health is excited to offer you access
to our new online member portal!
This member portal will allow you to interact with
your health plan, 24 hours a day, 7 days a week ?
at your convenience. The following features will be
available to you once you sign up:
? Request an ID card ? if you need a new ID card, you can easily request
one to be sent to you.
? View your covered benefits ? learn about your benefit level, what is
covered under your plan, and whether or not you have copayments for
certain services.
? Complete a health assessment ? complete a survey about your health,
learn about your risks, and see how you can make changes to your lifestyle
to improve your health.
? Change your PCP (Primary Care Provider) ? if you need to change your
doctor, you can easily do so on the portal.
? Wellness Topics ? get personalized health news articles from WebMD,?
based on the information you provide in your health assessment.
? Enroll in disease management ? if you have a chronic condition,
like asthma or diabetes, you can enroll in a specific disease management
program to help manage your health issue(s).
? Enroll in Mom?s GEMS maternity program ? if you are pregnant,
you can enroll in the Mom?s GEMS program to get information for
a healthy pregnancy and healthy baby.
horizonNJhealth.com Page 2Blue Notes Issue 4, 2015
Flu Shot Reminder
If you haven?t already, it?s time
to get your annual flu shot.
The flu shot will protect you from getting the flu.
You can get your flu shot from your
primary care provider.
If you are over 65, ask your
doctor or nurse about the
pneumonia shot and if
you need one. Most
people will only need
to get the shot once
after age 65.
Antibiotic Over-use
Did you know that antibiotics
do not fight viral infections like
colds, flu, and most sore throats?
Taking antibiotics when they are not
needed may cause you more harm than good.
When you take antibiotics and they do not work,
it can cause longer-lasting illnesses, more doctor
visits, the need for stronger medicines, and
life-threatening illness.
Do NOT:
n Take an antibiotic for a viral infection, unless your
doctor has prescribed one. Some of these viral
infections are:
? Colds or flu
? Most coughs and bronchitis
? Sore throats not caused by strep
? Runny nose/congestion
? Most sinus infections
n Take an antibiotic prescribed for someone else
n Skip medication doses, save it for later use, or
let anyone else use it ? always follow the doctor?s
instructions for taking and finishing your
medicine
Rapid Strep B Test
Strep throat is a bacterial throat infection and most
usually occurs in school-aged children. Before your
child?s doctor prescribes an antibiotic, he or she may
give your child a rapid Strep B test if your child?s
throat and symptoms seem like more than just a viral
sore throat. This test is done by brushing the child?s
throat with a cotton swab and testing for the
streptococcus bacteria. The results are usually ready
within 15 minutes. If your child has strep throat,
the doctor will prescribe an antibiotic to treat the
infection. If your child has strep throat, it is
important to follow the doctor?s instructions for
taking the prescribed antibiotics.
You can learn more about these topics by
visiting our website at horizonnjhealth.com.
From the home page, click Member Support,
then Resources. You can also get more
information about the topics below in your
Member Handbook.
Member Rights & Responsibilities
As a member of Horizon NJ Health, you have a partner
who will help you get the care you need. Horizon
NJ Health will treat you with respect and there are
certain rights you can expect. There are also certain
responsibilities that Horizon NJ Health expects
from you.
Utilization Management (UM) Decisions
You can contact Horizon?s Utilization Management
(UM) to discuss any medical decisions for which you
may have questions.
The Right to Appeal
You have the right to file a complaint or appeal with
Horizon NJ Health. There is a specific procedure you
will need to follow if you would like to do so.
Important Member Information
horizonNJhealth.com Page 3Blue Notes Issue 4, 2015
Horizon NJ Health would like to let
you know about the recent changes to
our drug formulary list (see box).
The changes found in this list will be added to
our drug formulary list on the Horizon NJ Health
website, horizonNJhealth.com. You can also
find the formulary guide, which includes an
explanation and listing of step therapy,
quantity/age/gender limits and drugs requiring
prior authorization, on the Horizon NJ Health
website.
Please talk with your Primary Care Provider
(PCP) about these changes. If your PCP decides
that, for medical reasons, you must take a drug
that is not on the formulary list or needs
pre-approval, including a brand name
medication exception, he or she can call us
Here is a list of recent changes: Formulary Changes
Formulary Change
Description
Brand (Generic)
Drug Name
Alternatives
(if applicable)
Not Covered Xyrem (sodium
oxybate)
Provigil, amphetamine,
methamphetamine,
dextroamphetamine,
methylphenidate, and
selegiline
Not Covered Syprine (trientine
hydrochloride)
Penicillamine
Covered Xarelto (rivaroxaban)
Covered Bydureon pen (exena-
tide extended-release)
and ask for special permission (prior authorization) for
you to get the drug.
Your PCP may call the Horizon NJ Health Pharmacy
Department at 1-800-682-9094 to request a prior
authorization.
Staying Safe
this Winter
With the cold weather comes ice and snow. Staying safe
during the winter months is very important and there are a
number of things you can do to reduce your risk of injury.
Avoiding falls
Did you know that falls are the main cause of injury-linked deaths
in adults 65 and older?
? If you are going to be outside in ice and snow, wear
rubber-soled boots or waterproof footwear.
? Be careful on snowy or icy sidewalks and steps.
Keeping Warm
? Stay mostly indoors during very cold temperatures.
? Layer your clothing and wear a hat and gloves when outside.
Ask for Help
? Ask a friend or family member to do the shoveling ? especially
if you have a chronic condition like heart disease or asthma,
if you have heart problems, or if you are elderly.
? Pay a neighbor or a shoveling service to shovel your front steps
and front walk.
horizonNJhealth.com Page 4Blue Notes Issue 4, 2015
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Member Services 1-877-7NJ-HEALTH (1-877-765-4325) (TTY: 711)
24 hours a day, seven days a week. horizonNJhealth.com
Fraud, Waste and Abuse Hotline: 1-855-FRAUD20 or
1-855-372-832 (TTY: 1-800-654-5505)
BLUE NOTES is published as a community service for the friends and patrons of
Horizon NJ Health, 210 Silvia St., West Trenton, NJ 08628. Information in
BLUE NOTES comes from a wide range of medical experts. If you have any concerns
or questions about specific content that may affect your health, please contact
your health care physician. Models may be used in photos and illustrations.
Horizon NJ Health is part of the Horizon Blue Cross Blue Shield of New Jersey enterprise,
an independent licensee of the Blue Cross and Blue Shield Association.
? 2015 Horizon Blue Cross Blue Shield of New Jersey.
Three Penn Plaza East, Newark, NJ 07105
BlueNotes
Colorectal Cancer ? Cancer of the colon or rectum ?
affects both men and women. Regular screenings
can catch colorectal cancer early, which is important for
successful treatment.
When should you get screened?
Screening for colon cancer should begin at 50 years old or when
your doctor says screening is needed. Talk to your doctor to see
when you should be screened and what type of test you should get.
Regular screenings are important and could save your life.
Tests to screen for colorectal cancer:
? Fecal occult blood test (FOBT) and fecal immunochemical test (FIT):
Doctors check stool samples for blood, which may be a sign of a polyp or cancer.
? Sigmoidoscopy: The doctor puts a flexible, lighted tube into the rectum and lower colon to
check for polyps and cancer.
? Colonoscopy: The doctor uses a longer, flexible tube to look at the entire colon and rectum.
? Double contrast barium enema: An X-ray test of the colon and rectum.
? CT colonography (virtual colonoscopy): A type of CT scan of the colon and rectum
Talk to Your Doctor About a Colorectal Screening
NJ Addiction
Services
Hotline
Do you or someone you know need help with
a drug or alcohol problem? For assistance and
a referral to treatment, call the NJ Addiction
Services Hotline toll-free at 1-844-276-2777.
Help is available 24 hours a day, 7 days a week.
horizonNJhealth.com
As of March 31, 2014, Horizon
NJ Health no longer offers its
NJ FamilyCare ADVANTAGE plan.
This is Horizon NJ Health?s program
for children who lack health care
coverage and whose family income
levels make them ineligible for
Medicaid or NJ FamilyCare.
