MLTSS Member Newsletters

Tikka Attach

Care Notes

horizonNJhealth.com

Issue 2, 2019

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21

In This Issue
Our commitment to quality ................................................ 1
Protecting you from the growing measles outbreak ......... 2
Updates to your NJ FamilyCare MLTSS services ............... 3
American Sign Language Services ..................................... 3
Remember to renew your NJ FamilyCare coverage .......... 3
Do you have both Medicaid and Medicare? ....................... 4
Updates to the Internal Appeal process ............................ 4
Do you have a backup plan? ............................................... 5
Questions about your housing options?
Our Housing Specialist can help. ........................................ 5
Breast cancer: the best prevention is early detection ....... 6
Formulary changes .............................................................. 7
Reminder: you have access to Member Advocates ........... 8
Prescription opioid pain medicine:
how to prevent misuse ........................................................ 9
Member rights and responsibilities .................................... 9
Notice of Nondiscrimination ............................................. 10
How we use and protect your private information .......... 11

Horizon NJ Health
wants to make sure you
have the information
you need to take
care of your health.
Our specially-trained
representatives are here
to help you understand
your benefits. If you
have any questions,
please call Managed
Long Term Services
& Supports (MLTSS)
Member Services at
1-844-444-4410
(TTY 711), 24 hours a
day, seven days a week,
365 days a year.

Our commitment to quality
Horizon NJ Health?s Quality Improvement (QI)
program works with members and providers
to improve the quality of care and services
you receive. Our QI program ensures these
services continue to be appropriate, necessary
and properly administered. We monitor
areas that affect the care our members get,

like access to care, screenings and member
satisfaction. For more information about
Horizon NJ Health?s QI program and its
progress toward goals, visit
horizonNJhealth.com/quality, or call
Member Services at 1-844-444-4410 (TTY
711) and ask for the Quality Department.

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21

Protecting you from the growing
measles outbreak
According to the Centers for Disease Control
and Prevention (CDC), 1,164 measles cases
have been confirmed in 30 states as of July.
This is the largest outbreak of measles in the
United States since 2000. There are currently
17 confirmed cases in New Jersey.

Symptoms
Measles is considered the most deadly of all
childhood rash/fever illnesses. Measles can
cause serious health problems such as ear
infections, pneumonia, swelling of the brain
and miscarriage in pregnant women.

Symptoms may include:
? Cough

? High fever

? Rash

? Red watery eyes

? Runny nose

If you have symptoms and could have been
exposed to the disease, please call your
doctor immediately.

How to protect your family
The MMR (measles, mumps and rubella)
vaccine protects children from measles,
mumps and rubella.

Vaccines are an important part of keeping
your child healthy ? today and in the future.
Please make sure your child is up to date
on all recommended vaccinations. If you
received the measles vaccine between 1963
and 1968, speak with your doctor about
getting revaccinated. Booster vaccines are not
necessary for those who received two doses
of measles vaccine as children. According to
the United States vaccination schedule, these
people are protected for life and do not ever
need a booster dose.

Unsure about your immunity?
If you are unsure whether you are immune
to measles, you should first try to find
your vaccine records or documentation of
measles immunity. If you do not have written
documentation of measles immunity, you
should get the MMR vaccine.

Another option is to have a doctor test your
blood to determine whether you are immune.
There is no harm in getting another dose of
MMR vaccine, even if you are already immune
to measles (or mumps or rubella).

Not sure if you are fully vaccinated? Talk with
your doctor.

Source: cdc.gov

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43

Updates to your NJ FamilyCare MLTSS services
At Horizon NJ Health, we will always let you know when there are changes to your
health benefits. As of April 1, 2019, there are changes to Office Based Addiction
Treatment services. Please take a moment to review the changes below. You can also
view a complete list of covered benefits at horizonNJhealth.com/covered_benefits.

? Office Based Addiction Treatment and Navigator Services: covered.

? Prescription Drugs (retail pharmacy):
Coverage includes:
o Atypical antipsychotics
o Buprenorphine/naloxone, buprenorphine, naltrexone and methadone or any other drug

within this category when used for treatment of opioid dependence
o Drugs that may be excluded from Medicare Part D coverage

Coverage excludes:
o Erectile dysfunction drugs; and
o Drugs not covered by a third-party Medicare Part D formulary

If you have any questions, please call Member Services toll free at 1-844-444-4410 (TTY 711)
24 hours a day, seven days a week.

Remember to renew your NJ FamilyCare coverage
As an NJ FamilyCare member, you must renew your coverage on time. If you miss
your renewal deadline, you may lose health coverage for you and your family.

Important reminders
? Check your mail: You may receive a form or blank application from NJ FamilyCare that you

will need to complete.
? Respond to any written requests right away: If NJ FamilyCare asks you to complete an

application, do so as soon as possible so there is no disruption in your coverage.
To renew your coverage, contact NJ FamilyCare at 1-800-701-0710 (TTY 1-800-701-0720)
or your eligibility agency, such as your local County Welfare Agency (CWA).

American Sign Language Services
Member Services handles all requests for American Sign Language (ASL) Services under
your covered benefits. Member Services will confirm eligibility and connect you to these
services. Requests require at least five business days. If you need to cancel or change a
service for any reason, Member Services can assist you by calling 1-844-444-4410 (TTY 711).

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4
Do you have
both Medicaid
and Medicare?

Horizon NJ Health members who have or who are
eligible for Medicare may also be eligible for
Horizon NJ TotalCare (HMO SNP). This plan
combines all covered Medicare and Medicaid
managed care benefits into one easy-to-use,
no-cost plan. Horizon NJ TotalCare (HMO SNP)
members have the following benefits:

? $245 per quarter to purchase health items
from the Health Products Benefit Catalog

? An additional $250 per quarter on a prepaid
Over-the-Counter (OTC) Benefit Card to purchase
eligible health care products from participating retail stores

? FitnessCoach? Program offering a free membership at participating fitness centers and
YMCAs, or free Home Fitness Kits

To learn more, call 1-888-328-5736 (TTY 711), 24 hours a day, seven days a week, or visit
HorizonBlue.com/TotalCare.

Additional
Benefits

$0 Cost
for Benefits

Dedicated
Care Manager

$0 Copay
for Prescription

Drugs

No Referrals
Needed

One ID Card

Horizon NJ TotalCare
(HMO SNP)

3

Updates to the Internal Appeal process
Horizon NJ Health has a process for members who ask us to review and change our decision if
we have denied or reduced services. This is called an Internal Appeal. There is an update to when
members can ask for a faster review time and how they can do so. If you or your treating provider
believe the 30 calendar-day decision timeframe is too long and could harm your health, you can
call us and ask for a fast appeal. During a fast appeal Horizon NJ Health will decide your Internal
Appeal within 72 hours of receiving it. You may ask for a fast appeal:

? If you are an inpatient in a facility,

? If the care you received was for an urgent or emergency health concern, OR

? It is medically necessary and taking 30 calendar days to decide the appeal could seriously
harm you in some way.

To ask for a fast appeal, please call 1-800-682-9094 x89606 (TTY 711), Monday through Friday,
8:30 a.m. to 5 p.m., Eastern Time (ET).

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5
MLTSS members have a set schedule for
the in-home services and care they receive.
However, there may be times when service
gaps could unexpectedly occur, such as a
Personal Care Assistant who is unable to show
up for a regularly scheduled home visit. This
is why all MLTSS members must develop a
backup plan with their Care Manager.

A backup plan includes:
? Telephone number of the agency or

person expected to provide back-up
care if the primary person cannot

? Instructions on how the member should
report the gap in care to his or her
Care Manager

? Member?s preference for having the
back-up care provided under these
unplanned circumstances

The MLTSS Care Manager works with
members, their caregivers and families as
well as service providers to make sure a plan
can be developed to address unexpected
cancellations. Members should keep a copy
of their backup plan handy.

If a service is unexpectedly canceled,
a member should:
? Call his or her Care Manager

? Call MLTSS Member Services at
1-844-444-4410 (TTY 711)

If you don?t already have a backup
plan, work with your Care Manager
to create one as soon as possible.

Horizon NJ Health has a Housing Specialist
who works closely with MLTSS members,
Care Managers, and state and county resource
agencies to help identify housing resources
in the community. Our Housing Specialist can
help the Care Team identify a community-
based residence for a member transitioning
out of a nursing facility. She can also provide
information and assistance about landlord-
tenant rights and how to apply for subsidized
housing vouchers.

The Housing Specialist helps members research
their housing options and gives them resources
for supportive housing service agencies that
can help meet their needs, such as:

? New Jersey County Boards of Social
Services: state.nj.us/humanservices/dfd/
programs/njsnap/cbss/index.html

? NJ 2-1-1: nj211.org or 1-877-652-1148
(TTY 711)

? New Jersey affordable developments by
county: state.nj.us/dca/divisions/codes/
publications/developments.html

Do you have a backup plan?

Questions about your housing options?
Our Housing Specialist can help.

6

If you would like to speak with the Horizon NJ Health Housing Specialist, please call
1-844-444-4410 (TTY 711), Monday through Friday, from 8:30 a.m. to 5 p.m., ET.

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5 6

Breast cancer: the best prevention
is early detection
A mammogram is the best way to find breast cancer early, when it is most treatable. Women should
have their first baseline mammogram between the ages of 35 and 39, and then once every year.

A mammogram can:
3 Detect symptoms years before you can feel a lump.

3 Take as little as 20 minutes with minimal discomfort for most women.

3 Save your life.

Routine mammograms are covered, at no cost to you.
Get a prescription from your doctor and schedule your mammogram today. If you have concerns
that are preventing you from getting your mammogram, please call Horizon Healthy Journey at
1-844-754-2451 (TTY 711), Monday through Friday, 8:30 a.m. to 5 p.m., ET.

EVERY 2 MINUTES
a woman is

DIAGNOSED
with breast cancer
in America.

1 IN 8
WOMEN
will develop
BREAST CANCER
in their lifetime.

3 out of 4
women who get

breast cancer have
NO family history of illness.

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107 8

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
limits and drugs requiring prior authorization, on the Horizon NJ Health website.

Here is a list of recent changes:

Covered Change Description Brand (Generic) Drug Name Alternatives (if applicable)
Covered Arikayce (amikacin liposome) ?

Covered Copiktra (duvelisib) ?

Covered Vitrakvi (larotrectinib) ?

Covered Xospata (gilteritinib) ?

Covered Delstrigo (doravirine, lamivudine, tenofovir disoproxil) ?

Covered Juluca (dolutegravir/ rilpivirine) ?

Covered Symtuza (darunavir, cobicistat, emtricitabine, tenofovir) ?

Covered Prevymis (letermovir) ?

Covered Nivestym (filgrastim-aafi) ?

Covered Udenyca (pegfilgrastim-cbqv) ?

Covered Revcovi (elapegademase-lvlr) ?

Covered Generic Epclusa (Sofosbuvir/Velpatasvir) ?

Covered Oxervate (cenegermin-bkbj) ?

Covered Incruse Ellipta (umeclidinium bromide) ?

Covered Takhzyro (lanadelumab-flyo) ?

Covered Aimovig (erenumab-aooe)

Not Covered Cafergot (ergotamine with caffeine)
Sumatriptan, Rizatriptan/Rizatriptan orally
disintegrating tablet (ODT) or Naratriptan

Not Covered Doral (quazepam)
Alprazolam, Clonazepam, Diazepam,

Lorazepam, Oxazepam, Temazepam 15mg,
Temazepam 30mg

Not Covered Restoril (temazepam) 7.5 mg, 22.5 mg
Temazepam 15mg, Temazepam 30mg,

Alprazolam, Clonazepam, Diazepam,
Lorazepam, Oxazepam

Not Covered Spiriva Handihaler (tiotropium) Incruse Ellipta

Formulary Changes

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107 8

Covered Change Description Brand (Generic) Drug Name Alternatives (if applicable)
Not Covered Tudorza Pressair (aclidinium bromide) Incruse Ellipta

Not Covered Opium tincture
loperamide, diphenoxylate/atropine,

bismuth subsalicylat

Not Covered Carafate (sucralfate) oral suspension generic Carafate tabs

Not Covered Naprosyn (naproxen) Suspension Ibuprofen suspension

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. Please note that
Horizon NJ Health maximum days supply limit is 30 days.

New generics
Horizon NJ Health is committed to providing the most up-to-date information regarding new
generics that are available to the market, and we encourage using generic products prior to using
brand name products when appropriate. Generic drugs are the same as brand name drugs in
quality, strength, purity and stability, as required by the Food and Drug Administration.

The following generic drugs are currently on the market or expected to be on the market within
the next three (3) months.

Generic name Brand Name
Ambrisentan Letairis

Dalfampridine Ampyra

Clozapine Fazaclo Orally Disintegrating Tablet (ODT)

Your PCP may call the Horizon NJ Health Pharmacy Department at 1-800-682-9094
to request a prior authorization.

All MLTSS members have access to a Member Advocate. Member Advocates work with you to
make sure any questions about your MLTSS benefits, services and decisions are answered. He
or she works closely with you, your care team and state representatives to make sure your needs
and goals are being met.

To speak with a Member Advocate, please call 1-844-444-4410 (TTY 711), Monday through
Friday, from 8 a.m. to 5 p.m., ET.

Reminder: you have access
to Member Advocates

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9 10

As a Horizon NJ Health member, you have rights, responsibilities and choices in the care
you get. Your member rights and responsibilities can be found in your Horizon NJ Health
MLTSS Member Handbook, or at horizonNJhealth.com/memberrights.

Member rights and responsibilities

If your doctor prescribes an opioid medicine like oxycodone (OxyContin), hydrocodone (Vicodin)
or methadone for your pain, there are important things you should know to help keep you safe.
Opioids are dangerous because they can cause serious side effects and can be very addictive.

If you are prescribed an opioid pain medicine:
? Take the medication exactly as

prescribed by your doctor.

? Tell your doctor about any other
prescription or over-the-counter
medicines you are taking.

? Do NOT drink alcohol.
? Store your medicine in a safe place,

out of reach from children and others.

? Tell your doctor about any side effects.

? Discard leftover pills safely.

? Do not share these medicines with others.

Opioid alternatives
First discuss with your doctor all your pain
treatment options and your concerns. There
may be safer medications that can help you.

If you are struggling with opioid addiction,
talk to your doctor, your Care Manager or
call Member Services at 1-844-444-4410
(TTY 711), 24 hours a day, seven days a week.

Source: U.S. Department of Health & Human Services:
hhs.gov/opioids

Prescription opioid pain medicine:
how to prevent misuse

More than 47,000
people died from
an opioid overdose

2.1 million
people had an

opioid use
disorder

11.4 million
people misused
prescription opioids

MLTSS_CareNotes_2019_Issue2_Final.indd 10 8/22/19 3:06 PM



9 10

Notice of Nondiscrimination Notice of Nondiscrimination


086-19-100 CMC0008179C (0719) An Independent Licensee of the Blue Cross and Blue Shield Association.


Horizon NJ Health complies with applicable Federal civil rights laws and does not discriminate against nor does it
exclude people or treat them differently on the basis of race, color, gender, national origin, age, disability, pregnancy,
gender identity, sex, sexual orientation or health status in the administration of the plan, including enrollment and benefit
determinations. Horizon NJ Health provides free aids and services to people with disabilities (e.g. qualified language
interpreters and information in other formats) and to those whose primary language in not English (e.g. information in
other languages) to communicate effectively with us.


Contacting Member Services
Call Member Services at 1-844-498-9393 (TTY 711) or the phone number on the back of your member ID card, if
you need the free aids and services noted above and for all other Member Services issues.