If you have questions about this
change, please call Member
Services at 1-877-7NJ-HEALTH
(1-877-765-4325), TTY: 1-800-654-
5505. You can also visit our website
at horizonNJhealth.com to learn more.
Important
NJ FamilyCare ADVANTAGE
Announcement
See Participating Providers
Our Member Services toll free
number is: 1-877-7NJ-HEALTH
(1-877-765-4325),
24 hours a day, seven days a week.
Members with speech or hearing
impairments may call TDD/TTY
toll free at 1-800-654-5505.
MEMBER SERVICES
Horizon NJ Health
210 Silvia Street
West Trenton, NJ 08628
A newsletter for Horizon NJ Health Members Issue 1, 2014
As a Horizon NJ Health member, you have access to the largest
network of participating Medicaid providers in the state of
New Jersey. In order to have your medical services covered,
you must see a provider in the Horizon NJ Health network. If you
see a provider who does not participate with Horizon NJ Health,
you may have to pay for the full cost of the services on your own.
Your primary care provider (PCP) can arrange all of your
medical care. Every Horizon NJ Health member has a PCP, and
you can change your PCP at any time. The name of your PCP is
on the front of your Horizon NJ Health ID card. Call this doctor
first whenever you need medical care. Your PCP can also refer
you to a specialist who participates with Horizon NJ Health if
you need extra care.
To find providers who participate with Horizon NJ Health,
you can use the online
Provider Directory.
Go to horizonNJhealth.com
and click Provider
Directory.
BlueNotes
horizonNJhealth.com Page 2Blue Notes Issue 1, 2014
Prostate cancer is the
second most common type
of cancer in American men.
One in six men will be
diagnosed with prostate
cancer during his lifetime,
according to the American
Cancer Society.
But if the cancer is found and treated early, most
men have a very good chance of surviving it.
That?s why prostate cancer testing should start
when you turn 50 years old or when your doctor
thinks it is the right time for you. It is even more
important for men with any of these risk factors to
be screened:
? Being African-American
? Having men in your family with prostate cancer
? Eating a lot of food high in saturated fat, like red
meat and high-fat dairy foods
? Being overweight
There are different tests used to screen for
prostate cancer. For most men, a PSA blood test
and digital rectal exam should be done every year.
Horizon NJ Health covers prostate cancer testing
when it is recommended by your doctor. Talk with
your doctor about being screened today.
You can also take steps to help prevent prostate
cancer:
? Eat plenty of fruits and vegetables each day.
? Limit foods like steak and hamburger and dairy
like ice cream, butter and cheese.
? Stay at the weight that is healthy for you.
Breast cancer is the second most common type
of cancer among women, but more women are
surviving the deadly disease because of routine
testing. Every woman should have breast exams
and/or mammogram screenings to help prevent
breast cancer.
Clinical Breast Exam
A clinical breast exam is a simple exam done by
your provider. Women in their twenties and thirties
should have an exam at least every three years and
women 40 and older should have an annual exam.
Mammogram
A mammogram is an X-ray of the breast that
checks for problems, such as tumors and cysts.
Women 40 years old and older should have a
mammogram every year.
Self-Breast Exam
Women should also check themselves with
monthly self-breast exams. Your provider can
teach you how. Tell your provider right away about
any changes to how your breasts usually look
and feel.
You may need screenings earlier or more often
if you have
a high risk
of breast
cancer.
Talk to your
doctor
about when
and how
often you
should be
tested.
Prostate Cancer Testing for Men
Breast Cancer Screening for Women
horizonNJhealth.com Page 3Blue Notes Issue 1, 2014
The goal of the Horizon NJ Health Quality Improve-
ment Program is to help you live a healthier life.
We focus on your health and the care you get when you
see a doctor. We want to make sure you are satisfied
with your care and the services you get.
The goals of the program are to make sure that:
? You have doctors available to you and that you get
the best care possible
? You are happy with Horizon NJ Health and your doctors
? We are making it easy for you to get good health care
? We are obeying the laws and standards set for Horizon
NJ Health by the state of New Jersey and accrediting
groups
If you would like more information about our
Quality Improvement Program, visit our website,
horizonNJhealth.com, or call 1-800-682-9094
(TTY: 1-800-654-5505) and ask for the Quality
Department.
If you would like to get
family planning
contraception services,
please call Member Services at 1-877-7NJ-HEALTH
(1-877-765-4325), TTY: 1-800-654-5505.
We can help you get the care you need and will tell
you where you can find a doctor or clinic near you.
You do not need a referral from your primary care
provider (PCP) for family planning services.
Most NJ FamilyCare D and NJ FamilyCare ADVANTAGE
members must see participating Horizon NJ Health
providers. All other members can get family planning
services from an out-of-network Medicaid provider
through the Medicaid Program using their Health
Benefits ID (HBID) card.
Quality Program Family
Planning
When you join Horizon NJ Health, you will be sent a
member ID card in the mail. Everyone in your family who is
a Horizon NJ Health member will get his or her own card.
If you did not get a card after you joined Horizon NJ Health,
please call Member Services at 1-877-765-4325
(TTY: 1-800-654-5505).
Check the card when you get it to make sure all of your
personal information, such as your name, is correct. Your primary
care provider?s (PCP) name and phone number are also on the
card. Make sure it lists the PCP you chose. You can change your
PCP at any time by calling Member Services.
Show your card every time you get health care ? when you
see your doctor or dentist, when you are referred to a specialist,
when you fill a prescription, when you have lab work done,
and if you go to an emergency room.
Please keep your Horizon NJ Health member ID card safe and
never let anyone else use or borrow it. If you lose your card, be
sure to call Member Services right away.
Member ID Cards
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horizonNJhealth.com Page 4Blue Notes Issue 1, 2014
A personal representative is a person you choose to work with
Horizon NJ Health for you to manage your enrollment, claims,
premiums, appeals or anything else related to your benefits. Your
personal representative can be a husband or wife, son, daughter or
other family member, a friend, a lawyer, or someone chosen by a court.
Your personal representative stands in for you if you do not feel well
enough to manage your health plan on your own. Even if you choose a
personal representative, you do not lose any of your rights, and you can
change or remove your personal representative at any time.
If you would like to name a personal representative, please fill out and
sign a Request for Personal Representative form. You can get the form
on the Horizon NJ Health website at horizonNJhealth.com or by calling
Member Services at 1-877-765-4325 (TTY: 1-800-654-5505).
If you have any questions, please call Member Services.
Please send your completed form to:
Horizon NJ Health Member Services
Attention: HIPAA Team
210 Silvia Street
West Trenton, NJ 08628
Horizon NJ Health will
cover care for members
younger than 18 years
old following all laws.
Parents or guardians have
the right to make medical
decisions and allow treat-
ment of dependents who are minors, or under
18 years old.
In certain cases, New Jersey law lets minors make
health care choices for themselves. Minors can
make choices without their parents or guardians
in these cases:
? Minors who go to an emergency room for an
emergency
? Minors who want family planning services,
maternity care or sexually transmitted disease
(STD) services
? Minors living on their own who have their
own Medicaid ID number as head of their
household
You Can Name a
Personal Representative
Treatment of Minors
Member Services 1-877-7NJ-HEALTH
(1-877-765-4325) (TDD/TTY: 1-800-654-5505)
24 hours a day, seven days a week.
horizonNJhealth.com
BLUE NOTES is published as a community service for the friends and patrons of
Horizon NJ Health, 210 Silvia St., West Trenton, NJ 08628. Information in
BLUE NOTES comes from a wide range of medical experts. If you have any concerns
or questions about specific content that may affect your health, please contact
your health care physician. Models may be used in photos and illustrations.
Horizon NJ Health is part of the Horizon Blue Cross Blue Shield of New Jersey enterprise,
an independent licensee of the Blue Cross and Blue Shield Association.
? 2014 Horizon Blue Cross Blue Shield of New Jersey.
Three Penn Plaza East, Newark, NJ 07105
Each year, Horizon NJ Health members are given
a survey that asks what Horizon NJ Health does well
and what it could do better.
Your answers help Horizon NJ Health make the services
we offer better for our members.
What you think matters! If you get a survey,
please fill it out and return it in the mail.
Member Satisfaction Survey
Like us on Facebook
www.facebook.com/HorizonNJH
www.twitter.com/HorizonNJHealth
@HorizonNJHealth
Follow us on Twitter
BlueNotes
? ? ??
?
A newsletter for Horizon NJ Health Members
horizonNJhealth.com
Issue 3, 2015
MEMBER SERVICES
Our Member Services toll free
number is: 1-877-7NJ-HEALTH
(1-877-765-4325),
24 hours a day, seven days a week.
Members with speech or hearing
impairments may call TDD/TTY
toll free at 1-800-654-5505.Horizon NJ Health
210 Silvia Street
West Trenton, NJ 08628
BlueNotes
MEMBER SERVICES
Avoiding the Flu
Do you need a
pneumonia vaccine?
Protect your family and yourself.
Now is a good time to schedule your
annual flu shots. Flu season can start as
early as October and most often peaks
in January/February. You need to get a flu shot each year to
protect yourself from getting the flu.
The flu usually lasts about a week to 10 days. It can lead to
more dangerous lung infections, such as pneumonia, mainly
among young children (6 months to 5 years old), people
65 years and older, and people with certain health issues.
Symptoms of the flu usually come on faster and harder than a
cold, and include fever, body aches, and a great need for rest.
Who needs a flu shot?
? Children age 6 months to 18 years
? People 50 years of age and older
? Pregnant women
? People who care for children younger than 6 months old
? People of any age with chronic illnesses, such as
asthma, diabetes, chronic kidney failure, etc.
? People who live in nursing homes and other
long-term care places
? People who live with, or care for individuals at high risk
for problems stemming from the flu
You can get a flu shot from your primary care provider.
If you are 65 years of age or older,
ask your doctor or nurse about the
pneumonia shot. Most people will
only need to get the shot once
after age 65.
A pneumonia shot is recommended
for people who:
? Have chronic, long-term health
problems like heart, lung or
sickle cell disease, diabetes,
alcoholism, cirrhosis, leaks of
cerebrospinal fluid or a
cochlear implant
? Have a disease or conditions
that lower the body?s resistance
to infection, such as HIV/AIDS,
Hodgkin?s disease, lymphoma
or leukemia
? Have long-term steroid use
? Are an adult with asthma
? Are an adult who smokes
horizonNJhealth.com Page 2Blue Notes Issue 3, 2015
Sexually Transmitted Infections (STI) and your children
Human Papillomavirus (HPV)
How to protect your daughters and sons
against this STI
You may feel a bit uneasy thinking about your child as being
sexually active. But the fact is, sooner or later, they likely
will be. It is very likely that they will be exposed to
human papillomavirus (HPV) ? the most common
sexually transmitted infection (STI). Certain HPV strains may
lead to genital warts and other strains can lead to cancer.
Now, with the HPV vaccine, you can protect your children
from getting HPV. The vaccine is a series of three shots, given
over a six month period of time by your child?s doctor.
Who should get the HPV vaccine?
? Preteens ? both boys and girls who are 11 or 12 years old
? Young women can get vaccinated through age 26
? Young men can get vaccinated through age 21
? People with a disease or condition that lower the body?s
resistance to infection, such as HIV/AIDS
Chlamydia
Chlamydia (Clam-mid-dee-a) is a (STI) that
most often has no immediate symptoms,
so many people do not even know they have it.
It can be easily cured with antibiotics.
However, if it is untreated, chlamydia can
make it hard for women to get pregnant or can
cause a tubal pregnancy.
Any person who is sexually active can get
chlamydia, but young people and men who
have sex with men are at the highest risk.
Chlamydia is transmitted through all types of
unprotected sex ? vaginal, oral and anal.
You can lower your risk for Chlamydia by:
? Having sex with only one partner who has
been tested negative for STIs
? Using a condom every time during sexual
intercourse
? Being abstinent ? not having sexual
intercourse
? Visiting the OB/GYN or family doctor for
regular exams
Get tested every year if you are:
? A sexually active woman younger than
25 years
? Pregnant or about to become pregnant
? An older woman who has a new sex partner or
more than one sex partner
? A sex partner who has a sexually transmitted
infection
? A male who has sex with males
horizonNJhealth.com Page 3Blue Notes Issue 3, 2015
October is Breast Cancer
Awareness Month
Have you scheduled your
mammogram?
Breast cancer is scary, but if it is found early,
women have a greater chance of living.
A mammogram is the best way to find breast cancer
early. A mammogram is an X-ray of your breast and
only takes about 20 minutes, with little discomfort.
It shows small lumps or growths that you or your
doctor may not be able to feel. By comparing one
year?s mammogram to the next, your doctor can tell
what?s normal for you. Changes in your mammogram
may point to breast cancer or illness.
Who needs a mammogram?
? Women should have a baseline mammogram
between ages 35-40
? Every woman over 40 should get an annual
mammogram
? If you have a family history of breast cancer,
you may need a mammogram earlier.
Talk to your doctor about this.
Know your breasts
All women should give themselves a monthly breast
self-exam. If you don?t know how, your doctor can
show you during a clinical breast exam. When you
know for yourself how your breasts are supposed to
look and feel, you can notice changes more easily.
Tell your doctor right away about anything you find
that doesn?t seem normal.
Living Better with Diabetes
If you have diabetes, Horizon NJ Health?s Diabetes
Management Program can help you manage your
condition. As you know, diabetes can cause major health
problems, but with simple tests and treatment,
many problems can be detected early and stopped.
What the Horizon NJ Health Diabetes Management
Program can do for you:
? Teach you about diabetes
? Talk to you about the long-term effects of diabetes
that is not controlled
? Help you learn about medicines used to treat diabetes
? Build a sick day care plan
? Show you how to check your daily progress with a blood
sugar testing machine
? Guide you to diabetes specialists , if needed
Preventive care is vital for controlling your diabetes.
You many need all or some of these tests yearly, or more
often to track and manage your condition.
Important tests for diabetics:
? HgA1C ? a blood test that measures your average
blood sugar over a three-month period
? Dilated retinal eye exam ? finds problems that can
lead to blindness
? Cholesterol ? measures the amount of fat in your blood,
and can identify your risk for heart attack or stroke
? Foot exam ? identifies your risk for a foot sore that can
lead to a serious infection
? Microalbuminuria (Kidney test) ? tests for protein in your
urine and can find kidney damage early
Talk to your doctor to see when or how often you should
have these tests.
To sign up for the Horizon NJ Health Diabetes
Management Program, call toll free at
1-800-682-9094 ext. 89634 (TTY: 1-800-684-5505).
Or, ask your doctor to sign you up.
n Get a mammogram yearly if you are
over 40 years old.
n You do not need a referral from your
doctor for a mammogram.
n Mammograms are covered by
Horizon NJ Health.
horizonNJhealth.com Page 4Blue Notes Issue 3, 2015
? ??? ?
?Member Services 1-877-7NJ-HEALTH
(1-877-765-4325) (TTY: 1-800-654-5505)
24 hours a day, seven days a week.
horizonNJhealth.com
Fraud, Waste and Abuse Hotline:
1-855-FRAUD20 or 1-855-372-8320
(TTY: 1-800-654-5505)
BLUE NOTES is published as a community service for the friends and patrons of
Horizon NJ Health, 210 Silvia St., West Trenton, NJ 08628. Information in
BLUE NOTES comes from a wide range of medical experts. If you have any concerns
or questions about specific content that may affect your health, please contact
your health care physician. Models may be used in photos and illustrations.
Horizon NJ Health is part of the Horizon Blue Cross Blue Shield of New Jersey enterprise,
an independent licensee of the Blue Cross and Blue Shield Association.
? 2015 Horizon Blue Cross Blue Shield of New Jersey.
Three Penn Plaza East, Newark, NJ 07105
BlueNotes
Other Health Insurance
If you have coverage through Horizon NJ Health and another health plan,
such as Medicare, be sure to follow the benefit guidelines of that plan.
This includes the need for referrals and using in-network doctors.