Filing a Section 1557 Grievance
If you believe that Horizon NJ Health has failed to provide the free communication aids and services or discriminated
against you for one of the reasons described above, you can file a discrimination complaint also known as a Section 1557
Grievance. Horizon NJ Health?s Civil Rights Coordinator can be reached by calling the Member Services number on the
back of your member ID card or by writing to:


Horizon NJ Health
Civil Rights Coordinator
PO Box 10194
Newark, NJ 07101



You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights
Complaint Portal, online at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail at U.S. Department of Health and
Human Services, 200 Independence Avenue, SW, Room 509F, HHH Building, Washington, D.C. 20201 or by phone
at 1-800-368-1019 or 1-800-537-7697 (TDD). OCR Complaint forms are available at
www.hhs.gov/ocr/office/file/index.html.


Language assistance
Si habla espa?ol, tiene a su disposici?n servicios gratuitos de asistencia ling??stica. Llame al 1-844-498-9393 (TTY 711).

?????????????????????????????? 1-844-498-9393?TTY 711?.
??: ???? ????? ??, ?? ?? ???? ??? ???? ? ????.
1-844-498-9393 (TTY 711)??? ??? ????.
ATEN??O: Se fala portugu?s, encontram-se dispon?veis servi?os lingu?sticos, gr?tis. Ligue para 1-844-498-9393
(TTY 711).



UWAGA: Je?eli m?wisz po polsku, mo?esz skorzysta? z bezp?atnej pomocy j?zykowej. Zadzwo? pod numer
1-844-498-9393 (TTY 711).
ATTENZIONE: In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare
il numero 1-844-498-9393 (TTY 711).

?????? ??????? ???????? ????? ??? ?????? ???? ????? ??? ??? :?????? ???? ???? .??????? ??1-844-498-9393 ?????? ???? ???? ???)711.(
PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang
bayad. Tumawag sa 1-844-498-9393 (TTY 711).
????????: ???? ?? ???????? ?? ??????? ?????, ?? ??? ???????? ?????????? ?????? ????????. ???????
1-844-498-9393 (???????? 711).
ATANSYON: Si w pale Krey?l Ayisyen, gen s?vis ?d pou lang ki disponib gratis pou ou. Rele 1-844-498-9393 (TTY
711).




CH? ?: N?u b?n n?i Ti?ng Vi?t, c? c?c d?ch v? h? tr? ng?n ng? mi?n ph? d?nh cho b?n. G?i s? 1-844-498-9393
(TTY 711).
ATTENTION : Si vous parlez fran?ais, des services d'aide linguistique vous sont propos?s gratuitement. Appelez le
1-844-498-9393 (ATS 711).

???? ??? ? ??? ?????? ??? ??? ????? ?? ??? ?? ???? ?? ?? ?? ???? ????? ???? ?? ??? :??????
1-844-498-9393 (TTY 711).

MLTSS_CareNotes_2019_Issue2_Final.indd 11 8/22/19 3:06 PM



Care Notes

Member Services 1-844-444-4410 (TTY 711) 24 hours a day, seven days a week. horizonNJhealth.com
CARE NOTES is published for members of Horizon NJ Health, 1700 American Blvd., Pennington, NJ 08534. Information in
CARE 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 TotalCare (HMO SNP) is an HMO Medicare Advantage Dual Eligible Special Needs plan with a Medicare contract and
a contract with the State of New Jersey Medicaid Program. Enrollment in Horizon NJ TotalCare (HMO SNP) depends on contract
renewal. 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. 086-19-97

Y0090_H8298_EC003624B_M

You can stay up-to-date with the latest company
news and health and wellness information. Follow
us on Twitter,? twitter.com/HorizonNJHealth.

Horizon NJ Health has joined active users on
Facebook? with our own corporate page,
facebook.com/HorizonNJH

How we use and protect your
private information

Horizon NJ Health is required to notify members of the availability of our Notice of
Privacy Practices, which can be found at horizonNJhealth.com/privacy-policy.
This Notice has important information about how Horizon NJ Health uses, discloses

and protects member information, as well as rights that members have regarding their protected
health information (PHI).

Horizon NJ Health complies with applicable federal civil rights laws and does not discriminate on
the basis of race, color, gender, national origin, age, disability, pregnancy, gender identity, sex,
sexual orientation or health status in the administration of the plan, including enrollment and
benefit determinations.

MLTSS_CareNotes_2019_Issue2_Final.indd 12 8/22/19 3:06 PM



Care NotesISSUE 3, 2019

Your health care needs
are important to us.



Horizon NJ Health wants to make sure you have the information you need to take care of your
health. Our specially-trained Member Services Representatives are here to help you understand
your benefits. If you have any questions, please call Managed Long Term Services & Supports
(MLTSS) at 1-844-444-4410 (TTY 711), 24 hours a day, seven days a week, 365 days a year.

In this issue
Reminder: get your flu shot ..................................................... 2

You may be eligible for Horizon NJ TotalCare (HMO D-SNP) ... 3

What you need to know about prostate cancer ....................... 4

Changes to management of the Horizon
Behavioral Health Program ....................................................... 4

Be prepared for an emergency ................................................ 5

Renew it or lose it! .................................................................. 6

How to choose a Personal Representative .............................. 6

Our commitment to quality ...................................................... 6

Managing your congestive heart failure ................................... 7

Adult Protective Services ......................................................... 8

Reminder: you have access to Member Advocates ................. 8

Formulary changes .................................................................. 9

Managing your medication ......................................................10

A reminder about lab services ................................................10

Member rights and responsibilities .........................................10

Online member support ..........................................................10

Nutrition and your health .........................................................11

NJ Peer Recovery ...................................................................11

Do you want to get your high school diploma?
We can help. ...........................................................................12

Information about your provider ..............................................12

Look out for health insurance fraud .........................................13

Notice of Nondiscrimination ....................................................14

2

Reminder: get your flu shot

Myth: The flu shot can give me the flu.
Truth: The flu shot does not cause the flu. The
shot is not an active form of the virus and is not
infectious. Some people may have a mild reaction
to the flu shot, like muscle soreness where the shot
was given or mild cold symptoms. The shot takes
1 to 2 weeks to protect you from the flu. If you get
sick after getting the flu shot, you may have come
in contact with a virus before you got the shot.

Myth: It?s better to get the flu than
a flu shot.
Truth: The flu is a serious disease, especially
for older adults and people with chronic health
conditions, like asthma or diabetes. The flu can
put you in the hospital and it can be deadly.

Getting the flu shot is your best protection against
the flu and also protects the people around you.

Myth: I don?t need to get a flu shot
every year.
Truth: The flu virus changes every year. Getting
a flu shot every year will help you stay protected
from the most dangerous strains. Your immune
system also declines over time, so getting a flu
shot every year will protect you.

Myth: The flu shot doesn?t work.
Truth: The flu shot works differently for everyone
and does not protect you from all strains of the flu.
If you do get the flu, getting a flu shot can lessen
your symptoms, which will reduce your risk for
a hospital stay and death.

The best way to prevent the flu
is to get a flu shot every year.

If you have not received your flu shot, you can get one at no cost from your doctor or local
participating pharmacy. Influenza (flu) is a contagious respiratory disease that can put you in the
hospital or cause death in serious cases.

Are you trying to decide if the flu shot is right for you? Here are answers to the most common
myths about flu shots.



You may be eligible for
Horizon NJ TotalCare (HMO D-SNP)

43

If you are eligible for both Medicaid and Medicare, you can get all your health care benefits
under one convenient plan. With Horizon NJ TotalCare (HMO D-SNP), you can receive benefits
and services at no cost to you. Horizon NJ TotalCare (HMO D-SNP) includes:

? $0 premiums

? $0 copays

? $0 deductibles

? No referrals

? $245 per quarter to purchase health items from our catalog

? An additional $250 per quarter on a prepaid Over-the-Counter (OTC) Benefit Card
to purchase eligible health care products from retail stores like Walmart or CVS

? And more!

If you join Horizon NJ TotalCare (HMO D-SNP), you will still keep your MLTSS benefits.

To learn more, call 1-888-328-5736 (TTY 711), 24 hours a day, seven days a week,
or visit HorizonBlue.com/TotalCare.

Changes to
management
of the Horizon
Behavioral
Health Program
On or about January
1, 2020, Horizon NJ
Health will move the
administrative and
clinical management of
the Horizon Behavioral
HealthSM Program,
behavioral health
services and benefits,
from Beacon Health
Options (formerly
ValueOptions) to
Horizon NJ Health?s
internal operations.

This change does not
impact your plan benefits
and services.

? You will continue
to have access to
behavioral health
services according to
your plan.

? There will be no
changes to the network
of behavioral health
care professionals that
participate with
your plan.

? You can still use the
phone numbers that
you currently use to
access behavioral
health care benefits
and services.

What you need to know
about prostate cancer

Risk factors
? Race ? African American men are 70% more likely to develop

prostate cancer than Caucasian or Hispanic men.

? Age ? 60% of prostate cancers are diagnosed in men over age 65.

? Family history ? Men with an immediate family member,
such as a father or brother who had it, are twice as likely to
develop prostate cancer.

Who should get screened?
Screening recommendations are different for each man. Talk to your
doctor to discuss your personal risk for prostate cancer and whether
or not you should get screened.

Women ? have the men in your life been screened?
Like many women, you may be the one scheduling appointments
for your family and keeping them on track with their health. Talk to
the men in your life about their risk and encourage them to talk with
their doctor about screening options.

Source: American Cancer Society, cancer.org

Prostate cancer is the most common
(non-skin) cancer among American men.

1 in 9 men will be diagnosed
in their lifetime.

174,650 new cases diagnosed each year.

If found early, prostate cancer is one of the
most treatable kinds of cancer.

THE STATS



Our
commitment
to quality
Horizon NJ Health?s
Quality Improvement
(QI) program works
with members and
providers to improve
the quality of care and
services you receive.
Our QI program ensures
these services continue
to be appropriate,
necessary and properly
administered. We
monitor areas that affect
the care our members
get, like access to care,
screenings and member
satisfaction. For more
information about
Horizon NJ Health?s QI
program and its progress
toward goals, visit
horizonNJhealth.com/
quality, or call Member
Services at 1-844-444-4410
(TTY 711) and ask for the
Quality Department.

Renew it or lose it!

Be prepared for an emergency

In order to be a Horizon NJ Health member, you must renew your
NJ FamilyCare coverage on time EVERY year. Call NJ FamilyCare at
1-800-701-0710 (TTY 1-800-701-0720) to find out your renewal date
or to ask for a renewal form.

What you need to know:
? If you don?t renew your NJ FamilyCare eligibility, you might have to

start over as a new applicant, and the approval process will take longer.

? The renewal process for members who are Aged, Blind and
Disabled is different and requires different updates.

? Keep your contact information updated so NJ FamilyCare can reach you.

What you need to do:
? Open and respond to all mail from your County Welfare Agency

(CWA) or your eligibility-determining agency.

? Contact your case worker at your CWA or call NJ FamilyCare at
1-800-701-0710 (TTY 1-800-701-0720). If you need the information
for your local CWA, please call the Managed Care hotline at
1-800-356-1561 (TTY 711) or visit state.nj.us/humanservices/dmahs/
clients/medicaid/payment/NJ_County_Welfare_Agencies.pdf.

? Pay your premiums on time, if you have one.

For questions, please call Member Services at 1-844-444-4410 (TTY 711),
24 hours a day, seven days a week, or speak with your Care Manager.

It may be hard to think about, but a disaster can
strike at any time. The best way to protect yourself
during an emergency or disaster is to be prepared.
This includes creating a plan with your family
or caregivers.

There are resources to help you get started:

NJ Register Ready ? New Jersey?s
Special Needs Registry for Disasters
Residents who may find it difficult to get to safety
during a major disaster should register. This
includes residents who have physical or cognitive
limitations, language barriers or do not have
transportation. It is free, confidential and could
help you get to safety during a major emergency,
like a hurricane.

? Register at registerready.nj.gov or
by calling 2-1-1 (TTY 711).

NJ 2-1-1
NJ 2-1-1 connects people in need with services
that can help. If there is a community emergency,
2-1-1 links emergency management professionals
with the public. The 2-1-1 staff helps callers get
help with the kinds of services they need.

? For more information, visit nj211.org or
call 2-1-1 (TTY 711).

65

How to choose a Personal
Representative
All Horizon NJ Health members have the right to choose a Personal
Representative ? someone you choose to work with us on your
behalf to handle your health care and benefits. If you have a Personal
Representative, you will still have all your rights. Your Personal
Representative stands in for you when you don?t feel well enough to
manage your health care benefits on your own. They can handle all
phone calls and written communications about your benefits.

To appoint a Personal Representative:
? Download a Request for Personal Representative Form

at horizonNJhealth.com/personalrep.

? Mail your completed form to the address provided.

Your Personal Representative can be your spouse, child, other relative,
family friend, lawyer or someone chosen by the court. You can also
change your Personal Representative at any time.

Federal Emergency Management
Agency (FEMA)
FEMA works with local governments to prepare
for and recover from disasters. This includes
working with emergency responders during
disasters and helping rebuild after, like when
Hurricane Sandy caused serious damage across
our state. New Jersey is part of FEMA?s Region II.

? For more information, visit fema.gov.

Office of Emergency Management (OEM)
The New Jersey OEM works with the State
Police, Emergency Management Organizations
and State Agencies to develop programs to
serve New Jersey before, during and after a
disaster. The office also works with the governor
to communicate to residents when a state of
emergency exists.

? For more information, visit ready.nj.gov.

If you have any questions about
preparing for disasters, talk to your

Care Manager or call Member Services
at 1-844-444-4410, 24 hours a day,

seven days a week.



7 8

Reminder:
you have access
to Member
Advocates

All MLTSS members
have access to a Member
Advocate. Member
Advocates work with
you to make sure
any questions about
your MLTSS benefits,
services and decisions
are answered. He or she
works closely with you,
your care team and state
representatives to make
sure your needs and
goals are being met.

To speak with a Member
Advocate, please call
1-844-444-4410 (TTY
711) Monday through
Friday, from 8 a.m. to 5
p.m., Eastern Time (ET),
or you can ask your Care
Manager to request that
a Member Advocate
contacts you.

Adult Protective Services
Adult Protective Services (APS) helps abused, neglected and exploited
at-risk or vulnerable adults who are not able to protect themselves.
It is common for the person doing the abusing or neglecting to be a
caregiver or even a family member.

A vulnerable adult is:
? Age 18 years and older, AND

? Living in the community, AND

? Due to a physical or mental illness, disability to understand
or ability to make, communicate or carry out decisions about
his or her well-being, AND

? Is being abused, neglected or exploited.

A community setting is considered a private residence OR any
non-institutional setting that is not licensed by, operated by, or under
contract with a state department or agency.

If you or someone you know suspects that a vulnerable adult is being
abused, neglected or exploited, New Jersey?s APS law requires you
to report it to the county APS office. Health care professionals, police
officers, firefighters, paramedics or emergency medical technicians
are also required to report abuse, neglect or exploitation.

How to report suspected abuse
? Call your county APS office. You can find a listing of county

APS at state.nj.us/humanservices/doas/home/adultpsp.html.

? Call the NJ Department of Human Services at 1-800-792-8820
(TTY 711).

? For an after-hours emergency, call 911.

Your call can be made anonymously and all reports, communications
and records about any APS incident are always confidential.

What happens once a report is made?
? APS investigates the report to determine if there is abuse.

? If abuse is happening, APS will develop a plan to stop it and
keep the victim safe.

? APS can help victims with services like medical or mental
health treatment and legal assistance.

Managing your congestive heart failure

Heart failure, or congestive heart failure (CHF),
happens when your heart cannot pump enough
blood and oxygen to support the other organs in
your body.

For those with CHF, early diagnosis and treatment,
including medication, a low-salt diet, and staying
active daily are important.