If thE SERVICE IS: USE thIS typE of doCtoR:
Use a doctor from that insurance?s network
(does not need to be in the Horizon NJ Health network)
Use a Horizon NJ Health network doctor
An approved, covered benefit from the other insurance,
including referrals from that insurance?s PCP,
prescription drugs and inpatient hospital stays
A medically necessary service that may not be covered by
the other insurance but is covered by Horizon NJ Health
(for example: personal care assistance services,
family planning services)
When You Have Other Insurance and NJ FamilyCare
If thE SERVICE IS: USE thIS typE of doCtoR:
An approved, Medicare-covered benefit
(for example: primary care, lab tests, specialists)
Inpatient hospital care
Emergency care received at a hospital
emergency department
A medically necessary service not covered
by Medicare but covered by Horizon NJ Health
(for example: dental services or hearing aids)
Use a Medicare doctor (does not need to be in the
Horizon NJ Health network)
Use a Medicare hospital. If possible, use a hospital
also in the Horizon NJ Health network
Go to the nearest hospital
Use a Horizon NJ Health network doctor
When You Have Both Medicare and NJ FamilyCare
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A newsletter for Horizon NJ Health Members
horizonNJhealth.com
Issue 2, 2015
MEMBER SERVICES
Our Member Services toll free
number is: 1-877-7NJ-HEALTH
(1-877-765-4325),
24 hours a day, seven days a week.
Members with speech or hearing
impairments may call TDD/TTY
toll free at 1-800-654-5505.Horizon NJ Health
210 Silvia Street
West Trenton, NJ 08628
BlueNotes
Getting the Care You Need
Your Primary Care Provider
(PCP) arranges all of your
care. Call your doctor?s
office first ? at any time,
24 hours a day, seven days a
week ? whenever you need
medical care. Your doctor
will know how to help.
Showing up for every doctor?s appointment is the only way
your doctor can make sure that you and your family are
getting the quality care you deserve. If you cannot keep
an appointment, call and let your doctor or dentist know
right away. That way, your doctor can use the time to help
another patient.
Sometimes, it can take a while to get an appointment, so
do not delay in calling your doctor to schedule one. When
you get to the doctor?s office on time for your appointment,
you should not have to wait longer than 45 minutes.
If you would like to change your PCP or are having
issues getting an appointment, you may call us at
1-877-765-4325 (TTY: 1-800-654-5505). Representatives are
available 24 hours a day, seven days a week, to help you.
Vaccines Offer
Critical Protection
You may recall a recent outbreak of
measles that started in Disneyland
several months ago. This outbreak
was an important reminder that
vaccines are safe, they work, and they save lives.
Vaccines are shots you get that protect against serious conta-
gious diseases that can cause major side effects or even death.
Getting vaccines as a child gives you a lifetime of protection.
It is also important to remember that getting vaccines helps
protect those around you who cannot be vaccinated, such as
infants and some people with weakened immune systems.
Most people who get vaccines do not have any problems.
Some have side effects such as mild fever and mild swelling
where the shot was given. These side effects are not nearly
as bad as the actual illness they protect against.
There are 10 vaccines children should get before age 2.
These vaccines are all covered by your health plan.
Talk to your doctor if you have questions or concerns about
vaccines. You can also find more information and vaccine
schedules on the Centers for Disease Control & Prevention
website at www.cdc.gov/vaccines.
If you or your children are not up to date on your
vaccines, call your doctor right away.
horizonNJhealth.com Page 2Blue Notes Issue 2, 2015
Horizon NJ Health has staff who help members who
have had a major health event or medical diagnosis.
Our goal is to help you get as healthy as possible as quickly
as you can. We can help you find the best place to get care
and share information about resources that can help.
Each member in our complex Case Management program
will get their own plan with goals, resources and benefits.
We help you carry out the plan, watch your progress and
follow up with phone calls to help with any issues.
There are a few ways we find members who may need help:
when your doctor sends us a bill, if you take certain
medicines, if you go to the emergency room or are admitted
to the hospital, or if your doctor asks us to help you.
Please call Horizon NJ Health at 1-800-682-9094, exten-
sion 89634 if you would like help (TTY: 1-800-654-5505).
Complex Case Management
Help Managing Your Disease
Horizon NJ Health offers programs
to help you manage all your
health care needs.
Our care management programs teach
members how to best deal with their
illness. Members get education, resources
and phone calls from Horizon NJ Health
nurses to help them reach their goals.
Horizon NJ Health provides support and
education for these disease management programs
and many others:
? Congestive heart failure (CHF)
? Chronic obstructive pulmonary disease (COPD) ? Diabetes
? High blood pressure (hypertension) ? Asthma
Members may enroll themselves in a care management
program or be enrolled at their Primary Care Provider?s
suggestion.
If you would like to enroll in a care management program,
please call Horizon NJ Health toll-free at 1-800-682-9094,
extension 89634 (TTY: 1-800-654-5505). All members can
get care management and can disenroll from care
management at any time.
Behavioral Health Care
Horizon NJ Health provides mental health and
substance abuse benefits for members of the
Division of Developmental Disabilities (DDD).
DDD members can call Horizon Behavioral Health
toll-free at 1- 877-695-5612 (TTY: 1-800-654-5505)
for more information.
Most Horizon NJ Health members get mental health
and/or substance abuse services through the
Medicaid program. To get services for adults 18 years
old and older, call your Primary Care Provider or
the NJ FamilyCare Hotline for mental health services
at 1-800-356-1561 during business hours.
Starting July 1st, 2015, you can contact the
IME (Interim Managing Entity) at 1-844-276-2777
for substance use disorder services (available
24 hours a day).
For after-hours service, call NJ Mental Health Cares
toll-free at 1-866-202-4357 (TTY: 1-877-294-4356).
To get services for children younger than 18 years
of age, call the Children?s System of Care at
1-877-652-7624 (TTY: 1-866-896-6975).
If you need these complex
Case Management services,
our nurses and care managers
can help you get the care you
need and guide you through
the health care system.
horizonNJhealth.com Page 3Blue Notes Issue 2, 2015
Does Your Child Have a Fever?
If you think your child is sick, use a thermometer
to take their temperature. This is the only
real way to know if your child has a fever.
Be sure to read the instructions that come with
the thermometer and store the paper with the
thermometer in case you need to read them again.
There are a few different ways to take a temperature.
Talk to your child?s doctor about how to get the best
reading or if you have questions about taking your
child?s temperature.
? Rectum. This method gives you the best reading for
children under age 3. Lubricate the tip of a digital
thermometer with a water-soluble jelly such as
KY Jelly. Insert just the tip of the thermometer into
the child?s bottom ? no more than half an inch.
Keep the thermometer still until the temperature
shows up on the screen.
? Mouth. You may use this method for children who
can keep a thermometer under their tongue with
their mouth closed. Do not let your child eat or
drink anything for 15 minutes before you take a
temperature. Put the thermometer under the
child?s tongue and have your child close their lips
around it. Have your child sit still. You may hold
the thermometer in place until the temperature
shows up on the screen.
? Armpit. This method may not give you the most
accurate reading. Make sure the skin under your
child?s arm is dry. Place the tip of the thermometer
into the center of the armpit. Hold your child?s
elbow down closely against their body.
Keep the thermometer still until the temperature
shows up on the screen.
Wash the tip of the thermometer with soap and warm
water when you are done. (Do not put the whole
thermometer in water.) If you use a thermometer in
the rectum, never use the same one in the mouth.
A normal tempera-
ture range is between
97.5?F and 99.5?F.
Most pediatricians
consider a tempera-
ture above 100.4?F
a sign of a fever.
According to the American Academy of
Pediatrics, call your child?s doctor if your child:
? Is younger than 3 months old and has a temperature
of 100.4?F or higher
? Has a fever that rises above 104?F repeatedly
? Looks very ill, is unusually drowsy, or is very fussy
? Has been in a very hot place, such as an
overheated car
? Has other symptoms, such as a stiff neck, severe
headache, severe sore throat, severe ear pain, an
unexplained rash, or repeated vomiting or diarrhea
? Has immune system problems, such as sickle cell
disease or cancer, or is taking steroids
? Has had a seizure
? Still ?acts sick? once his or her fever is brought down.
? Has a fever that persists for more than 24 hours in
a child younger than 2 years
? Has a fever that persists for more than 3 days
(72 hours) in a child 2 years old or older
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horizonNJhealth.com Page 4Blue Notes Issue 2, 2015
? ??? ?
?Member Services 1-877-7NJ-HEALTH
(1-877-765-4325) (TTY: 1-800-654-5505)
24 hours a day, seven days a week.
horizonNJhealth.com
Fraud, Waste and Abuse Hotline:
1-855-FRAUD20 or 1-855-372-8320
(TTY: 1-800-654-5505)
BLUE NOTES is published as a community service for the friends and patrons of
Horizon NJ Health, 210 Silvia St., West Trenton, NJ 08628. Information in
BLUE NOTES comes from a wide range of medical experts. If you have any concerns
or questions about specific content that may affect your health, please contact
your health care physician. Models may be used in photos and illustrations.
Horizon NJ Health is part of the Horizon Blue Cross Blue Shield of New Jersey enterprise,
an independent licensee of the Blue Cross and Blue Shield Association.
? 2015 Horizon Blue Cross Blue Shield of New Jersey.
Three Penn Plaza East, Newark, NJ 07105
BlueNotes
If you have asthma, there are ways to prevent an asthma attack.
Controlling your asthma triggers will help lower
symptoms and help keep your asthma from flaring up.
Common indoor asthma triggers:
? Dust and dust mites ? Animals with fur or feathers
? Food allergies ? Cold, flu and other infections
? Mold ? Cockroaches
? Strong odors ? Tobacco smoke
Common outdoor asthma triggers:
? Weather ? Pollen ? Air pollution
Know how to control your asthma triggers.
Ways to control asthma triggers indoors:
? Avoid smoking ? Clean, dust and vacuum regularly
? Keep animals out of your home
? Use pest control to keep cockroaches out of your home
? Do not use products with strong odors
Always have your asthma medications with you and be sure to
follow your asthma treatment plan. If your Primary Care Provider
(PCP) prescribes a controller medication, you must take it every
day, even when your asthma is fine. Always have your quick relief
medication on hand.
See your PCP immediately if:
? You are using your quick relief
medication more than two times
per week
? Your asthma stops you from going
to work or school
? Your asthma wakes you up at night
The Horizon NJ Health Asthma ?Breathe Easy? Program helps
members with asthma reduce their risk of asthma attacks,
relieve attacks when they occur and learn how to prevent them
Horizon NJ Health nurses can help you:
? Create a treatment plan ? Make doctor appointments
? Coordinate your asthma care ? Get asthma management supplies
? Learn about self-management
? Remember to schedule preventive care
Asthma ?Breathe Easy? is open to members of all ages.
Join by calling toll-free at 1-800-682-9094,
extension 89634 (TTY: 1-800-654-5505).
If you have a new name, address, or phone number, call
NJ FamilyCare at 1-800-701-0710 (TTY: 1-800-701-0720).
Representatives are available Monday and Thursday
from 8 a.m. to 8 p.m. and Tuesday, Wednesday and
Friday from 8 a.m. to 5 p.m.
If your NJ FamilyCare eligibility was done through your
local County Welfare Agency (CWA), then you must report
any changes to that CWA.
It is important to keep this information up to date
so you never have issues getting health care
benefits or services.
Note that this information should be changed
with NJ FamilyCare first, not Horizon NJ Health.
NJ FamilyCare will let us know about the change.
Be sure to keep your personal information up to date with your health plan.Have You Moved?
? ? ??
?
A newsletter for Horizon NJ Health Members
horizonNJhealth.com
Issue 1, 2015
MEMBER SERVICES
Our Member Services toll free
number is: 1-877-7NJ-HEALTH
(1-877-765-4325),
24 hours a day, seven days a week.
Members with speech or hearing
impairments may call TDD/TTY
toll free at 1-800-654-5505.Horizon NJ Health
210 Silvia Street
West Trenton, NJ 08628
BlueNotes
Lead Testing for Children
Lead poisoning can cause serious but preventable illness.
Children can get lead poisoning by swallowing or inhaling lead.
Screening for lead poisoning must be done for all children between the ages of 9 and 18 months
(preferably at 12 months) and again between 18 and 26 months (preferably at 24 months).
If the test result is not normal, your doctor will recommend testing often and a Horizon NJ Health nurse
will help you until the level is in the normal range.
Lead can be found in:
? Homes built before 1978
? Drinking water from lead pipes and solder in plumbing
? Some soil, spices, imported candies, makeup,
folk medicine, stained glass and batteries
? Some children?s toys and jewelry made in China
All it takes is a simple blood test
to find out if your child has
lead poisoning.
Children who have lead poisoning may not show symptoms until they get older.
Take your child to his or her primary care provider to be tested.
horizonNJhealth.com Page 2Blue Notes Issue 1, 2015
Needing an Advance Directive
Your Doctor
Can Help You
Determine
Where to
Get Care
Are you pregnant?
Call the Mom?s GEMS program
24/7 Nurse hotline with your
questions or concerns.
Toll-free: 1-877-765-4325
(TTY: 1-800-654-5505)
You have the
right to decide
what kind of
medical care
you want or do
not want to get.
An advance directive is a document that helps you
to decide what type of care you would like if you
become too sick to speak or decide for yourself. You
can put that decision into writing or you can name
someone else who understands what you want.
Now, while you are healthy, is the time to think
about an advance directive. Your doctor can help
you make one. Talk to him or her about your
care options.
There are three kinds of advance directives in
New Jersey:
? A proxy directive means you can name a person
(18 years old or older) to make your health care
choices when you no longer can.
? An instruction directive tells your desires/
instructions for care.
? A combined directive names a person and
gives instructions for care.
The State of New Jersey has more information
online at www.state.nj.us/health/advancedirective.
Your doctor?s office can provide most of the basic
health care you need. Sometimes, your doctor
may send you to another doctor, center or lab
to have certain services done.
Unless you have a referral from your doctor, you
should not go to a hospital for non-urgent care,
such as routine testing. If your doctor says you
need to go somewhere else for a special service,
be sure to ask him or her where you should go.
The goal of the Horizon NJ Health Quality
Improvement Program is to help you live
a healthier life.
We focus on your health and the care you get when
you see a doctor. We want to make sure you are
satisfied with your care and the services you get.
The goals of the program are to make sure that:
? We are making it easy for you to get good health care.
? You have doctors available to you and that you get
the best care.
? You are happy with Horizon NJ Health and your doctors.
? We are obeying the laws and standards set for
Horizon NJ Health by the state of New Jersey and
accrediting groups.
If you would like more information about our
Quality Improvement Program, visit our website,
www.horizonNJhealth.com, or call
1-800-682-9094 (TTY: 1-800-654-5505)
and ask for the Quality department.
Focus on Quality
horizonNJhealth.com Page 3Blue Notes Issue 1, 2015
Healthy Food Choices
A healthy diet is very important
to your health.
We?re Here to Help You
Did you know that Horizon NJ Health Member Services
representatives are available to help you at
any time of day, any day of the week?
Eating too much and choosing unhealthy
foods that are high in fat, sugar and salt can
lead to many serious conditions like high
blood pressure and high cholesterol and
becoming overweight. It is important to
control your portion sizes and choose foods
that are high in protein and fiber and full of
vitamins and nutrients.
Here are some tips for making the best
food choices:
? Eat at least five servings of fruit and vegetables
a day.
? Choose whole grains like brown rice and wheat
bread instead of white rice and white bread.
? Choose nonfat or low-fat dairy products like
milk, yogurt and cheese.
? Bake or grill meat instead of frying it, and
choose lean proteins like chicken and fish.
? Pick snacks high in fiber and protein that will
keep you feeling full, such as unsalted nuts,
popcorn without butter, veggie sticks with
hummus, and all-fruit smoothies.
? Drink lots of water to help fill you up.
? Read nutrition labels so you are aware of how
many calories and how much fat, sugar and salt
are in the foods you choose.
? Be a good role model for
children ? teach them how
to make healthy food
choices and show them how
tasty healthy food can be.
Our staff is ready to help you get the most out of your
Horizon NJ Health membership, 24 hours a day, seven
days a week, including holidays. Any time you have a
question about your benefits, how Horizon NJ Health works,
or how to get the care you need, give us a call.