Symptoms:
? Shortness of breath

? Trouble breathing while lying down

? Weight gain and swelling in the feet, legs,
ankles or stomach

? Feeling tired and weak

If you have CHF, talk to your doctor or Care Manager
about your treatment options. It is important to
follow a plan to keep heart failure under control.
By telling your symptoms early, you can stay
healthy and may not need to go to the hospital.

ABOUT HALF
of people who develop
CHF die within 5 YEARS
of diagnosis.

ONE IN 9 DEATHS
in 2009 included CHF
as a contributing cause.

ABOUT 5.7 MILLION
adults in the United States
have heart failure.

Source: cdc.gov/heartdisease/about.htm
Reports to APS should be made right away.



9
Formulary changes
We want to let you know about the recent changes to our formulary list, also called preferred
drug list (see box). The changes found in this list will be added to our Drug Formulary list at
horizonNJhealth.com/covered_drugs. This list includes an explanation and listing of step therapy,
quantity/age limitations and drugs that require prior authorization (approval).

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. Please note that Horizon NJ Health?s maximum days?
supply limit is 30 days.

We encourage you to use Laboratory Corporation of America?
Holdings (LabCorp) when getting laboratory services. LabCorp
is your laboratory services provider.

You can visit horizonNJhealth.com/findadoctor to find a
LabCorp location near you. Select Other HealthCare Services from
the dropdown menu, then type Laboratory in the Service Type
dropdown menu.

LabCorp also offers online appointment scheduling for all New Jersey
Patient Service Centers. Visit labcorp.com/PSC to find a location.
Walk-in patients are welcome.

You can use LabCorp Patient, an online service, to download and
print your test results on your own. Register at patient.labcorp.com.
LabCorp will give your test results to your doctor before posting
them to your online account.

A reminder about lab services

10

Member
rights and
responsibilities

As a Horizon NJ Health
member, you have
rights, responsibilities
and choices in the
care you get. Your
member rights and
responsibilities can be
found in your Horizon
NJ Health Member
Handbook or at
horizonNJhealth.com/
memberrights.

Drug Name Recommendation Alternatives

Aimovig (erenumab-aooe) Covered N/A

Apokyn (apomorphine) Not Covered Levodopa or Carbidopa/Levodopa

Apriso (mesalamine) Not Covered Generic Lialda

Cablivi (caplacizumab-yhdp) Covered N/A

Femring (estradiol) Not Covered Climara, Estradiol patch

Firdapse (amifampridine) Covered N/A

Gynazole (butoconzaole) Not Covered Clotrimazole, Miconazole, Terconazole

Indocin (indomethacin) suspension Not Covered Ibuprofen suspension

Lialda (mesalamine) Covered N/A

Lotrimin (clotrimazole) solution Not Covered
Over-The-Counter alternative (e.g. Lotrimin AF [clotrimazole], Monistat [miconazole],
Micatin [miconazole], Lamisil AT), Ketoconazole, Spectazole (econazole) cream

Lyrica (pregablin) capsules Covered N/A

Metrolotion (metronidazole) Not Covered Metrocream, Metrogel

Nucala (mepolizumab) Not Covered Fasenra

Phenergan VC with codeine
(promethazine/phenylephrine/codeine)

Not Covered Promethazine with Codeine and Sudafed PE or Sudafed

Plexion (sulfacetamide sodium-sulfur)
suspension

Not Covered
Generic Plexion Cleansing Emulsion 10-5%
(sodium sulfacetamide/sulfur 10-5% emulsion)

Timoptic XE (timolol) gel Not Covered Generic Timoptic (timolol solution)

Zyrtec (cetirizine) chewable Not Covered Over-The-Counter Cetirizine tabs, syrup; Over-The-Counter Loratadine tabs/syrup

Online
member
support

Once you register
and sign in at
horizonNJhealth.com,
you have access to
your plan information
24 hours a day, seven
days a week.

You can easily:

? Change your PCP

? Request a new
member ID card

? Find tools for
healthy living

? And much more

Over-the-counter (OTC) and herbal medicines are
medicines you can buy at a pharmacy without a
prescription from your doctor. These medicines can help
you feel better by treating or preventing health problems
like allergies, constipation, cough and cold, heartburn and

many more. While you don?t need a prescription from your doctor to get
these medicines, it is very important to let your doctor and pharmacist
know all OTC and herbal medicines you are currently taking.

These medicines may cause side effects when taken with the
medicines your doctor prescribes. They can also cause other
medicines to act differently than intended. If you see more than one
doctor or fill prescriptions at more than one pharmacy, it?s important
to tell everyone involved in your care about all the medicines you are
taking, including OTC and herbal medicines. If you are having trouble
managing your medications, please contact your Care Manager for help.

Managing your medication

Take all medicines ? OTC and prescription ?
exactly as the label says to make sure they are working

the best way they can to treat your condition.



Eating the right food is an important part of your overall health
and wellness. What we eat can affect our energy, sleep and weight.
Eating a balanced diet is the best way to ensure you are getting
the vitamins and nutrients you need for your body.

Build your healthy meal:

? Each meal should have foods from at least three different food groups.

? Each snack should have foods from at least two different food groups.

? Choose whole grains like brown rice or quinoa.

? Choose dairy products that are low fat.

? Choose lean protein like fish or poultry.

Eating meals with foods from different groups will help decrease portion size and keep you satisfied
until your next meal. To learn more about the five food groups and the daily recommendations for
children and adults, please visit choosemyplate.gov.

Nutrition and your health

1211

If you or someone you love is struggling with addiction, call 1-833-422-2765 (TTY 711)
to connect with a Peer Support Specialist and start getting help today.

? Connect you to groups in your area
to help you study

? Give you telephone coaching throughout
the process to help you stay on track

? Work with you one-on-one to understand your
situation and remove any barriers that are preventing
you from getting your diploma, such as transportation
to the testing center or childcare during the test*

? Pay the pre-test and test fees**

Do you want to get your high
school diploma? We can help.

* Services will be provided when needed. Not all members
will receive these services.

**Limited to three attempts.

Horizon Neighbors in Health: Education Works can help you get
your high school diploma. You will get a custom plan that fits your life,
to help you study for and get your diploma ? all at no cost to you!

Horizon Neighbors in Health: Education Works will:

To enroll in Horizon Neighbors in Health:
Education Works, you must:

? Be a current Horizon NJ Health member

? Have a valid photo ID card, such as driver?s license or state ID card

? Be 18 years of age or older

? Not have a high school diploma or equivalent

? Not be enrolled in an accredited high school

Getting a high school diploma can open doors to better job opportunities.

For more information, call 1-800-682-9094 x52076 (TTY 711),
Monday through Friday, 9 a.m. to 5 p.m.,(ET), or email
EducationWorks@HorizonBlue.com.

Font=Avenir next
bold and medium

Are you struggling with an opioid addiction or other substances?
Are you in recovery and need support? NJ Peer Recovery will listen,
help and offer hope. NJ Peer Recovery is a peer-support line providing
confidential, accessible and responsive telephonic support. You can
connect to trained NJ Peer Recovery Support Specialists by phone who
will provide emotional and informational support. You will be connected
with someone who knows your struggles and has been in your shoes.
The specially-trained representatives know wellness and recovery
principles and will share their experience with you ? since they?ve been
through their own addiction and recovery. They will support you with
overall wellness, including physical, emotional and mental health.

NJ Peer Recovery offers:

? Support seven days a week from 8 a.m. to 8 p.m., ET

? Help with a personal wellness and recovery plan

? Relapse and overdose prevention tools

? Access to recovery, wellness and treatment resources

NJ Peer Recovery

Information
about your
provider

Information about
your provider,
including your PCP
and specialist, can be
found when you search
our Online Doctor
& Hospital Finder at
horizonNJhealth.com/
findadoctor. There you
can see:

? Provider?s name,
office location
and phone number

? Specialty

? Professional
qualifications

? Languages spoken

To find additional
information regarding
a provider, including
the medical school
attended and residency
completion, visit one of
the following websites:

NJ Division of
Consumer Affairs:
njconsumeraffairs.gov

American Board of
Medical Specialties:
abms.org



13

Notice of NondiscriminationLook out for health insurance fraud
Health insurance fraud affects everyone. You can help identify and prevent it.

Some common types of health insurance fraud schemes are:

? Billing for services that did not happen

? Faking a patient?s diagnosis to justify a test, surgery or other procedure that
is not medically necessary

? Claiming non-covered treatment are medically-necessary procedures

? Performing medically-unnecessary procedures to get a payment

? Billing for a higher level of service to get a higher payment

? Kickbacks or bribes

? Changing claims or prescriptions

Horizon NJ Health always verifies member information over the phone before talking to you about
your benefits or services. This is an important step we take to protect your information and guard
against fraud. To report health insurance fraud, call 1-855-FRAUD20 (1-855-372-8320) (TTY 711).

14

Notice of Nondiscrimination


086-19-100 CMC0008179C (0719) An Independent Licensee of the Blue Cross and Blue Shield Association.


Horizon NJ Health complies with applicable Federal civil rights laws and does not discriminate against nor does it
exclude people or treat them differently on the basis of race, color, gender, national origin, age, disability, pregnancy,
gender identity, sex, sexual orientation or health status in the administration of the plan, including enrollment and benefit
determinations. Horizon NJ Health provides free aids and services to people with disabilities (e.g. qualified language
interpreters and information in other formats) and to those whose primary language is not English (e.g. information in
other languages) to communicate effectively with us.


Contacting Member Services
Call Member Services at 1-844-498-9393 (TTY 711) or the phone number on the back of your member ID card, if
you need the free aids and services noted above and for all other Member Services issues.


Filing a Section 1557 Grievance
If you believe that Horizon NJ Health has failed to provide the free communication aids and services or discriminated
against you for one of the reasons described above, you can file a discrimination complaint also known as a Section 1557
Grievance. Horizon NJ Health?s Civil Rights Coordinator can be reached by calling the Member Services number on the
back of your member ID card or by writing to:


Horizon NJ Health
Civil Rights Coordinator
PO Box 10194
Newark, NJ 07101



You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights
Complaint Portal, online at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail at U.S. Department of Health and
Human Services, 200 Independence Avenue, SW, Room 509F, HHH Building, Washington, D.C. 20201 or by phone
at 1-800-368-1019 or 1-800-537-7697 (TDD). OCR Complaint forms are available at
www.hhs.gov/ocr/office/file/index.html.


Language assistance
Si habla espa?ol, tiene a su disposici?n servicios gratuitos de asistencia ling??stica. Llame al 1-844-498-9393 (TTY 711).

?????????????????????????????? 1-844-498-9393?TTY 711?.
??: ???? ????? ??, ?? ?? ???? ??? ???? ? ????.
1-844-498-9393 (TTY 711)??? ??? ????.
ATEN??O: Se fala portugu?s, encontram-se dispon?veis servi?os lingu?sticos, gr?tis. Ligue para 1-844-498-9393
(TTY 711).



UWAGA: Je?eli m?wisz po polsku, mo?esz skorzysta? z bezp?atnej pomocy j?zykowej. Zadzwo? pod numer
1-844-498-9393 (TTY 711).
ATTENZIONE: In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare
il numero 1-844-498-9393 (TTY 711).

?????? ??????? ???????? ????? ??? ?????? ???? ????? ??? ??? :?????? ???? ???? .??????? ??1-844-498-9393 ?????? ???? ???? ???)711.(
PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang
bayad. Tumawag sa 1-844-498-9393 (TTY 711).
????????: ???? ?? ???????? ?? ??????? ?????, ?? ??? ???????? ?????????? ?????? ????????. ???????
1-844-498-9393 (???????? 711).
ATANSYON: Si w pale Krey?l Ayisyen, gen s?vis ?d pou lang ki disponib gratis pou ou. Rele 1-844-498-9393 (TTY
711).




CH? ?: N?u b?n n?i Ti?ng Vi?t, c? c?c d?ch v? h? tr? ng?n ng? mi?n ph? d?nh cho b?n. G?i s? 1-844-498-9393
(TTY 711).
ATTENTION : Si vous parlez fran?ais, des services d'aide linguistique vous sont propos?s gratuitement. Appelez le
1-844-498-9393 (ATS 711).

???? ??? ? ??? ?????? ??? ??? ????? ?? ??? ?? ???? ?? ?? ?? ???? ????? ???? ?? ??? :??????
1-844-498-9393 (TTY 711).

Here?s what you can do:

ALWAYS

? Review anything you get in the mail from Horizon NJ Health, a doctor or other
health care providers.

? Ask for a copy of everything you sign.

? Be suspicious of anyone giving free tests or screenings in exchange for your
member ID card number.

NEVER

? Give your health insurance ID card number to anyone except your doctor, clinic,
hospital or other health care provider.

? Give your health insurance ID card number to anyone who calls you without you
asking and offers you free goods or services (durable medical equipment or medication).

? Let anyone borrow or use your health insurance ID card or number.

? Ask your doctor or health care provider for treatment or care you do not need.

? Sign your name to a blank form.

? Share your medical records or medical information with anyone except your doctor,
clinic, hospital or other health care provider.



Care Notes

Member Services 1-844-444-4410 (TTY 711) 24 hours a day, seven days a week. horizonNJhealth.com

CARE NOTES is published for members of Horizon NJ Health, 1700 American Blvd., Pennington, NJ 08534. Information in
CARE 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 TotalCare (HMO D-SNP) is an HMO Medicare Advantage Dual Eligible Special Needs plan with a Medicare
contract and a contract with the State of New Jersey Medicaid Program. Enrollment in Horizon NJ TotalCare (HMO D-SNP)
depends on contract renewal. 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.
Y0090_H8298_EC004612_M 086-19-133



Care Notes

horizonNJhealth.com

Issue 1, 2020



In this issue
We?re here for you ?????????????????????????????????????????????????????????????????? 2
Member rights and responsibilities ???????????????????????????????????????? 2
Helping you get the most from your plan ?????????????????????????????? 3
When to Contact Your MLTSS Care Manager ???????????????????????? 4
Support from Care Managers ????????????????????????????????????????????????? 4
Don?t lose your health insurance ???????????????????????????????????????????? 4
Sign up at horizonNJhealth.com ??????????????????????????????????????????? 5
Horizon NJ TotalCare (HMO D-SNP):
All your benefits in one plan ??????????????????????????????????????????????????? 5
Have you scheduled your annual wellness exam? ?????????????????? 6
Preventing bedsores ??????????????????????????????????????????????????????????????? 6
First aid for seizures ???????????????????????????????????????????????????????????????? 7
Get the facts on aspiration pneumonia ?????????????????????????????????? 7
Coverage for your mind and body ????????????????????????????????????????? 8
Recovery support for those who need it ??????????????????????????????? 8
Caring for a loved one with a cognitive impairment ?????????????? 9
Taking steps to prevent falls ????????????????????????????????????????????????? 10
Changes to covered medicines ?????????????????????????????????????????????11
Taking your medicines as prescribed ????????????????????????????????????12
New generics ?????????????????????????????????????????????????????????????????????????12
Advance directives ?????????????????????????????????????????????????????????????????13
Our commitment to quality ???????????????????????????????????????????????????13
Reminder: you have access to Member Advocates ??????????????13
Notice of Nondiscrimination ??????????????????????????????????????????????????14

Your health care needs are important to us? Our specially-trained Member Services
Representatives are here to help you understand your benefits. If you have any

questions, please call the Managed Long Term Services & Supports (MLTSS) team at
1-844-444-4410 (TTY 711), 24 hours a day, seven days a week, 365 days a year?

2

We?re here for you
As the novel coronavirus (COVID-19) has become a global concern, Horizon NJ Health
continues to respond to this public health issue to provide the information and services
you need. We understand that you may feel uneasy, and we want you to know that
we?re working hard for our members to help you get the care you need. Your health
and well-being are our top priorities.

You can get the latest COVID-19 information from these credible resources:
? World Health Organization (WHO): who.int
? Centers for Disease Control and Prevention (CDC): cdc.gov
? National Institutes of Health (NIH): nih.gov
? New Jersey Department of Health: nj.gov/health
? New Jersey COVID-19 Information Hub: covid19.nj.gov

Here are 3 ways to get care:
1. Call before you go. It is important to call your doctor or other health care facility before

you go there. When you call, inform them of your concerns, and they will give you further
directions. Your doctor may offer virtual visits, or telemedicine, via video, chat or phone
instead of in-office visits.

2. Get answers any time of day. Call our 24/7 Nurse Line at 1-800-711-5952 (TTY 711).
This gives you access to licensed nurses who can answer your health questions.

3. Is it an emergency? Always call 911 if you are experiencing a medical emergency.

For answers to frequently asked questions about novel coronavirus and related coverage,
please visit horizonNJhealth.com/coronavirus. Member Services is here for you at
1-844-444-4410 (TTY 711), 24 hours a day, seven days a week.

As a Horizon NJ Health member, you have rights, responsibilities and choices in the
care you get? Your member rights and responsibilities can be found in your Horizon
NJ Health MLTSS Member Handbook or at horizonNJhealth.com/memberrights?

Member rights and responsibilities



43

Helping you get the
most from your plan

Our promise is to give you the best possible experience with your Horizon NJ Health
plan. To keep that promise, we are working hard to offer you exceptional programs,
care management and member services that go beyond normal MLTSS plans.

Follow these tips to get the most from your plan:
1. Build a relationship with your Primary

Care Provider
The right care starts with your Primary Care
Provider (PCP). Your PCP should:

? Listen carefully to your health concerns

? Help you get access to a specialist

? Explain things in a clear and
understandable way

? Talk to you about any medications you
are taking

If you need to change your PCP for any reason,
please call Member Services.

2. Let your personal Care Manager
coordinate your health care needs

You?ll get a Plan of Care with health goals that
are right for you ? with support along the way
so you can reach them. Your Care Manager will
help connect your doctors and pharmacists
and even assist with prior authorizations (pre-
approvals) for any services you need. To reach a
Care Manager, call 1-844-444-4410 (TTY 711)
Monday through Friday, 8 a.m. to 5 p.m.

3. Schedule your wellness visits and
health screenings

Life moves fast, and it can be easy to lose track
of time. That?s why we will send you important
reminders for upcoming appointments or
vaccines, like your annual flu shot. The flu
vaccine is your best protection from the flu.
Preventive care can save your life.

4. Get appointments with your doctor
quickly and easily

Your time is valuable. If you are on time for your
appointment, you should not have to wait too
long to see your doctor. Things to remember:

? When making your appointment, ask to
be the first one seen that day.

? Call us if you need help getting an
appointment with a specialist.

? Ask your doctor?s office to let you know
if they are running late.

Visit horizonNJhealth.com/bonustips
to learn more about what you get with
your plan!

Your MLTSS Care Manager is someone you can trust to
get you the services and care you need. He or she is a
great health education resource and will work with you
and your doctors to help you stay as healthy as possible.
You can expect your MLTSS Care Manager to check in
with you every 90 days if you live at home, or every
180 days if you live in a facility. He or she will also
check in with you after you?ve been in the hospital.

You should contact your MLTSS Care Manager if you:
? Experience a fall, have a hospital stay or Emergency Room

(ER) visit

? Have trouble getting an appointment with your doctor

? Have problems with your facility (if you reside in one)

? Have problems with your service providers

? Have questions about your benefits

? Need information about other MLTSS services

If you cannot reach your MLTSS Care Manager, you can call
Member Services at 1-844-444-4410 (TTY 711), 24 hours day,
seven days a week.

For emergencies, you should always call 911 first.

When to contact your MLTSS Care Manager

As a NJ FamilyCare member, you must renew your coverage on time. If you miss
your renewal deadline, you may lose your health coverage.

Important reminders
? Check your mail: You may receive a form or blank application from NJ FamilyCare that

you will need to complete.

? Respond to any written requests right away: If NJ FamilyCare asks you to complete an
application, do so as soon as possible so there is no disruption in your coverage.

To renew your coverage, contact NJ FamilyCare at 1-800-701-0710 (TTY 1-800-701-0720) or
your local County Welfare Agency (CWA).

Don?t lose your health insurance

Support from
Care Managers
One of the things MLTSS
Care Managers can assist
with is Nursing Facility
transition. Care Managers
will work closely with
members, to assess their
needs on an ongoing
basis and maintain a Plan
of Care. Care Managers
will identify the member?s
goals, arrange care and
support, and provide
information about local
resources to help him or
her live as independently
as possible. They will
also help members with
housing, education and
employment, when
applicable, so the member
can be self-sufficient.



5
As a Horizon NJ Health member, you have access to our secure member web portal. Once
you sign up, you have access to your plan information 24 hours a day, seven days a week.

You can use the portal to:
? Change your PCP

? Request a new member ID card

? Enroll in one of our Disease Management
programs

? Find tools for healthy living

? And much more

Sign up at
horizonNJhealth.com

Horizon NJ TotalCare (HMO D-SNP):
All your benefits in one plan
If you are eligible for both Medicare and Medicaid, you may be eligible for Horizon NJ TotalCare
(HMO D-SNP). This plan combines all covered Medicare and Medicaid health care benefits into
one easy-to-use, no-cost plan. Horizon NJ TotalCare (HMO D-SNP) includes:

? $0 copays

? $0 premiums

? No referrals

? A $0 gym membership or home fitness
program with FitnessCoach?

? Up to $300 per quarter on an
Over-the-Counter (OTC) Benefit Card to
spend on health items at participating
retail stores

? Up to $250 per quarter to spend on personal
items from our catalog

For more information, call 1-888-328-5736 (TTY 711),
24 hours a day, seven days a week, or visit
HorizonBlue.com/TotalCare.

Additional
Benefits

$0 Cost
for Benefits

Dedicated
Care Manager

$0 Copay
for Prescription

Drugs
No Referrals

Needed

One ID Card

Horizon NJ TotalCare
(HMO D-SNP)

6

Have you scheduled your annual wellness exam?
Seeing your Primary Care Provider (PCP) for an annual wellness exam is important, even
if you feel healthy and well. Annual wellness exams help your PCP find and treat any
possible health issues early, before they become serious. During times of outbreaks, such
as measles or the more recent COVID-19, ask your doctor when it would be best for you
to schedule your annual exam.

At your annual wellness visit, your
doctor will:
? Check your weight and blood pressure

? Measure your body mass index (BMI)

? Examine you for physical signs of health
issues

? Let you know if you need any screenings
or immunizations, based on your age
and other risk factors

There are no copays for
annual exams ? they are part

of your covered benefits.

Your PCP?s name and phone number are on
your Horizon NJ Health member ID card. If you
need to change your PCP, log in to the secure
member web portal at horizonNJhealth.com,
or call 1-844-444-4410 (TTY 711).

Bring a list of any health
questions or concerns with
you to your annual wellness
exam so you can discuss
them with your doctor?

Preventing bedsores
Bedsores are open wounds found on the skin.
They are common among older adults and
people with disabilities. Bedsores are caused by
long periods of pressure on the skin against a
hard surface, such as a bed, chair or wheelchair.
They are often found on bony areas of the body
such as the hips, back, heels, ankles and buttocks.

Symptoms of bedsores can include:
? Changes in skin color

? Open sores

? Swelling of the skin

? Skin feeling cooler or warmer to the touch

What you can do to help prevent
bedsores:
? Change your body position at least

every two hours

? Change wet clothing/diapers often

? Check your whole body every day for
signs of sores

? Drink plenty of fluids

? Keep your skin clean and dry

? Use mild soaps and moisturizers

? Use pillows and pads to reduce pressure
on bony areas of the body



8
Finding the right treatment for mental health and substance use disorders can be overwhelming.
We want to help you find the right care that works for you. Behavioral health services are covered
under your Horizon NJ Health benefits.

Your benefits include but are not limited to:
? Inpatient hospital stays for mental health care and substance use disorders

? Outpatient services including therapy, medication monitoring, partial care,
partial hospitalization and outpatient substance use disorder services

? Short-term residential substance use disorder treatment

? Medication-assisted treatment

? Community support services and clinics

Your health is our top priority. If you need help finding treatment for behavioral health services,
talk to your Care Manager, or call Member Services at 1-844-444-4410 (TTY 711), 24 hours a day,
seven days a week.

Coverage for your mind and body

If you are living with a substance use disorder or are in recovery, you can get help from someone
who has been there. With NJ Peer Recovery, support is just a phone call away.

A Peer Support Specialist is waiting to help you:
? Build your plan for better health and recovery

? Discover relapse and overdose prevention tools

? Find resources to help in your recovery and treatment

Call 1-833-422-2765 (TTY 711), 8 a?m? to 8 p?m?,
seven days a week to connect with a Peer Support
Specialist and start getting help today?

Font=Avenir next
bold and medium

Recovery support for those who need it

7

First aid for seizures

Get the facts on aspiration pneumonia

Do you know how to care for someone who is having a seizure?
A seizure can happen quickly, and there are important first aid steps to follow in order to
keep a person safe until the seizure stops. A seizure usually lasts for only a few minutes.

Aspiration pneumonia happens when food, saliva, liquids or vomit are breathed into the lungs
instead of being swallowed into the stomach. The elderly, people with dementia, stroke survivors
and people with conditions like Parkinson?s disease, multiple sclerosis and cerebral palsy often
have trouble swallowing and are at a higher risk of getting aspiration pneumonia.

If someone is having a seizure, you should:
? Check for a medical bracelet.

? Ease the person onto the floor.

? Gently turn the person onto his or her side.

? Clear the area of anything hard or sharp.

? Place something soft under the person?s
head.



? Loosen tight clothing around the neck.

? Time the seizure. Call 911 if the seizure
lasts longer than five minutes.

? Stay with the person until the seizure ends.

? Remain calm.

Signs/symptoms of aspiration
pneumonia may include:
? Confusion

? Feeling very tired

? Fever, chills or chest pain

? Hoarse voice after swallowing

? Raised breathing rate

? Shortness of breath

? Wet coughing after eating

Ways to prevent aspiration pneumonia:
? Avoid medicines that cause drowsiness.

? Eat slowly and take small bites.

? Practice exercises to strengthen throat
muscles.

? See a speech pathologist or swallow
therapist.

? Sit upright while eating.

? Use proper oral hygiene.

Source: MedlinePlus, medlineplus.gov

You should NEVER:
? Put anything in the person?s mouth?
? Hold the person down or try to stop

their movements? Sources: American Epilepsy Society, aesnet.org,
cdc.gov/epilepsy/about/first-aid.htm



9 10

Taking steps to prevent falls
Falls are the most common cause of injury in older adults, but the good news is
that they can be prevented. There are easy steps you can take to prevent falls and
stay independent.

You may be more likely to fall if you:
? Are overweight ? Have impaired vision or hearing

? Drink alcohol ? Have low levels of vitamin D

? Have arthritis (joint swelling) ? Take drugs that make you drowsy

? Have dementia

Talk to your doctor today about your risk for falls and ask about taking vitamin D supplements
to improve bone, muscle and nerve health.

Have your eyes checked
at least once a year.5

Assess your home safety. Keep floors clear,
and install grab bars in stairwells and the bathroom.4

Exercise at home or in the gym,
such as yoga and regular stretching.2

Speak to your doctor about your medications and
any changes you feel in your strength or balance.1

3 Ask for help with carrying groceries and home/yard maintenance.

Source: cdc.gov

Here?s what
you can do:

Caring for a loved one with a cognitive impairment (decline in memory or thinking skills) can be
challenging. Even having a simple conversation can be difficult. Cognitive impairment in older
adults can be caused by medication side effects, illness, depression and dementia. Alzheimer?s
disease is the most common type of dementia. Cognitive impairment caused by medication side
effects and depression can be reversed with treatment. Others, such as Alzheimer?s disease,
cannot be reversed, but it can be treated for a period of time.

Individuals with cognitive impairment may experience:
? Aggressive or impulsive behaviors ? Memory problems

? Fixation on/repetition of an idea or activity ? Paranoia (suspicion or mistrust of people)

? Incontinence (trouble holding urine or bowels) ? Poor judgment

? Lack of motivation ? Wandering

It can be helpful to ask your loved one a question at a time and use simple language. For example,
instead of asking ?Would you like to come in and sit down and have a snack?? use
simple statements such as ?Sit down here.? and ?Here?s a snack for you.?

Wandering and poor judgement could lead to dangerous situations and the need for 24-hour
supervision. In the case of an emergency, call 911.

Resources
? The Arc of New Jersey: arcnj.org
? Family Caregiver Alliance:

caregiver.org/caring-adults-cognitive-and-memory-impairment
? Alzheimer?s Association: alz.org

Caring for a loved one with
a cognitive impairment



11

There are recent changes to our formulary list, also called a preferred drug list (see box).
The changes found in this list will be added to our Drug Formulary list at
horizonNJhealth.com/covered_drugs. This list includes an explanation and listing of
step therapy, quantity/age limitations and drugs that require prior authorization (approval).

Here is a list of recent changes:
Covered Change Description Brand (Generic) Drug Name Alternatives (if applicable)
Covered Diacomit (stiripental) ?
Covered Kanjinti (trastuzumab-anns) ?
Covered Mvasi (bevacizumab-awwb) ?
Covered Nuvigil (armodafinil) ?
Covered Ruzurgi (amifampridine) ?
Covered Symjepi (epinephrine) ?
Covered Turalio (pexidartinib) ?
Covered Vyndamax (tafamidis) ?
Covered Vyndaqel (tafamidis meglumine) ?
Covered Xpovio (selinexor) ?
Not Covered Alinia (nitazoxanide) metronidazole, tinidazole
Not Covered Alocril (nedocromil) Cromolyn, Ketotifen, Patanol
Not Covered Avastin (bevacizumab) Mvasi
Not Covered Axid (nizatadine) solution Ranitidine syrup

Not Covered Betopic-S (betaxolol) Betaxolol solution, Timolol solution, Levobunolol, Carteolol
Not Covered Canasa Suppository (mesalamine) rectal mesalamine
Not Covered Cimduo (lamivudine/tenofovir disoproxil) generic Epivir + generic Viread
Not Covered Dificid (fidaxomicin) vancomycin capsules
Not Covered Herceptin (trastuzumab) Kanjinti
Not Covered Ovide (malathion) Permetherin or Pyrethrin therapy

Not Covered Promethazine/DM Syrup (promethazine/dextromethorphan)

Delsym with an antihistamine,
Robitussin with an antihistamine,
dextromethorphan/chlorpheniramine,
dextromethorphan/doxylamine

Not Covered sfRowasa (mesalamine) rectal mesalamine
Not Covered Trexall (methotrexate) methotrexate tablets

Please talk with your 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. Please note that Horizon NJ Health?s maximum days? supply limit is 30 days.

Changes to covered medicines

12

Following your doctor?s orders for taking your medicines (medication adherence)
is important for managing a medical condition, recovering from illness, and
maintaining your health and well-being.

Tips on taking your medication the right way and safely:
? Take your medication at the same time every day.

? Try taking your medications with a daily routine, like brushing teeth or eating breakfast.
Check to see if you should take your medication on a full or empty stomach.

? Use a pill box or holder to keep track of correct dose and times.

? Refill your pill container at the same time each week, if you use one.

? Buy timer caps for your pill bottles and set them to go off when your dose is due. If your
pill box has a timer function, use it.

? Be sure to bring enough of your medication, plus a few days extra when you are travelling.

? If you are flying, keep your medication in your carry-on bag in case your luggage is lost.