We also have 24-hour translation services available at
no cost. These translators know many languages,
including sign language.
We can also arrange for a translator to talk over the phone
with you and your doctor during your visit to the doctor.
The translator will make sure your doctor knows what you are
saying and you know what the doctor is saying.
You can call Member Services toll-free at 1-877-7NJ-HEALTH
(1-877-765-4325). Speech- and hearing-impaired members
can call us toll-free at 1-800-654-5505.
horizonNJhealth.com Page 4Blue Notes Issue 1, 2015
? ??? ?
?Member Services 1-877-7NJ-HEALTH
(1-877-765-4325) (TTY: 1-800-654-5505)
24 hours a day, seven days a week.
horizonNJhealth.com
Fraud, Waste and Abuse Hotline:
1-855-FRAUD20 or 1-855-372-8320
(TTY: 1-800-654-5505)
BLUE NOTES is published as a community service for the friends and patrons of
Horizon NJ Health, 210 Silvia St., West Trenton, NJ 08628. Information in
BLUE NOTES comes from a wide range of medical experts. If you have any concerns
or questions about specific content that may affect your health, please contact
your health care physician. Models may be used in photos and illustrations.
Horizon NJ Health is part of the Horizon Blue Cross Blue Shield of New Jersey enterprise,
an independent licensee of the Blue Cross and Blue Shield Association.
? 2015 Horizon Blue Cross Blue Shield of New Jersey.
Three Penn Plaza East, Newark, NJ 07105
Visit the Dentist Twice a Year
Taking care of your teeth and gums is
important to your body?s overall health.
You should visit your dentist at least twice a year for
a checkup and cleaning. Most people do not know when
cavities are in their teeth or their gums are not healthy.
Dentists can find signs of dental disease, which can lead
to problems in other parts of your body, too.
It is also important for children to visit the dentist.
Visits should start when a child turns 1 year old or when the
first tooth can be seen.
You can go for a checkup and cleaning every six months, and
more often if you have special health care needs. Make sure
that you complete the treatment your dentist recommends.
You do not need a referral from your primary care provider or pre-approval from Horizon
NJ Health for routine dental care, such as cleanings, fillings and X-rays.
Schedule an appointment with your dentist today. If you do not have a dentist or need help
making an appointment, Member Services can help you.
Remember:
A hospital Emergency Room (ER) is not the best
place to go for dental pain or infection, because
the ER is not set up to provide full dental care like
a dental office. If you have a dental emergency,
contact your dentist or call Horizon NJ Health at
1-877-7NJ-HEALTH (1-877-765-4325) for help
finding one in your area.
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.KMG?WU?QP?(CEGDQQMv>ViL????V?????????? ??
BlueNotes
? ? ??
?
People in New Jersey are starting to
suffer the effects of a respiratory virus
known as Enterovirus D68, or EV-D68.
A newsletter for Horizon NJ Health Members
horizonNJhealth.com
Issue 4, 2014
MEMBER SERVICES
Our Member Services toll free
number is: 1-877-7NJ-HEALTH
(1-877-765-4325),
24 hours a day, seven days a week.
Members with speech or hearing
impairments may call TDD/TTY
toll free at 1-800-654-5505.Horizon NJ Health
210 Silvia Street
West Trenton, NJ 08628
Help Protect Yourself
and Loved Ones
Against Enterovirus
People who have EV-D68 have mild to
severe respiratory symptoms, and some
infections can be serious.
Mild symptoms are runny nose, sneezing, cough,
body and muscle aches, and sometimes fever.
Severe symptoms include difficulty breathing
and worsening asthma symptoms.
EV-D68 is spread through close contact with
infected people. The virus can spread when an
infected person coughs or sneezes. You can
also become infected by touching things with
the virus on them then touching your mouth,
nose or eyes.
Most people who get the virus will not need
treatment. Those with serious illness may need
to go to the hospital.
How can you keep from getting EV-D68?
? Wash your hands with soap and water for 20 seconds,
especially after changing diapers. Don?t rely on hand
sanitizer because it does not work against EV-D68.
? Don?t touch your ? or a child?s ? eyes, nose or mouth
with unwashed hands.
? When you cough or sneeze, do it into a tissue and
throw it out right away.
? Avoid kissing, hugging and sharing cups or utensils
with people who are sick.
? Keep often-used surfaces such as toys and doorknobs
clean and disinfected, especially if someone is sick.
? If you are sick, stay home!
? Keep up with your shots
(vaccines). It is important
to get a flu shot if you are
elderly, young or have a
chronic illness. This can
help protect you against
other infections and more
severe illness if you are
infected with EV-D68 at
the same time as the flu.
BlueNotes
horizonNJhealth.com Page 2Blue Notes Issue 4, 2014
When to Take Antibiotics
Everyone Needs an Annual Exam
Did you know that
antibiotics do not fight
viral infections like colds, flu,
most sore throats and some
cases of bronchitis?
Taking antibiotics when
they are not needed
may cause you more harm than good.
When antibiotics do not work, it can
cause longer-lasting illnesses, more
doctor visits or extended hospital stays,
the need for stronger medicine, and
life-threatening illness.
Here are some simple things you should
and should not do to help your medicine
be effective:
Do:
n Talk with your doctor about the right use
of antibiotics.
n Take antibiotics exactly as the doctor tells you.
Keep taking the medicine even if you feel better.
n Make sure your children take medicine
as prescribed.
Do NOT:
n Take an antibiotic (unless instructed by
your doctor) for a viral infection like:
? Colds or flu
? Most coughs and bronchitis
? Sore throats not caused by strep
? Runny noses
n Demand antibiotics when a doctor says they
are not needed.
n Skip medication doses, save it for later use,
or let anyone else use it.
n Use alcohol. Alcohol may prevent antibiotics
from being effective.
You do not have to be sick
to go to the doctor.
It is a good idea to make an appoint-
ment with your Primary Care Provider
(PCP) at least once a year for a checkup.
This visit is a great time to talk to
your doctor about any health concerns
you have and get important health
readings like blood pressure and
cholesterol. Your doctor can also tell
you about other screenings you might
need based on your age, health history
and other risk factors.
Regular checkups help stop health problems before they
start. They also help find problems early when your chances
of a cure are much better. Having a relationship with your
PCP will also keep you from having to go to the emergency
room for things that are not emergencies.
Children need routine visits, too. It is important for
children to get well care, immunizations, eye exams,
dental exams and lead screenings to maintain good health.
If you or your child have not visited your PCP in a while,
call to make an appointment today. If you do not know
who your PCP is, look on your Horizon NJ Health ID card ?
his or her name and phone number are on the front.
If you would like to change your PCP, call Horizon NJ Health
Member Services at 1-877-765-4325. TTY: 1-800-654-5505.
Prior Approval for Medical Services
Horizon NJ Health has a Utilization Management department that
works with your providers to help make sure you get all the services you
need. If your doctor thinks you need a service that requires prior approval
(or preauthorization) from Horizon NJ Health, he or she will contact us to
get approval for you.
As a Horizon NJ Health member, you have a right to appeal Horizon
NJ Health?s preauthorization decision about your service. To do this,
please call Member Services at 1-877-7NJ-HEALTH (1-877-765-4325),
TTY: 1-800-654-5505. Detailed information about how to appeal a
decision is also in your Horizon NJ Health Member Handbook.
horizonNJhealth.com Page 3Blue Notes Issue 4, 2014
Did You Get
your Flu Shot?
It is not too late. Although
October and November are the
best times to get your shot, you
can still get a flu shot through the
winter. Call your doctor today.
It is most important for these people
to get their seasonal flu shot:
? Pregnant women
? Children over 6 months of age and
young adults
? People who live with or care for children
younger than 6 months of age
? People with chronic disease such as
asthma, diabetes, heart disease,
kidney or liver disease and cancer
Being pregnant is
such an exciting time!
Taking care of yourself
while you are pregnant
can give your baby a
great start at life.
The Horizon NJ Health
GEMS program can help.
GEMS means ?Getting
Early Maternity Services.?