? Set reminders when you are getting low on medications.

? Be sure to see your doctor regularly.

If you have any questions about your medication, please talk to your doctor or pharmacist.

Source: fda.gov/drugs/special-features/why-you-need-take-your-medications-prescribed-or-instructed

New generics
Horizon NJ Health is committed to providing the most up-to-date information regarding new
generics that are available. We encourage the use of generic products prior to using brand name
products, when appropriate. Generic drugs are the same as brand name drugs in quality, strength,
purity and stability, as required by the Food and Drug Administration.

The following generic drugs are expected to be on the market within the next three (3) months.

Generic name Brand Name
Pregabalin Lyrica

Taking your medicines
as prescribed



14

Notice of Nondiscrimination Notice of Nondiscrimination


086-19-100 CMC0008179C (0719) An Independent Licensee of the Blue Cross and Blue Shield Association.


Horizon NJ Health complies with applicable Federal civil rights laws and does not discriminate against nor does it
exclude people or treat them differently on the basis of race, color, gender, national origin, age, disability, pregnancy,
gender identity, sex, sexual orientation or health status in the administration of the plan, including enrollment and benefit
determinations. Horizon NJ Health provides free aids and services to people with disabilities (e.g. qualified language
interpreters and information in other formats) and to those whose primary language is not English (e.g. information in
other languages) to communicate effectively with us.


Contacting Member Services
Call Member Services at 1-844-498-9393 (TTY 711) or the phone number on the back of your member ID card, if
you need the free aids and services noted above and for all other Member Services issues.


Filing a Section 1557 Grievance
If you believe that Horizon NJ Health has failed to provide the free communication aids and services or discriminated
against you for one of the reasons described above, you can file a discrimination complaint also known as a Section 1557
Grievance. Horizon NJ Health?s Civil Rights Coordinator can be reached by calling the Member Services number on the
back of your member ID card or by writing to:


Horizon NJ Health
Civil Rights Coordinator
PO Box 10194
Newark, NJ 07101



You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights
Complaint Portal, online at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail at U.S. Department of Health and
Human Services, 200 Independence Avenue, SW, Room 509F, HHH Building, Washington, D.C. 20201 or by phone
at 1-800-368-1019 or 1-800-537-7697 (TDD). OCR Complaint forms are available at
www.hhs.gov/ocr/office/file/index.html.


Language assistance
Si habla espa?ol, tiene a su disposici?n servicios gratuitos de asistencia ling??stica. Llame al 1-844-498-9393 (TTY 711).

?????????????????????????????? 1-844-498-9393?TTY 711?.
??: ???? ????? ??, ?? ?? ???? ??? ???? ? ????.
1-844-498-9393 (TTY 711)??? ??? ????.
ATEN??O: Se fala portugu?s, encontram-se dispon?veis servi?os lingu?sticos, gr?tis. Ligue para 1-844-498-9393
(TTY 711).



UWAGA: Je?eli m?wisz po polsku, mo?esz skorzysta? z bezp?atnej pomocy j?zykowej. Zadzwo? pod numer
1-844-498-9393 (TTY 711).
ATTENZIONE: In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare
il numero 1-844-498-9393 (TTY 711).

?????? ??????? ???????? ????? ??? ?????? ???? ????? ??? ??? :?????? ???? ???? .??????? ??1-844-498-9393 ?????? ???? ???? ???)711.(
PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang
bayad. Tumawag sa 1-844-498-9393 (TTY 711).
????????: ???? ?? ???????? ?? ??????? ?????, ?? ??? ???????? ?????????? ?????? ????????. ???????
1-844-498-9393 (???????? 711).
ATANSYON: Si w pale Krey?l Ayisyen, gen s?vis ?d pou lang ki disponib gratis pou ou. Rele 1-844-498-9393 (TTY
711).




CH? ?: N?u b?n n?i Ti?ng Vi?t, c? c?c d?ch v? h? tr? ng?n ng? mi?n ph? d?nh cho b?n. G?i s? 1-844-498-9393
(TTY 711).
ATTENTION : Si vous parlez fran?ais, des services d'aide linguistique vous sont propos?s gratuitement. Appelez le
1-844-498-9393 (ATS 711).

???? ??? ? ??? ?????? ??? ??? ????? ?? ??? ?? ???? ?? ?? ?? ???? ????? ???? ?? ??? :??????
1-844-498-9393 (TTY 711).

13

Advance directives
Do you have an advance directive? If you don?t, you should make one now, while you are healthy
enough to make your own health care decisions. An advance directive is a legal document that lets
others know how you want to be cared for if you become too sick to tell them. It is also called a
living will. It is helpful to your family and doctors at the end stages of your life.

In New Jersey, there are three kinds of advance directives:
? A proxy directive names the person you

want to make your health care decisions
for you when you no longer can. This
person must be at least 18 years old.

? An instruction directive details your
wishes and instructions for your own care.

? A combined directive names a person
and gives instructions for your care. It
is a combination of a proxy directive
and instruction directive.

Reminder: you have access to
Member Advocates

All MLTSS members have access to a Member Advocate. These are people who work
with you to make sure any questions about your MLTSS benefits, services and decisions
are answered. He or she works closely with you, your care team and state representatives
to make sure your needs and goals are being met.

To speak with a Member Advocate, please call 1-844-444-4410 (TTY 711) Monday
through Friday, from 8 a.m. to 5 p.m., or ask your Care Manager for a Member
Advocate to contact you.

Our commitment to quality
Horizon NJ Health?s Quality Improvement (QI) program works with members and providers to
improve the quality of care and services you receive. Our QI program ensures these services
continue to be appropriate, necessary and properly administered. We monitor areas that
affect the care our members get, like access to care, screenings and member satisfaction. For
more information about Horizon NJ Health?s QI program and its progress toward goals, visit
horizonNJhealth.com/quality, or call MLTSS Member Services at 1-844-444-4410 (TTY 711)
and ask for the Quality Department.

Before you make an advance directive, you should talk to your doctor about your care options.
For more information and forms, you can visit state.nj.us/health/advancedirective.



Care Notes
Member Services 1-844-444-4410 (TTY 711) 24 hours a day, seven days a week. horizonNJhealth.com
CARE NOTES is published for members of Horizon NJ Health, 1700 American Blvd., Pennington, NJ 08534. Information in
CARE 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 TotalCare (HMO D-SNP) is an HMO Medicare Advantage Dual Eligible Special Needs plan with a Medicare contract
and a contract with the State of New Jersey Medicaid Program. Enrollment in Horizon NJ TotalCare (HMO D-SNP) depends on
contract renewal. 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. ? 2020 Horizon
Blue Cross Blue Shield of New Jersey. Three Penn Plaza East, Newark, New Jersey 07105. 086-20-15
Y0090_H8298_EC005346_M

Your voice matters.
You may get a survey in the mail asking about

your health care experience. We encourage you
to complete this survey so we can learn more.



Care Notes

horizonNJhealth.com

Issue 1, 2019



21

Horizon NJ Health wants to make sure you have the information you need to take
care of your health. Our specially-trained Member Services Representatives are here
to help you understand your benefits. If you have any questions, please call Managed
Long Term Services & Supports (MLTSS) Member Services at 1-844-444-4410
(TTY 711), 24 hours a day, seven days a week, 365 days a year.

6 tips to get the most from your health plan ...........................................................................................................2
Caring for a loved one: you are not alone ...............................................................................................................3
Horizon NJ TotalCare (HMO SNP) ? All your benefits in one plan ............................................................................4
Our commitment to quality .....................................................................................................................................4
Save money with NJSave ........................................................................................................................................4
Caring for a loved one with a cognitive impairment ...............................................................................................5
A reminder about lab services .................................................................................................................................6
Need a ride? ............................................................................................................................................................6
Member rights and responsibilities ........................................................................................................................6
Older Americans Month 2019 .................................................................................................................................6
Are you at risk for aspiration pneumonia? ...............................................................................................................7
Preventing bedsores ................................................................................................................................................8
Renew it or lose it! ...................................................................................................................................................8
Colon cancer is treatable. Detect it early by a simple screening. .............................................................................9
First aid for seizures .............................................................................................................................................. 10
Reminder: you have access to Member Advocates ............................................................................................... 10
Formulary Changes .............................................................................................................................................. 11
Make fall prevention a priority ............................................................................................................................. 12
Our Notice of Nondiscrimination ......................................................................................................................... 13
Getting help in your language ............................................................................................................................ 14

6 tips to get the most from
your health plan

In this issue

Build a relationship with your
Primary Care Provider

Quality care starts with your Primary Care Provider
(PCP) ? someone who you trust with your health
and well-being. We also work with your PCP to:

? Encourage you to get annual checkups and
preventive screenings ? at no cost to you

? Coordinate your care with other doctors
or specialists

Get an appointment with
your doctor quickly and easily

Your time is valuable. If you are on time for your
appointment, you should not have to wait too
long to see your doctor.

Things to remember:
? When making your appointment,

ask to be the first one seen that day.

? Call us if you need help getting an
appointment with a specialist.

? Ask your doctor?s office to let you know
if they are running late.

Enjoy convenient access
to all of your plan information

Register or sign in at horizonNJhealth.com to:
? View your member ID card or request

a new ID card

? Change your PCP

? Get a list of covered prescription drugs

? Get important plan information

? Find a doctor, hospital or specialist near you

Be sure to get a referral from your PCP to see
a specialist. You do not need a referral to see
a dentist or Ob/Gyn, or for routine eye care
or mammograms.

Work with a Care Manager
to help you coordinate all of
your health care needs

Our Care Managers can help you understand
your benefits and help you get the care you
need. They can help you:

? Better manage chronic conditions such as
diabetes or high blood pressure

? Arrange other resources or services you
may need

Care Managers are available Monday through
Friday, from 8 a.m. to 5 p.m., Eastern Time
(ET). Please call 1-844-444-4410 (TTY 711).

Watch for reminders when
you are due for appointments
or preventive care

Getting preventive health screenings or
vaccines, like annual wellness visits or flu
shots, are an important part of your health.
Many of these are covered under your
benefits so there is no cost to you. If you
have questions or concerns about a vaccine
or screening, call Horizon Healthy Journey at
1-844-754-2451 (TTY 711).

Renew your NJ FamilyCare
eligibility every year

Don?t risk losing your coverage.

? Call your County Welfare Agency (CWA)
or NJ FamilyCare at 1-800-701-0710
(TTY 1-800-701-0720) to find out your
renewal date.

? If you receive a form, blank application
or written request from NJ FamilyCare,
respond right away.

1

3

4

5

6

2



3 4

Save money
with NJSave
NJSave is an electronic
application system for
New Jersey seniors
and disabled residents
to access savings and
assistance programs
all in one place.

Save Money on:
? prescription costs

? living expenses

To find out if you qualify
for any programs
that provide financial
assistance for health care
costs and living expenses,
visit njdoas-ua.force.com/
njsave/quickstart.

Caring for a loved one:
you are not alone
Caregivers are responsible for tasks that can be draining, especially activities of daily living (ADLs).
ADLs are often physically hard to do, including helping your loved one bathe, toilet, get dressed and
eat. Being a caregiver can be harder if your loved one has a cognitive (decline in memory or thinking
skills) disease such as dementia. Your loved one may be moody, wander away from home or be in a
dangerous situation, like leaving the stove on or forgetting to turn off the faucet.

Every situation has different hardships. Some caregivers find that they cannot leave their loved
one alone or have so many responsibilities that they must cut back working hours or stop working
altogether. If there is no other household income, this can cause financial problems.

Avoiding burnout
To avoid feeling exhausted, it is important that you take care of yourself first. Exercise, eat healthy
meals that are good for you, and make time to do things you enjoy, like meeting friends or reading.

Groups like your local Area Agency on Aging can also help caregivers find support, including
ways to handle finances, finding an in-home aide or connections with other caregivers.
Find your local chapter by visiting n4a.org. Your Care Manager can assist with caregiver supports -
be sure to discuss it with them. You can also find resources at horizonNJhealth.com under the
For Caregivers tab.

If you are eligible for Medicaid and Medicare, you can get all your
health care benefits under one convenient plan. With Horizon
NJ TotalCare (HMO SNP), you can receive benefits and services
at no cost to you. Horizon NJ TotalCare (HMO SNP) includes:

? $0 premiums

? $0 copayments

? $0 deductibles

? No referrals

? $245 per quarter to purchase health items
from the Health Products Benefit Catalog

? NEW: An additional $250 per quarter on a prepaid
Over-the-Counter (OTC) Benefit Card to purchase eligible
health care products from retail stores like Walmart or CVS

Horizon NJ TotalCare (HMO SNP)
All your benefits in one plan

To learn more, call 1-888-328-5736 (TTY 711),
24 hours a day, seven days a week, or visit
HorizonBlue.com/TotalCare.

Our commitment to quality
Horizon NJ Health?s Quality Improvement (QI) program works with
members and physicians to improve the quality of care and services
you receive. Our QI program ensures these services continue to
be appropriate, necessary and properly administered. We monitor
areas that affect the care our members get, like access to care,
screenings and member satisfaction. For more information about
Horizon NJ Health?s QI program and its progress toward goals,
visit horizonNJhealth.com/quality, or call Member Services at
1-844-444-4410 (TTY 711) and ask for the Quality Department.



Resources
Center for Parent Information and Resources, parentcenterhub.org/repository/intellectual
Family Caregiver Alliance, caregiver.org/caring-adults-cognitive-and-memory-impairment
Alzheimer?s Association, alz.org

65

Older
Americans
Month 2019
May is recognized as Older
Americans Month. The
Administration of Aging
announced that the 2019
theme is: Connect, Create,
Contribute. Older adults
and their communities are
encouraged to:

? Connect with friends,
family and services that
support participation

? Create by engaging in
activities that promote
learning, health and
personal enrichment

? Contribute your time,
talent and life experience
to benefit others

Recognizing older adults
and their contributions
makes stronger
communities and benefits
all its members. For more
information about Older
Americans Month and
how you can get involved,
visit acl.gov/oam.

A reminder about
lab services

Need a ride?

We encourage you to use Laboratory Corporation of America?
Holdings (LabCorp) when getting laboratory services. LabCorp is
your laboratory services provider.

You can visit horizonNJhealth.com/findadoctor to find a LabCorp
location near you. Select Other Healthcare Services from the
dropdown menu, then type Laboratory in the search field.

LabCorp also offers online appointment scheduling for all
New Jersey Patient Service Centers. Visit labcorp.com/PSC
to find a location. Walk-in patients are welcome.

You can use LabCorp Patient, an online service, to download
and print your test results on your own. You can register at
patient.labcorp.com. LabCorp will give your test results to your
doctor before posting them to your online account.

Caring for a loved one
with a cognitive impairment
Caring for a loved one with a cognitive impairment (decline in memory or thinking skills) can be
challenging. Even having a simple conversation can be difficult. Individuals with cognitive impairment
can experience:

? Aggressive or impulsive behaviors ? Fixation on/repetition of an idea or activity

? Lack of motivation ? Incontinence (trouble holding urine or bowels)

? Memory problems ? Paranoia (suspicion or mistrust of people)

? Poor judgment ? Wandering

To help your loved one, keep language simple, and ask one question at a time. For example,
instead of asking ?Would you like to come in and sit down and have a snack?? use simple statements
such as ?Sit down here.? and ?Here?s a snack for you.?

Wandering and poor judgment could lead to dangerous situations and the need for 24-hour
supervision. Use the resources below and know who to contact in your community in case of
an emergency.

If you have questions about cognitive impairment or would like more information, you can talk to your
loved one?s Care Manager, or call Member Services at 1-844-444-4410 (TTY 711), 24 hours a day,
seven days a week.