Joining our program will help you with:
? Getting visits with an obstetrician/gynecologist
(OB/GYN) doctor: you should start getting care
during your first trimester (first 14 weeks)
of pregnancy.
? Access to specialists: These are other doctors
who can care for you during your pregnancy,
including your dentist.
? Care and Case Management: Our case managers
can speak with you 24 hours a day, seven days
a week to answer your questions.
? Transportation: Some members can get help to
and from doctor appointments. Call your GEMS
case manager or LogistiCare at 1-866-527-9933
(TTY: 1-866-288-3133) to learn more.
? Nutrition advice: Learn more about healthy eating
that can help you and your baby grow.
? Breastfeeding: Breastfeeding is the healthiest choice
for your baby. Call WIC at 1-866-44NJWIC
(1-866-446-5942) or your GEMS case manager for
information and help.
? Nurse visits: In some cases, a nurse may be able to
visit you to answer questions about your baby?s care.
? Health care for your baby during his or her first
60 days of life.
It is important to care for yourself after your baby
is born as well. Our GEMS team will help
you schedule your postpartum doctor appoint-
ment. This checkup should be within 21 and
56 days of your baby?s birth date.
The sooner your sign up for the GEMS program,
the better your chances are of having a healthy,
full-term baby. Call the Horizon NJ Health GEMS
Prenatal Program toll-free at 1-800-682-9094
(TTY: 1-800-654-5505) and ask for the
GEMS department.
horizonNJhealth.com Page 4Blue Notes Issue 4, 2014
? ??? ?
?Member Services 1-877-7NJ-HEALTH
(1-877-765-4325) (TTY: 1-800-654-5505)
24 hours a day, seven days a week.
horizonNJhealth.com
Fraud, Waste and Abuse Hotline:
1-855-FRAUD20 or 1-855-372-8320
(TTY: 1-800-654-5505)
BLUE NOTES is published as a community service for the friends and patrons of
Horizon NJ Health, 210 Silvia St., West Trenton, NJ 08628. Information in
BLUE NOTES comes from a wide range of medical experts. If you have any concerns
or questions about specific content that may affect your health, please contact
your health care physician. Models may be used in photos and illustrations.
Horizon NJ Health is part of the Horizon Blue Cross Blue Shield of New Jersey enterprise,
an independent licensee of the Blue Cross and Blue Shield Association.
? 2014 Horizon Blue Cross Blue Shield of New Jersey.
Three Penn Plaza East, Newark, NJ 07105
Keeping Your Children at a Healthy Weight
Gaining too much weight is a
very serious health problem
for children, teens and adults.
It is especially important to help keep your children
at a healthy weight to help prevent serious health
problems as they get older. Carrying extra weight
can put your child at risk of:
? Heart disease, high blood pressure, diabetes and
problems breathing and sleeping
? Being depressed or sad
More children are becoming overweight. If your child is overweight, the best way reach a healthy
weight is to be more active and eat healthy food. Have your family work as a ?team? to help:
? Buy healthier foods like fruit, vegetables, lean meat (like chicken and fish), whole grains
(like brown rice and whole-wheat bread), and low-fat dairy (like milk, cheese and yogurt).
? Involve your child in planning and making meals so they can learn about good nutrition.
? Read nutrition labels and control portion sizes.
? Limit snacking times. Monitor what your child eats at school.
? Take part in community or school activity programs.
? Be active as a family, like taking a walk or bike ride
together every night.
? Limit time spent being inactive, such as watching TV
and playing video games.
? Reward your child with things other than food.
? Give your child praise so he/she is encouraged
to stay on a healthy path.
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.KMG?WU?QP?(CEGDQQMv>ViL????V?????????? ??
BlueNotes
horizonNJhealth.com
Changes Ahead for Those who Get Long-Term Care
Our Member Services toll free
number is: 1-877-7NJ-HEALTH
(1-877-765-4325),
24 hours a day, seven days a week.
Members with speech or hearing
impairments may call TDD/TTY
toll free at 1-800-654-5505.
MEMBER SERVICES
Horizon NJ Health
210 Silvia Street
West Trenton, NJ 08628
A newsletter for Horizon NJ Health Members Issue 2, 2014
Horizon NJ Health will start to
provide Managed Long-Term
Services and Supports (MLTSS),
which are home- and community-
based services that are now
managed by the Medicaid
program. The MLTSS program
will keep all of your services
under one program to make
things easier for you.
MLTSS benefits include assisted living, community, residential, mental health, and substance
abuse services, as well as wellness and recovery programs. It also affects people in these
Medicaid programs:
? AIDS Community Care Alternatives Program (ACCAP)
? Community Resources for People with Disabilities (CRPD)
? Global Options for Long-Term Care (GO)
? Traumatic Brain Injury (TBI)
If you currently get these services, you do not have to do anything for this change.
The services will be moved under Horizon NJ Health automatically.
Horizon NJ Health looks forward to providing your MLTSS starting in July 2014.
BlueNotes
horizonNJhealth.com Page 2Blue Notes Issue 2, 2014
Care/Case/Disease
Management Programs
Complex Case Management
Horizon NJ Health offers a holistic approach
to help manage all your health care needs
and will assist to coordinate services.
Our Care Management Programs teach members
how to manage their disease. Members get
educational information, access to resources and
phone calls from Horizon NJ Health nurses to help
them reach their personal program goals.
Horizon NJ Health provides support and education
for the following disease management programs
but is not limited to:
? Congestive heart failure (CHF)
? Chronic obstructive pulmonary disease (COPD)
? Diabetes
? High blood pressure (hypertension)
? Asthma
Members may receive outreach, to
participate in care management by:
? Your PCP?s suggestion
? Self referral
If you would like to enroll in
a care management program,
please call Horizon NJ Health
toll free at 1-800-682-9094,
extension 89634
(TTY: 1-800-654-5505).
All members are
entitled to care
management and
can disenroll from
care management
at any time.
Horizon NJ Health has staff dedicated
to help members who have had a
major health event or diagnosis.
If you need these complex case management
services, our nurses and care managers can help
you get the care you need and guide you through
the health care system.
Our goal is to help the member get as healthy as
possible as quickly as possible. We can help find
the best facility for treatment and share information
about extra resources that may be available.
Each member under our complex care management
program will receive a personal care management
plan with performance goals, resources and
benefits. We help the member carry out the plan,
monitoring the member?s progress and following up
with phone calls to help address any issues.
We use many sources of information to find
members who may need help: when your doctor
sends us his bill, if you take certain medications, if
you have been to the emergency room or admitted
to the hospital, or your doctor asks us to help you.
Please call Horizon NJ Health at 1-800-682-9094,
extension 89634 if you would like help
(TTY: 1-800-654-5505).
horizonNJhealth.com Page 3Blue Notes Issue 2, 2014
Complex Case Management
Horizon NJ Health would like to let you
know about recent changes to our drug
formulary list. The changes found in
the list on the right will be added to
our drug formulary list on the Horizon
NJ Health website, horizonNJhealth.com.
If you would like a paper copy of the
drug formulary list, please call Member
Services toll-free at 1-877-765-4325
(TTY: 1-800-654-5505), 24 hours a day,
seven days a week, and ask for one.
Please talk with your primary care
provider (PCP) about these changes.
If your PCP decides that, for medical
reasons, you must take a drug that is
not on the formulary list or needs
pre-approval, including a brand name
medication exception, he or she can
call us and ask for special permission
(prior authorization) for you to get
the drug.
Formulary Change
Description
Brand (Generic)
Drug Name
Alternatives
(if Applicable)
Not Covered Oruvail (ketoprofen ER)
Motrin (ibuprofen), Naprosyn
(naproxen), Lodine (etodolac),
Daypro (oxaprozin), Relafen
(nabumetone), Voltaren
(diclofenac), Mobic (Meloxicam)
Not Covered Lidex (fluocinonide) solution
Aristocort A (triamcinolone),
Kenalog (triamcinolone),
Topicort (desoximetasone)
Not Covered
Diprolene (betametha-
sone dipropionate
augmented) ointment
Temovate/Temovate E/Clobex
(clobetasol), Ultravate
(halobetasol propionate),
Diprosone (betamethasone
dipropionate) ointment
Covered
Diprosone (betametha-
sone dipropionate)
ointment
Covered Vitafol-One (prenatal vitamin)
Covered Sirturo (bedaquiline)
Covered Cystaran (cysteamine)
Covered Tecfidera (dimethyl fumarate)
Covered
Abilify Maintena
(aripiprazole)
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,I?\RX?ZRXOG?OLNH?D?SULQWHG?FRS\?RI?DQ\?PDWHULDO?IRXQG?RQ?RXU?ZHEVLWH??SOHDVH?FDOO?0HPEHU?6HUYLFHV?WROO?IUHH?DW???????0,?*'#.6*?