LogistiCare coordinates non-emergency transportation to covered
medical appointments, at no cost to you. Here?s what you can
do to easily and conveniently schedule a ride:

? Call the LogistiCare Reservation Line 48 hours in advance of your
appointment toll free at 1-866-527-9933 (TTY 1-866-288-3133)
from 8 a.m. to 4:30 p.m., ET.

? Make your reservation online at member.logisticare.com.
? Download the free LogistiCare Trip Manager from the app

store on any smartphone and schedule your ride via the app.

As a Horizon NJ Health member, you have rights, responsibilities
and choices in the care you get. Your member rights and
responsibilities can be found in your Horizon NJ Health Managed
Long Term Services & Supports (MLTSS) Member Handbook,
or at horizonNJhealth.com/memberrights.

Member rights
and responsibilities



Signs/symptoms of aspiration pneumonia may include:
? Delirium (confusion)

? Raised respiratory (breathing) rate

? Fever, chills or chest pain

? Shortness of breath

? Fatigue (tired)

? Hoarse voice after swallowing

? Wet coughing after eating

To prevent aspiration pneumonia:
? See a speech pathologist or swallow therapist

? Practice exercises to strengthen throat muscles

? Use proper oral hygiene

? Eat slowly and take small bites

? Sit upright while eating

? Avoid medicines that cause drowsiness

7

Renew it or
lose it!
Your health benefits with
Horizon NJ Health depend
on your NJ FamilyCare
coverage. You must
renew your NJ FamilyCare
coverage on time in order
to keep your membership
with Horizon NJ Health.
If you miss your renewal
deadline, you risk losing
health coverage for you
and your family.

What you need to do:
? Check your mail: You

may receive a form from
NJ FamilyCare that you
will need to complete.

? Respond to any written
requests right away:
If NJ FamilyCare asks you
to confirm your family
size or complete an
application, you must do
so as soon as possible so
there is no disruption in
your coverage.

To renew your coverage, or
find out your renewal date,
contact NJ FamilyCare
at 1-800-701-0710 (TTY
1-800-701-0720) or your
eligibility agency, such as
your local County Welfare
Agency (CWA).

Older adults, people with dementia, stroke survivors and people with conditions like Parkinson?s
disease, multiple sclerosis and cerebral palsy often have trouble swallowing. This may put them at a
higher risk of getting aspiration pneumonia. Aspiration pneumonia happens when food, saliva, liquids
or vomit are breathed into the lungs instead of being swallowed into the stomach.

Are you at risk for aspiration pneumonia?

Preventing bedsores
Bedsores are open wounds found on the skin. They are common
among older adults and people with disabilities. Bedsores are caused
by long periods of pressure on the skin against a hard surface, such as
a bed, chair or wheelchair. They are often found on bony areas of the
body such as the hips, back, heels, ankles and buttocks.

You should see your doctor right away if you notice any
changes in your skin.

Sources: Mayo Clinic, Johns Hopkins Medicine

To prevent bedsores, you should:

? Check your whole body every day for signs of sores

? Pay attention to bony areas of the body

? Keep your skin clean and dry

? Use mild soaps and moisturizers

? Change wet clothing/diapers often

? Change your body position at least every two hours

? Drink plenty of fluids

? Use pillows and pads to reduce pressure on bony
areas of the body

If you think you are at risk
for aspiration pneumonia,
talk to your doctor, as
you may have a higher
risk of being admitted
to the hospital.

Source: MedlinePlus, medlineplus.gov
8

Changes in skin color

Open sores

Swelling of the skin

Skin feeling cooler or warmer to the touch than other areas

Symptoms of bedsores include:



Colon cancer is treatable.
Detect it early by a simple screening.

Screening Description How Often?

Fecal Occult Blood Test Also referred to as FOBT or FIT test ? a lab test that looks for blood in a stool sample. Once a year

Flexible Sigmoidoscopy A procedure that uses a tiny camera on a thin tube to view the rectum and lower third of the colon to check for signs of cancer. Every 5 years

Colonoscopy Similar to a sigmoidoscopy, but uses a longer tube to view the entire colon. Every 10 years

CT Colonoscopy A CT scanner is used to take images of the colon. Every 5 years

FIT-DNA test Also referred to as the stool DNA test ? a lab test that checks for DNA changes and blood in a stool sample. Every 1 to 3 years

109

Colorectal cancer, also called colon cancer, occurs in the colon or rectum. If you?ve had colorectal
polyps or inflammatory bowel disease, your risk of getting colon cancer is higher. Both men and
women, usually age 50 or older, can get colon cancer. When colon cancer is found early, the
chances of successful treatment are greater. Talk to your PCP to see which of the following tests
are best for you. Screenings save lives!

If you have any questions about preventive screenings, call the Horizon Healthy Journey line at
1-844-754-2451 (TTY 711), Monday through Friday from 8:30 a.m. to 5 p.m., ET.

Source: Centers for Disease Control and Prevention, cdc.gov/cancer/colorectal

Reminder:
you have access
to Member
Advocates
All MLTSS Members
have access to a Member
Advocate. Member
Advocates work with you
to make sure any questions
about your MLTSS benefits,
services and decisions
are answered. He or she
works closely with you,
your care team and state
representatives to make
sure your needs and
goals are being met.

To speak with a Member
Advocate, please call
1-844-444-4410 (TTY 711)
Monday through Friday,
from 8 a.m. to 5 p.m., ET.

First aid
for seizures

Seizures can happen quickly, and it is important to know
how to care for someone who is having a seizure. First aid
for seizures involves keeping a person safe until the seizure
stops by itself.

If someone is having a seizure, you should:
? Call 911, and check for a medical bracelet.

? Ease the person onto the floor.

? Gently turn the person onto his or her side.

? Clear the area of anything hard or sharp.

? Place something soft under the person?s head.

? Loosen tight clothing around the neck.

? Time the seizure.

? Stay with the person until the seizure ends.

? Stay calm.

You should never:
? Put anything in the person?s mouth.

? Hold the person down or try to stop their movements.

If you have seizures or care for someone who does, ask your
doctor for more information about what to do during and
after a seizure.

Sources: American Epilepsy Society, aesnet.org
Centers for Disease Control & Prevention, cdc.gov/epilepsy/about/first-aid.htm

90%1 in 350+
90% of

cases occur in
people age 50

or older.
If found and

treated early, the
five-year survival

rate is 90%.

One in three
people develop
colorectal cancer

if they have a
family history.

Colorectal Cancer FACTS



12

Covered Change Description Brand (Generic) Drug Name Alternatives (if applicable)
Covered Cimduo (lamivudine, tenofovir disoproxil fumarate)
Covered Symfi Lo (efavirenz, lamivudine, tenofovir disoproxil fumarate)
Covered Symfi (efavirenz, lamivudine, tenofovir disoproxil fumarate)
Covered Renflexis (infliximab-abda)
Covered Crysvita (burosumab-twza)
Covered Jynarque (tolvaptan)
Covered Steglatro (ertugliflozin)
Covered Segluromet (ertugliflozin and metformin)
Covered Generic Albuterol HFA
Covered Lumigan (bimatoprost) 0.03%
Covered Aristada Initio (aripiprazole)
Covered Aristada (aripiprazole)
Covered Fulphila (pegfilgrastim-jmdb)
Covered Retacrit (epoetin alfa-epbx)
Covered Mulpleta (lusutrombopag)
Covered Tibsovo (ivosidenib)

Covered Humira (adalimumab) 10 mg/0.1 ml, 20 mg/0.2 ml, 40 mg/0.4 ml, 80 mg/0.8 ml,
Not Covered Remicade (infliximab) Renflexis
Not Covered Condylox (podofilox) gel Generic Condylox Solution
Not Covered Kristalose (lactulose) pack Lactulose Solution
Not Covered Jardiance (empagliflozin) Steglatro
Not Covered Synjardy (empagliflozin and metformin) Segluromet
Not Covered Ventolin HFA (albuterol) Authorized Generic Ventolin HFA, ProAir HFA
Not Covered Zytiga 500 mg (abiraterone) Generic Zytiga 250 mg
Not Covered Xtandi (enzalutamide) Generic Zytiga 250 mg
Not Covered Erleada (apalutamide) Xtandi
Not Covered Innopran XL (propranolol) Generic Inderal LA (propranolol)
Not Covered Inderal XL (propranolol) Generic Inderal LA (propranolol)
Not Covered Zelboraf Tafinlar/Mekinist
Not Covered Cotellic Tafinlar/Mekinist
Not Covered Neulasta (pegfilgrastim) Fulphila
Not Covered Procrit (epoetin) Retacrit

Formulary Changes

Please talk with your 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. Please note that Horizon NJ Health?s maximum days? supply limit is 30 days.
Your PCP may call the Horizon NJ Health Pharmacy Department at 1-844-444-4410 (TTY 711)
to request a prior authorization.

We want to let you know about the recent changes to our formulary list, also called preferred drug
list (see box). The changes found in this list will be added to our Drug Formulary list on our website at
horizonNJhealth.com. You can also find the approved drug list online. This list includes an explanation
and listing of step therapy, quantity/age limitations and drugs that require prior authorization (approval).
Here is a list of recent changes:

Make fall prevention a priority
Each year, millions of older adults fall. Falls are the most common cause of injury
in older adults. You may be more likely to fall if you:

? Have arthritis (joint swelling) ? Have dementia

? Have low levels of vitamin D ? Have impaired vision or hearing

? Are overweight ? Take drugs that make you drowsy

? Drink alcohol

Don?t lose your independence! Falls can be avoided. Many people don?t think it will happen to them.

6 Must-haves to prevent falls
1. A regular exercise routine. Keep moving with activities that improve

your strength and balance. Try walking or Tai Chi.

2. Grab bars and handrails. These should be installed in tubs and on stairs to help
you get in and out (and up and down) with ease.

3. Good lighting. If you can?t see well, falls are more likely to occur by tripping
in low-lit areas of your house.

4. Medication check with your doctor. Make sure your doctor knows about all
of the medications you are taking, including over-the-counter. Tell your doctor right
away if your mediciation makes you dizzy.

5. Updated glasses. Have your vision checked once a year and make sure you
get a new pair if your vision changes.

6. Clutter free home. Get rid of things that you could trip over like loose rugs or wires.

Bonus tip:
Ask your doctor about vitamin D supplements for improved bone, muscle and nerve health.

3 MILLION

ONE OUT OF FOUR
older adults fall each year,

but less than half tell their doctor.

ONE OUT OF FIVE
falls causes a serious injury such as

broken bones or a head injury.

Older people are treated in the ER for fall injuries.



ATTENTION: If you speak a language other than English, language
assistance services, free of charge, are available to you. Call
1-844-444-4410 (TTY 711). This document is also available in other
languages, as well as other formats, such as large print and Braille.

ATENCI6N: si habla espafiol, tiene a su disposici6n servicios gratuitos de asistencia linguistica.

Llame al 1-844-444-4410 (TTY711).

;.1? : :t<o?f?ftm?m1crx: , f?PJ tJ:92,JtJtt?s!am:13.;IJij?? 0 8ll5Z? 1-844-444-4410
(TTY711 ).

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1-844-444-4410 (TTY711)? 0 ? ? .2loH ?? Al 2..

ATEN<;AO: Se fala portugues, encontram-se disponiveis servivos linguisticos, gratis. Ligue

para 1-844-444-4410 (TTY711).

??at.l: ?l?1. ct.it :>J<>i(?Lc-0. C>U.Hct.L ?' ctl R:?G-8 ?l"tll ??l? ?cu? ct.l-ll?l l-ll? G'Lt.Hu-\:.1. ?- $1.at.
8? 1-844-444-4410 (TTY711).

UWAGA: Jezeli m6wisz po polsku, mozesz skorzysta6 z bezplatnej pomocy j?zykowej.

Zadzwon pod numer 1-844-444-4410 (TTY711).

ATTENZIONE: In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza
linguistica gratuiti. Chiamare il numero 1-844-444-4410 (TTY 711).

?.J) 4410-444-844-1 ?Y. J....:.:ii .u?'-! ? .)lji:i ?y.111 r.?w1 -::.iL.? u? ,:i..i111 .fi?I ?? w.iS 1?J :?yJ..
.(711 ("?1_, ?I ?lA

P AUNA WA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong

sa wika nang walang bayad. Tumawag sa 1-844-444-4410 (TTY711).

BHHMAHHE: EcmI Bbl roB0p1ue Ha pyccKOM jl3bIKe, TO BaM ,r:i:ocTyrrHhI 6ecrrnaTHbie ycnynI
rrepeBo,r:i:a. 3BOHIITe 1-844-444-4410 (Tenerniirr 711).

ATANSYON: Si w pale Kreyol Ayisyen, gen sevis ed pou lang ki disponib gratis pou ou. Rele

1-844-444-4410 (TTY 711).

t.? ?: ? 3-TfCT ? ? e; ? 3fTqc), ?
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? al ? ti f, I <.I ci I ? 3 q <>I <S:tf e; I
1-844-444-4410 (TTY 711) ? ? ? I

CHU Y: NSu b.;in n6i TiSng Vi?t, c6 cac dich V\l h6 trq ngon ngfr mi?n phi danh cho b.;in. Goi s6
1-844-444-4410 (TTY 711).

ATTENTION : Si vous parlez franvais, des services d'aide linguistique vous sont proposes
gratuitement. Appelez le 1-844-444-4410 (ATS 711).

u-:..fi J\.5. _ u::t y?..i ();/A us.a wL.? ? ..i..l.a ? u'-/j .fi Y.I _;i 'Lli:t c11 y, _,..i) Y.\ ).1 :)..i ?
1-844-444-4410 (TTY 711).

Horizon NJ Health complies with applicable Federal civil rights laws and does not discriminate
against nor does it exclude people or treat them differently on the basis of race, color, gender,
national origin, age, disability, pregnancy, gender identity, sex, sexual orientation or health status
in the administration of the plan, including enrollment and benefit determinations.

Horizon NJ Health provides free aids and services to people with disabilities to communicate
effectively with us, such as qualified sign language interpreters and information written in
other languages.

Contacting Member Services
Please call Member Services at 1-844-444-4410 (TTY 711) or the phone number on the back
of your member ID card, if you need the free aids and services noted above and for all other
Member Services issues, including:

? Claim, benefits or enrollment inquiries
? Lost/stolen ID cards
? Address changes
? Any other inquiry related to your benefits or health plan

Filing a Section 1557 Grievance
If you believe that Horizon NJ Health has failed to provide the free communication aids and
services or discriminated on the basis of race, color, gender, national origin, age, or disability,
you can file a discrimination complaint also known as a Section 1557 Grievance. Horizon
NJ Health?s Civil Rights Coordinator can be reached by calling the Member Services number
on the back of your member ID card or by writing to the following address:

Horizon NJ Health ? Civil Rights Coordinator
PO Box 10194
Newark, NJ 07101

You can also file a civil rights complaint with the U.S. Department of Health and Human
Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint
Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

Office for Civil Rights Headquarters
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201
1-800-368-1019 or 1-800-537-7697m(TTY)

OCR Complaint forms are available at www.hhs.gov/ocr/office/file/index.html.
Para ayuda en espa?ol, llame a 1-844-444-4410 (TTY 711).