????????????????:H?DUH?DYDLODEOH????KRXUV?D?GD\????GD\V?D?ZHHN?3HRSOH?ZLWK?KHDULQJ?RU?VSHHFK?GLIILFXOWLHV?FDQ?FDOO?RXU?7''?77<?VHUYLFH?DW????????????????
YYY?JQTK\QP0,JGCNVJ?EQOYYY?JQTK\QP0,JGCNVJ?EQOYour PCP may call the Horizon NJ Health Pharmacy Department at 1-800-682-9094 to request a prior authorization. A pharmacy representative is available 24 hours a day, seven days a week.
Formulary
Changes
horizonNJhealth.com Page 4Blue Notes Issue 2, 2014
Did you know that Horizon NJ Health covers
many over-the-counter (OTC) products with
a prescription?
Examples of different OTC classes are listed below:
If, for medical reasons, you cannot switch to an OTC
alternative, please contact the Pharmacy department
at 1-800-682-9094, extension 81014, to request prior
authorization. Office hours are Monday through
Friday from 8 a.m. and 6 p.m. and Saturday from
9 a.m. to 4:30 p.m. A pharmacist is available 24 hours
a day, seven days a week.
The drug formulary is available on the Horizon
NJ Health website, horizonNJhealth.com, or
you can call Member Services at 1-877-765-4325
TTY: 1-800-654-5505) for a copy of the formulary
guide.
Over the Counter (OTC)
Product Availability
Common
Symptom
Preferred OTC Medications
[Brand Tradenames]
Allergies
Generic OTC Loratadine [Claritin](Tablets or
Syrup), Loratadine Oral-Disintegrating Tablets
(Alavert), Loratadine-D [Claritin-D]
OTC Cetirizine [Zyrtec](Tablets, Chewable
Tablets or Syrup), Cetirizine ?D [Zyrtec-D]
OTC Fexofenadine [Allegra Allergy],
Fexofenadine ?D [Allegra-D]
Heartburn Prilosec OTC, Zegerid OTC, Prevacid 24HR
Vaginal
Anti-Fungals
Generic OTC Clotrimazole [Gyne-Lotrimin,
Mycelex] or OTC Miconazole [Monistat ] or
Tioconazole [Vagistat-1] Vaginal products
Cold Sores Abreva
Allergies
(Eye Drops)
Zaditor OTC, Alaway, Generic Naphcon-A,
Opcon-A
Cough and Cold Most products, including Robitussin, Pediacare, Dimetapp, Mucinex
Lice OTC Permethrin [Nix]
At Horizon
NJ Health,
we care about
the treatment
you get from
your doctors.
We want to make
sure you get the
very best care.
If you are not happy with any health care
service you get, or you feel you were not
treated well, you can call Member
Services toll free at 1-877-765-4325
(TTY: 1-800-654-5505), 24 hours a day,
seven days a week.
You could also send a letter to:
Horizon NJ Health
Attn: Member Complaints
200 Stevens Drive
Philadelphia, PA 19113-1570
We will look into your complaint. You will
receive an answer from Horizon NJ Health.
? If your complaint is an emergency,
we will look into it right away.
? If your complaint is about urgent care,
you will get a response within 48 hours.
? If you submit a complaint by mail, we will
try to contact you by telephone within
24 hours of receiving your complaint.
If your complaint is not resolved within five
business days, you will get a written notice
about the outcome within 30 calendar days
from when we receive your complaint.
For more information about complaints,
please refer to your Horizon NJ Health
Member Handbook.
If You Have a Complaint
horizonNJhealth.com Page 5Blue Notes Issue 2, 2014
How to Get Mental Health Care
If you are having overwhelming feelings
of sadness, anxiety or depression or
are struggling with substance abuse,
there are resources to help.
Horizon NJ Health provides mental health benefits
for members of the Division of Developmental
Disabilities (DDD). DDD members can call
Horizon Behavioral Health toll free at 1-877-695-5612
(TTY: 1-800-508-6975) for more information.
All other Horizon NJ Health members can get
mental health and/or substance abuse services
through the NJ FamilyCare program.
You do not need a referral from your PCP to
see a mental health or substance abuse provider.
If you think you or a family member needs help with
a mental health or substance abuse problem, call
your primary care provider or the New Jersey Divi-
sion of Mental Health Services at 1-800-382-6717
(TTY: 1-877-294-4356) during business hours.
For after-hours service, call NJ Mental Health Cares
toll-free at 1-866-202-4357 (TTY: 1-877-294-4356).
To get services for children younger than 18 years
old, call the Children?s System of Care at
1-877-652-7624 (TTY: 1-866-896-6975). You can also
call Horizon NJ Health Member Services for help at
1-877-765-4325 (TTY: 1-800-654-5505).
Horizon NJ Health cares about
your total well-being.
You deserve the best health care. As a member of
Horizon NJ Health, you have a partner who will help you
get the care you need. Horizon NJ Health will treat you
with respect and there are certain rights you can expect
from Horizon NJ Health. There are also responsibilities
that Horizon NJ Health expects from you.
To learn more about your rights and responsibilities as
a Horizon NJ Health member, you can view the full list in
your Member Handbook. The rights and responsibilities
are also posted on our website at horizonNJhealth.com.
From the home page, click Member Support, then
Resources, then How Horizon NJ Health Works.
Member Rights & Responsibilities
horizonNJhealth.com Page 6Blue Notes Issue 2, 2014
Member Services 1-877-7NJ-HEALTH
(1-877-765-4325) (TTY: 1-800-654-5505)
24 hours a day, seven days a week.
horizonNJhealth.com
Fraud, Waste and Abuse Hotline:
1-855-FRAUD20 or 1-855-372-8320
(TTY: 1-800-654-5505)
BLUE NOTES is published as a community service for the friends and patrons of
Horizon NJ Health, 210 Silvia St., West Trenton, NJ 08628. Information in
BLUE NOTES comes from a wide range of medical experts. If you have any concerns
or questions about specific content that may affect your health, please contact
your health care physician. Models may be used in photos and illustrations.
Horizon NJ Health is part of the Horizon Blue Cross Blue Shield of New Jersey enterprise,
an independent licensee of the Blue Cross and Blue Shield Association.
? 2014 Horizon Blue Cross Blue Shield of New Jersey.
Three Penn Plaza East, Newark, NJ 07105
BlueNotes
How to Find a Doctor
Using the Online
Provider Directory
It is easy to find a doctor
to fit your needs using our
online provider directory.
To use the directory,
go to our website at
horizonNJhealth.com.
Click Need a Doctor on the
right side of your screen.
From this page, you can
search for primary doctors,
specialists, hospitals, dentists, pharmacies and other
health care services.
The best way to narrow your search is to click on
the Advanced Physician Search link. If you know the
name of the provider you are looking for, enter his
or her last name in the Last Name field. Or, to see a
list of providers in your area, enter your ZIP code in
the ZIP Code field. There is a large list of specialties
to choose from ? pick the specialty you need from
the drop-down menu.
To search a larger or smaller region, you can define
your search by filling any of these fields: city, county,
state, and search radius. If you prefer a male or
female provider or someone who speaks a different
language, you can search using these fields, too.
On the right side of your screen, you can narrow
your search by checking any of the boxes that are
important to you, such as wheelchair accessible
offices.
Using all of these search features can help you
find the best provider for you. If you have any
questions about using the provider directory or
choosing a doctor, you can call Member Services at
1-877-765-4325 (TTY: 1-800-654-5505).
As a Horizon NJ Health member,
you have access to the largest network
of Medicaid doctors in the state.
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