1413

Our Notice of Nondiscrimination Getting help in your language



You can stay up-to-date with the latest company
news and health and wellness information.
Follow us on Twitter,?
twitter.com/HorizonNJHealth

Horizon Blue Cross Blue Shield of New Jersey
has joined active users on Facebook? with
our own corporate page,
facebook.com/HorizonNJH

Facebook ?f ? Logo CMYK / .eps Facebook ?f ? Logo CMYK / .eps

Care Notes
Member Services 1-844-444-4410 (TTY 711) 24 hours a day, seven days a week. horizonNJhealth.com
CARE NOTES is published for members of Horizon NJ Health, 1700 American Blvd., Pennington, NJ 08534. Information in CARE
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 TotalCare (HMO SNP) is an HMO Medicare Advantage Dual Eligible Special Needs plan with a Medicare contract and
a contract with the State of New Jersey Medicaid Program. Enrollment in Horizon NJ TotalCare (HMO SNP) depends on contract
renewal. 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.
Y0090_H8298_EC002873_M 086-19-21





horizonNJhealth.com

Care NotesIssue 2, 2020



2
In this issue
Your updated member materials are available??????????????????????? 2
Referrals no longer needed! ??????????????????????????????????????????????????? 2
Reminder: you have access to Member Advocates ??????????????? 2
If you are due for a colonoscopy, don?t wait? ????????????????????????? 3
Should you be screened for prostate cancer? ??????????????????????? 4
Services for children diagnosed with Autism
Spectrum Disorder ?????????????????????????????????????????????????????????????????? 4
Answers to your health questions, 24/7 ????????????????????????????????? 5
Chat with a nurse ??????????????????????????????????????????????????????????????????? 5
Tips for caregivers ?????????????????????????????????????????????????????????????????? 6
Changes to covered medicines ?????????????????????????????????????????????? 7
Over-the-counter medicines ??????????????????????????????????????????????????? 7
Access to your plan information online ?????????????????????????????????? 8
You may be eligible for
Horizon NJ TotalCare (HMO D-SNP) ?????????????????????????????????????? 8
Early detection can save your life ??????????????????????????????????????????? 9
When to go to the Emergency Room ?????????????????????????????????? 10
Help for members living with addiction ????????????????????????????????11
Understanding how your care is delivered ????????????????????????????11
Language translator services ?????????????????????????????????????????????????11
Our Housing Specialist is here to help ??????????????????????????????????12
Mark your calendar: it?s almost time for your flu shot ??????????12
Delivering compassion during challenging times ??????????????????13
Notice of Nondiscrimination ??????????????????????????????????????????????????14

Your health is important to us? Our specially-trained Member Services Representatives
can help you understand your benefits so you can reach your best health. If you have

any questions, please call Managed Long Term Services & Supports (MLTSS)
at 1-844-444-4410 (TTY 711), 24 hours a day, seven days a week, 365 days a year?

You have quick and easy access to your plan information.
Visit horizonNJhealth.com/annualmaterials to view the updated materials, including:
? 2020 Member Handbook

- Find details about your benefits.
- Review top 10 frequently asked questions.
- Learn about the extra care we take with your private health information.

? Provider Directory

It?s easier than ever for you to get access to quality health care. Horizon NJ Health members no
longer need a referral from their Primary Care Provider (PCP) to visit an in-network specialist. This
means you can make an appointment with an in-network specialist without getting a referral from
your PCP.

As a reminder, you must use a specialist in Horizon NJ Health?s provider network.
To find a specialist, please visit horizonNJhealth.com/findadoctor, or call Member Services
at 1-844-444-4410 (TTY 711), 24 hours a day, seven days a week.

Referrals no longer needed!

Reminder: you have access to Member Advocates

Your updated member
materials are available

To request a printed copy of any of these materials, call us at 1-844-444-4410 (TTY 711).

All MLTSS members have access to a Member Advocate. Member Advocates work with you to make sure
your questions about your MLTSS benefits, services and decisions are answered. He or she works closely
with you, your care team and state representatives to make sure your needs and goals are being met.

To speak with a Member Advocate, please call 1-844-444-4410 (TTY 711) Monday through Friday,
8 a.m. to 5 p.m., Eastern Time (ET), or ask your Care Manager for a Member Advocate to contact you.



When physical abuse, child abuse and/or neglect of a child are suspected, examinations
at an Emergency Room (ER) are covered under your benefits. An ER visit is also covered
for a child who is placed in foster care after hours? If you suspect child abuse, please
call the NJ Child Abuse Hotline at 1-877-NJ-Abuse (TTY 711)?

Prostate cancer is the second most common cancer among men in the United States.
The goal of prostate cancer screening is to find cancer early, even before you may have symptoms.

Prostate cancer risk factors include:
? Age: your risk increases after age 50
? Race: African-American men are more likely to get prostate cancer
? Family history: having a father or brother with prostate cancer more than doubles your risk
Should you get screened for prostate cancer? Talk with your doctor about your risk and decide
together if a prostate cancer screening is right for you.

Effective April 1, 2020, Horizon NJ Health began covering medically necessary Applied Behavior
Analysis (ABA) services for children diagnosed with Autism Spectrum Disorder (ASD). ABA therapy
can help to increase language and communication skills and improve attention, focus, social
skills and memory.

The following ASD services will continue to be covered by Horizon NJ Health:

? Physical Therapy, Speech Therapy and Occupational Therapy

? Sensory Integration (SI) provided by Occupational Therapists

? Augmentative and Alternative Communication (AAC) assessments and devices

A qualified health care professional must make an autism diagnosis and determine the need for
ABA services. This provider will help develop an autism treatment plan. If you have questions about
the ABA services in your child?s treatment plan, please contact the provider handling your child?s
diagnosis and treatment.

3 4

Should you be screened for prostate cancer?

Services for children diagnosed with Autism
Spectrum Disorder

If you are due for a
colonoscopy, don?t wait.

Getting a colonoscopy may not be something you look forward to, but it can save your life. It is
recommended that you get your first colonoscopy at age 50. If you?ve had polyps or inflammatory
bowel disease, your risk of getting colon cancer is higher.

Ask your PCP about these screenings:

Source: Centers for Disease Control and Prevention, cdc.gov/cancer/colorectal

Source: American Cancer Society, Cancer.org/cancer/prostate-cancer.html

Screening Description How Often?

Fecal Occult
Blood Test

Also referred to as FOBT or FIT test ? a lab test
that looks for blood in a stool sample? Once a year

Flexible
Sigmoidoscopy

A procedure that uses a tiny camera on a thin tube
to view the rectum and lower third of the colon
to check for signs of cancer?

Every 5 years

Colonoscopy Similar to a sigmoidoscopy, but uses a longer tube to view the entire colon? Every 10 years

CT Colonoscopy A CT scanner is used to take images of the colon? Every 5 years

FIT-DNA test
Also referred to as the stool DNA test ? a lab test
that checks for DNA changes and blood in a
stool sample?

Every 1 to 3
years

if caught early
100%AMERICAN MEN1 in 9 TREATABLE

will be diagnosed in their lifetime



5 6

Source: nia.nih.gov/health/taking-care-yourself-tips-caregivers

Caring for a loved one with a chronic illness can be difficult and stressful. Taking care of yourself
is the most important thing you can do as a caregiver. Use these tips to help you manage your
own health and well-being.

Tips for caregivers

g Acknowledge your feelings. Frustration and anger are common at times.
g Take care of yourself by eating healthier foods, exercising and getting

enough sleep.

g Don?t be afraid to ask for help and accept help from others.
g ?Ask questions of the doctors and health care team who are caring for

your family, spouse or partner.

g Watch out for signs of depression, and get professional help when you need it.
g Join a caregiver support group.
g Give yourself credit for doing the best you can in one of the toughest

jobs there is.

Answers to your health questions, 24/7

Chat with a nurse

When you have everyday health questions, or even when you have more serious health
concerns, getting information you can count on is as easy as calling our 24/7 Nurse Line.
When you call the toll-free number, a registered nurse will give you reliable health
information right away.

Nurse Chat is a real-time live online chat tool that lets you chat with a nurse or doctor
for free. Registered nurses are available 24 hours a day, seven days a week and
can help you understand symptoms related to COVID-19, or help with other health
concerns. If the nurse determines a need, he or she can connect you with a doctor
for a video consult.

How to use the Nurse Chat Tool:
1. Visit HorizonBlue.Pager.com.
2. Answer the questions to determine if your health concern or symptoms are related

to COVID-19 or a different health issue.

3. Enter your Member ID, date of birth, phone number and email address.

You can chat about any health concerns related to urgent care, like cough, fever, sore throat,
pink eye and more ? all at no cost to you.

The 24/7 Nurse Line can answer
questions about:
? General health concerns

? Health screenings and immunizations

? A diagnosis from your doctor

? Nutrition and exercise

? The level of care (urgent or self-care)
you need

While the 24/7 Nurse Line is a great
information resource, it is not a
substitute for a doctor?s care or

emergency services? For medical care,
call your doctor?s office first ? 24 hours

a day, seven days a week?

To access the 24/7 Nurse Line call 1-800-711-5952 (TTY 711)?



7 8

Over-the-counter medicines
Over-the-counter (OTC) and herbal medicines are medicines you can buy without a prescription
from your doctor. These medicines can help you feel better by treating or preventing health
problems like allergies, constipation, cough and cold, heartburn and many more. While you don?t
need a prescription from your doctor to get these medicines, it is very important to let your doctor
and pharmacist know all OTC and herbal medicines you are currently taking.

These medicines may cause side effects when taken with the medicines your doctor prescribes.
They can also cause other medicines to act differently than intended. If you see more than one
doctor or fill prescriptions at more than one pharmacy, it?s important to tell everyone involved in
your care about all the medicines you are taking, including OTC and herbal medicines.

Take all medicines ? OTC and prescription ? exactly as the label says to make sure they are
working the best way they can to treat your condition.

Access to your plan information online
All Horizon NJ Health members can register to use our secure member web portal
on horizonNJhealth.com. Once you sign in, you have access to your plan information
24 hours a day, seven days a week.

You can easily:
? Change your PCP
? Enroll in one of our Disease Management programs

? Request a new member ID card

? Find tools for healthy living

? And much more

You may be eligible for Horizon NJ TotalCare
(HMO D-SNP)
If you are eligible for both Medicaid and Medicare, you can get all your health care benefits
under one convenient plan. With Horizon NJ TotalCare (HMO D-SNP), you get the following
benefits and services at no cost to you:
? $0 premiums

? $0 copays

? $0 deductibles

? $300 every 3 months on an Over-the-Counter (OTC) Benefit Card
to spend on health items at participating retail stores

? $250 every 3 months to spend on personal items from our catalog

? And more!

Changes to covered medicines
Our formulary list, also called a Prescription Drug Listing, is changing. The changes listed
below will be added to our Drug Formulary list at horizonNJhealth.com/covered_drugs.
This list includes an explanation and listing of step therapy, quantity/age limitations and
drugs that require prior authorization (approval).

Here is a list of recent changes:

Covered Change Description Brand (Generic) Drug Name Alternatives (if applicable)
Covered Baqsimi (glucagon) ?

Covered Generic Suboxone (buprenorphine-naloxone) films ?

Covered Reblozyl (luspatercept-aamt) ?
Covered Truxima (rituximab-abbs) ?
Covered Ziextenzo (pegfilgrastim-bmez) ?
Covered Ogivri (trastuzumab-dkst) ?
Covered Pretomanid ?
Covered Trikafta (elexacaftor, tezacaftor and ivacaftor) ?
Covered Oxbryta (voxelotor) ?
Covered Givlaari (givosiran) ?
Not Covered Rituxan (rituximab) Truxima

Please talk with your PCP about these changes. If your PCP decides that, for medical reasons, you
must take a medicine that is not on the formulary list or needs pre-approval, including a brand name
medicine exception, he or she can call us and ask for special permission (prior authorization) for you
to get the medicine. Please note that Horizon NJ Health?s maximum days? supply limit is 30 days.

To learn more, call 1-888-328-5736 (TTY 711), 24 hours a day,
seven days a week, or visit HorizonBlue.com/TotalCare.



109

When to go to the Emergency Room
When you are not feeling well, it?s sometimes hard to know where to go for care.
There are a number of medical conditions that are considered emergencies because
they need very quick treatments that are only available in a hospital setting, and not
getting treatment could put your health in serious danger. If you have a true medical
emergency, you should go to the nearest Emergency Room (ER), or call 911.

Below are examples of emergency situations. If you experience any of these,
you should go to the ER or call 911:
? Bleeding that cannot be stopped

? Broken bones

? Chest pain

? Drug overdose

? Fainting or dizziness

? Problems breathing, moving or speaking

? Sudden numbness or weakness

? Vaginal bleeding with pregnancy

? You have thoughts of hurting yourself or others

If your symptoms come on slowly or you are unsure if it is a medical emergency, call your PCP.
Your doctor will give you advice on what to do.

After you are discharged from the hospital
The most important thing to do after a hospital stay or visit to the ER is call your PCP and make
an appointment to see him or her within five to seven days. If you cannot call for an appointment,
ask a friend or family member to call for you.

Your PCP knows your health history and can help answer your questions, explain any tests that were
performed in the hospital, review your medications, including any new ones that were prescribed,
and coordinate follow up care with a specialist.

If you need help getting to your doctor?s appointment, call LogistiCare at 1-866-527-9333
(TTY 1-866-288-3133).

After a recent hospital stay you are at risk for being admitted back into the
hospital. The best way to prevent a hospital readmission is to follow up with your
PCP within seven days of any inpatient hospital or rehabilitation facility stay.

What is stopping you from getting a mammogram?

Lack of time ? The actual procedure only takes 3 to 5 minutes. Most facilities offer evening
hours and some have weekend appointments.

Cost ? Routine mammograms are covered, and there is no cost to you.

Pain ? Some women feel a little discomfort, but most do not find it painful. If you?ve had a painful
mammogram in the past, tell your technician.

?I?d rather not know? ? A breast health problem will not go away on its own. A mammogram
could save your life.

For any questions or concerns about how to complete your mammogram this year or for
help finding a doctor or facility, please call Horizon Healthy Journey at 1-844-754-2451
(TTY 711), Monday through Friday, 8:30 a.m. to 5 p.m.

Early detection can save your life.

To schedule your mammogram:

Call your doctor and
ask for a mammogram
prescription?

1 2 Contact a participating radiology facility once you
get your prescription?

A mammogram can detect breast cancer early, when it is most treatable. Women should have
their first baseline mammogram between the ages of 35 and 39, and then once every year.
Routine mammograms are covered, at no cost to you.



11

Finding information about housing resources can be challenging, but Horizon NJ Health has
a Housing Specialist who can help. Our Housing Specialist works closely with MLTSS members,
Care Managers, and state and county resource agencies to help identify housing resources in
the community. Here are some of the ways our Housing Specialist can help:

? Work with your Care Team to identify community-based residences if you are
transitioning out of a nursing facility

? Give you information and about landlord-tenant rights

? Explain how to apply for subsidized housing vouchers

The Housing Specialist helps you research your housing options and gives you resources
for supportive housing services agencies to help you meet your needs, such as:

? New Jersey County Boards of Social Services: state.nj.us/humanservices/dfd/programs/
njsnap/cbss/index.html

? NJ 2-1-1: nj211.org or 1-877-652-1148 (TTY 711)
? New Jersey affordable developments by county: state.nj.us/dca/divisions/codes/

publications/developments.html

12

Our Housing Specialist is here to help
If you are living with a Substance Use Disorder or you are in recovery,
help is available from someone who?s been through it. NJ Peer Recovery?s
Peer Support Specialists are only a phone call away.

Horizon NJ Health sometimes needs to review your care before it is approved to make sure it is
medically necessary and appropriate. Decisions are made based on your health care needs and plan
benefits. Horizon NJ Health does not offer rewards or incentives to our employees for denials of
coverage or service. We also do not stop providers from discussing all available treatment options,
even if it is not covered by your plan.

Prior authorization
Prior authorization means that you need to request approval for a service before it will be covered.
If you or your doctor needs to request prior authorization, please call 1-844-444-4410 (TTY 711),
Monday through Friday, from 8 a.m. to 5 p.m.

If you need treatment outside of normal business hours, please call your doctor. An on-call doctor
will be available 24 hours a day, seven days a week. If it is a true medical emergency, call 911.

Help for members living with addiction

Horizon NJ Health can provide telephonic language translator services for members during office
visits with their providers. Members who require a translator can have their provider request one at
the time of service. In order to use translator services, the member must be actively enrolled with
Horizon NJ Health, the doctor must be a participating provider in the Horizon NJ Health network
and the office visit must be for covered services.

During their office visit, members who require this service can ask their provider to call Provider
Services at 1-800-682-9091, Monday through Friday, from 8 a.m. to 5 p.m. After hours, members
can ask their provider to call Member Services at 1-844-444-4410 (TTY 711).

Language translator services

Understanding how your care is delivered

Font=Avenir next
bold and medium

Call 1-833-422-2765 (TTY 711), 8 a.m. to 10 p.m.,
seven days a week to connect with a Peer Support Specialist
and start getting help today.

If you would like to speak with the Horizon NJ Health Housing Specialist,
please call 1-844-444-4410 (TTY 711), Monday through Friday, from
8:30 a?m? to 5 p?m?, ET?

If you got your flu shot in the fall, congratulations on taking an
important step to protect your health. By getting a flu shot, you
helped protect yourself and others from getting the flu, which can
cause hospitalization and even death.

Each year, you will need a flu shot to protect yourself, since the
flu strain changes. The best time to get your flu shot is October or
November, before flu season peaks. You can get your free flu shot at your doctor?s
office or at a participating pharmacy, once the vaccine becomes available.

Mark your calendar: it?s almost
time for your flu shot

Flu vaccines are a covered benefit at no cost to you?



14

Notice of Nondiscrimination

13

Notice of Nondiscrimination


086-19-100 CMC0008179C (0719) An Independent Licensee of the Blue Cross and Blue Shield Association.


Horizon NJ Health complies with applicable Federal civil rights laws and does not discriminate against nor does it
exclude people or treat them differently on the basis of race, color, gender, national origin, age, disability, pregnancy,
gender identity, sex, sexual orientation or health status in the administration of the plan, including enrollment and benefit
determinations. Horizon NJ Health provides free aids and services to people with disabilities (e.g. qualified language
interpreters and information in other formats) and to those whose primary language is not English (e.g. information in
other languages) to communicate effectively with us.


Contacting Member Services
Call Member Services at 1-844-498-9393 (TTY 711) or the phone number on the back of your member ID card, if
you need the free aids and services noted above and for all other Member Services issues.


Filing a Section 1557 Grievance
If you believe that Horizon NJ Health has failed to provide the free communication aids and services or discriminated
against you for one of the reasons described above, you can file a discrimination complaint also known as a Section 1557
Grievance. Horizon NJ Health?s Civil Rights Coordinator can be reached by calling the Member Services number on the
back of your member ID card or by writing to:


Horizon NJ Health
Civil Rights Coordinator
PO Box 10194
Newark, NJ 07101



You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights
Complaint Portal, online at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail at U.S. Department of Health and
Human Services, 200 Independence Avenue, SW, Room 509F, HHH Building, Washington, D.C. 20201 or by phone
at 1-800-368-1019 or 1-800-537-7697 (TDD). OCR Complaint forms are available at
www.hhs.gov/ocr/office/file/index.html.


Language assistance
Si habla espa?ol, tiene a su disposici?n servicios gratuitos de asistencia ling??stica. Llame al 1-844-498-9393 (TTY 711).

?????????????????????????????? 1-844-498-9393?TTY 711?.
??: ???? ????? ??, ?? ?? ???? ??? ???? ? ????.
1-844-498-9393 (TTY 711)??? ??? ????.
ATEN??O: Se fala portugu?s, encontram-se dispon?veis servi?os lingu?sticos, gr?tis. Ligue para 1-844-498-9393
(TTY 711).



UWAGA: Je?eli m?wisz po polsku, mo?esz skorzysta? z bezp?atnej pomocy j?zykowej. Zadzwo? pod numer
1-844-498-9393 (TTY 711).
ATTENZIONE: In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare
il numero 1-844-498-9393 (TTY 711).

?????? ??????? ???????? ????? ??? ?????? ???? ????? ??? ??? :?????? ???? ???? .??????? ??1-844-498-9393 ?????? ???? ???? ???)711.(
PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang
bayad. Tumawag sa 1-844-498-9393 (TTY 711).
????????: ???? ?? ???????? ?? ??????? ?????, ?? ??? ???????? ?????????? ?????? ????????. ???????
1-844-498-9393 (???????? 711).
ATANSYON: Si w pale Krey?l Ayisyen, gen s?vis ?d pou lang ki disponib gratis pou ou. Rele 1-844-498-9393 (TTY
711).




CH? ?: N?u b?n n?i Ti?ng Vi?t, c? c?c d?ch v? h? tr? ng?n ng? mi?n ph? d?nh cho b?n. G?i s? 1-844-498-9393
(TTY 711).
ATTENTION : Si vous parlez fran?ais, des services d'aide linguistique vous sont propos?s gratuitement. Appelez le
1-844-498-9393 (ATS 711).

???? ??? ? ??? ?????? ??? ??? ????? ?? ??? ?? ???? ?? ?? ?? ???? ????? ???? ?? ??? :??????
1-844-498-9393 (TTY 711).

John* struggled to find the right place to call
home ? somewhere that would meet his needs
and fit his budget. That?s why he was especially
happy to settle into his new apartment. John?s
Horizon NJ Heath Care Manager, Jamie Lewis,
worked with him for over a year, to help him
manage chronic conditions that affected his
ability to perform many of the activities of daily
living. He was finally able to enjoy the simple
comforts of his new home.

?I could tell how excited he was about it,?
said Jamie. ?He couldn?t wait to show it off.?

John?s health and financial situation made it
challenging to take care of things like grocery
shopping, but local food resources helped him
get what he needed. When COVID-19 struck,
John had a hard time accessing the resources
that normally helped him. The pandemic had
temporarily left local organizations unable to
reach the community members that relied
on them.

?When I checked in to see how all of this was
affecting him, he was worried and anxious.
After all he?s been through to stay independent,
I couldn?t let him down,? Jamie said.

Jamie gathered essential supplies from her
church?s food pantry and bought fresh items
from the grocery store, delivering them right
to his door. She noticed during a previous visit
that John?s new home had a refrigerator and a
microwave, but not a full kitchen. She made sure
to add microwavable food to his care package
so he would have some hot meals.

? John had a huge smile on his face when I
brought him the groceries. Times like this ?
people helping people ? have a real impact
on a person?s life,? Jamie said. ?Even though
it seemed like a small act, it eased his mind,
and he could relax knowing he had food.
Sometimes I feel like our members aren?t
given enough compassion from the world
around them.?

It made a world of difference for John to know that
Jamie was there for him. ?I was almost out of food,
and there was nowhere to turn,? he said. ?I had
no idea how I was going to make it through the
next couple of weeks. When Jamie just showed up
with all those groceries, a huge weight was lifted
off my shoulders, and for the first time, I felt like
everything was going to be ok.?

Delivering compassion
during challenging times

* Not the member?s real name. Names and personal details
have been changed to protect privacy.

Horizon NJ Health?s Care Managers understand the dedication and long hours that are part of the
job. It?s not an easy task, but they believe in going above and beyond, and sometimes that means
delivering groceries to a member?s doorstep.



Care Notes
Member Services 1-844-444-4410 (TTY 711) 24 hours a day, seven days a week. horizonNJhealth.com
CARE NOTES is published for members of Horizon NJ Health, 1700 American Blvd., Pennington, NJ 08534. Information in
CARE 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 TotalCare (HMO D-SNP) is an HMO Medicare Advantage Dual Eligible Special Needs plan with a Medicare contract
and a contract with the State of New Jersey Medicaid Program. Enrollment in Horizon NJ TotalCare (HMO D-SNP) depends on
contract renewal. 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.
? 2020 Horizon Blue Cross Blue Shield of New Jersey. Three Penn Plaza East, Newark, New Jersey 07105.

Visit horizonNJhealth.com/carenotes to read a bonus issue of Care Notes

086-20-57 Y0090_H8298_ECN00112_M

horizonNJhealth.com

Horizon NJ Health
1700 American Blvd.
Pennington, NJ 08534



horizonNJhealth.com

Care NotesIssue 3, 2020



In this issue
Feed your healthy lifestyle ???????????????????????? 2
5 ways to keep your smile healthy ?????????????????? 3
Your covered medicines ?????????????????????????? 3
Are you getting enough sleep? ???????????????????4
Your laboratory services provider ??????????????????5
Do you want to get your high school diploma?
We can help. ??????????????????????????????????5
Protecting yourself during the COVID-19 pandemic ???6
Making it easier to get care ? No referrals! ?????????? 6
Keep your vaccines up to date ????????????????????7
Stay active for a healthier you ?????????????????????8
Do you have a backup plan? ??????????????????????9
Member Advocates are here to help ???????????????9
Do you need a ride to your medical appointment? ?? 10
A stress-busting program for caregivers ?????????? 10
Chat with a nurse anytime ??????????????????????11

Your health is important
to us. That?s why our
Member Services
Representatives are
specially trained to
help you understand
your benefits so you
can reach your best
health. If you have any
questions, please call
us at 1-844-444-4410
(TTY 711). We?re here
for you 24 hours a day,
seven days a week,
365 days a year.



2
Making healthy food choices is an important way to manage your health and well-being. The foods
you eat can affect your body, mood and energy levels. When you choose foods that are nutritious
and low in saturated fats, sodium and added sugar, you can stay healthier now and in the future.

Five food groups
Aim for a balance of healthy foods and beverages from these groups:

Feed your healthy lifestyle

Visit choosemyplate.gov to find resources and tools to help you make healthy choices.
Source: United States Department of Agriculture, choosemyplate.gov

Fruits
? Choose fresh, canned (in water or 100% juice), frozen or dried fruit
? Most fruits are low in calories, fat and sodium and contain important nutrients like:
o Potassium o Dietary fiber o Vitamin C o Folic acid

Vegetables
? Fill half your plate with vegetables and fruits
? Choose red, orange and dark-green vegetables like red peppers, carrots and broccoli
? If eating canned vegetables, choose options that are ?reduced sodium,? ?low sodium?

or ?no salt added?

Grains
? Choose whole grains over highly-processed grains
? Try whole wheat pasta and brown rice in place of white pasta or white rice
? Eat 100% whole wheat bread instead of white bread
? Look for these words as the first whole grain listed on the Nutrition Facts label:

o Whole wheat o Buckwheat o Whole rye o Whole oats o Bulgur
o Brown rice o Wild rice o Oatmeal o Whole grain cornmeal

Dairy
? Choose low-fat (1%) or fat-free (skim) milk, yogurt and cheese
? If you are allergic to milk or cannot digest lactose, choose lactose-free, rice or soy

milk that has at least 300 mg of calcium per serving

Protein
? Proteins from animal sources include meat, poultry, seafood and eggs. If you choose

to eat animal protein:
o Choose lean or low-fat cuts of meat like turkey, chicken or pork. Remove the fat

and skin from the meat and stick with a 3-ounce portion, which is about the size
of a deck of cards

o Fish and poultry have less saturated fat than other animal proteins. Try to eat seafood
twice a week, and choose fish that is rich in omega-3 fatty acids like salmon or mackerel

? Proteins from plant sources are low in saturated fat and high in fiber, including:

o Beans o Peas o Lentils o Soy products o Unsalted nuts and seeds



3
Good oral health is important to your body?s overall health. You should visit your
dentist twice a year for an oral exam and cleaning. These twice-yearly checkups are
covered under your plan. You do not need prior authorization from Horizon NJ Health
for routine dental care, such as regular cleanings, fillings and X-rays.

How to keep your mouth healthy:
1. Brush teeth twice a day with a fluoride toothpaste.
2. Floss between teeth at least once a day.
3. Avoid sugary foods and drinks.
4. Do not use any tobacco products. If you smoke, quit.
5. Complete all courses of treatment your dentist recommends.

If you need help finding a dentist, visit horizonNJhealth.com/findadoctor and choose Dentist
from the dropdown menu. You can also call Member Services at 1-800-682-9090 (TTY 711).

5 ways to keep your smile healthy

Source: Centers for Disease Control and Prevention, cdc.gov

Horizon NJ Health has a formulary list, also called a Prescription Drug Listing, that lists all the
medicines we cover under your plan. If you want information about your prescription medicine,
such as an explanation and listing of step therapy, quantity/age limits and if your medicine
requires prior authorization (approval), please visit horizonNJhealth.com/covered_drugs.

Your covered medicines



4
How much sleep do you need?

Are you getting enough sleep?
Getting enough quality sleep is not just important for your physical health, but also for your brain
function and well-being. Sleep also supports growth and development in children and teens.

If you don?t get enough sleep, you can develop a condition called sleep deprivation. Sleep
deprivation can lead to mental and physical health problems. It can also lead to issues with safety,
like driving. Talk to your doctor if you have trouble getting enough quality sleep.

Age Daily recommended amount of sleep

Infants 4-12 months old 12-16 hours

Children 1-2 years old 11-14 hours

Children 3-5 years old 10-13 hours

Children 6-12 years old 9-12 hours

Teens 13-18 years old 8-10 hours

Adults 18 years and older 7-8 hours

Follow these tips for better sleep
? Go to sleep and wake up at the same time every day ? even on weekends.

? Make sure your bedroom is dark, quiet, relaxing and at a comfortable temperature.

? Remove electronics like TVs, smart phones and computers from your bedroom,
and avoid using electronics at least 30 minutes before bedtime.

? Avoid large meals, alcohol and caffeine before bedtime.

? Exercise regularly.

Source: National Heart, Lung, and Blood Institute, nhlbi.nih.gov/health-topics/sleep-deprivation-and-deficiency
cdc.gov



5
If your doctor prescribes any lab tests, use Laboratory Corporation of America? Holdings (LabCorp)
to complete them. LabCorp is your laboratory services provider. To find a LabCorp location near
you, visit horizonNJhealth.com/findadoctor. Select Other HealthCare Services from the dropdown
menu, then type Laboratory in the Service Type dropdown menu.

LabCorp offers convenient online scheduling for appointments throughout New Jersey.
Visit LabCorp.com/PSC to find a Patient Service Center near you. Walk-in patients are also welcome.
LabCorp will send your test results to your doctor but you can also register at Patient.LabCorp.com
to download and print your test results.

Having a high school diploma can open up so many doors, including better job opportunities.
Horizon Neighbors in Health: Education Works is a program we offer to our members to help
them get there. We offer a custom plan that fits your lifestyle, to help you study for and get
your diploma ? all at no cost to you!

Your laboratory services provider

Do you want to get your high school diploma?
We can help.

Work with you one-on-one to understand your
situation and remove any barriers that are preventing
you from getting your diploma, such as transportation
to the testing center or childcare during the test*

Pay the pre-test and test fees**

To enroll, you must:
? Be a current Horizon NJ Health member

? Have a valid photo ID card, such as a driver?s license or state ID card

? Be 18 years of age or older

? Not have a high school diploma or equivalent

? Not be enrolled in an accredited high school

For more information, call 1-800-682-9094 x52076 (TTY 711), Monday through Friday,
9 a.m to 5 p.m., Eastern Time (ET), or email EducationWorks@HorizonBlue.com.

* Services will be provided when needed. Not all members will receive these services.
** Limited to three attempts.

Connect you to groups in your
area to help you study

Give you telephone coaching
to help you stay on track

Horizon Neighbors in Health: Education Works will:



6
Protecting yourself during the COVID-19 pandemic

The COVID-19 public emergency has changed so much for so many people, but there are steps you
can take to protect yourself and others around you. The Centers for Disease Control and Prevention
(CDC) recommends that you follow these guidelines to avoid COVID-19 illness:

? Wash your hands: Use soap and water for 20 seconds.
o If soap and water is not available, use hand sanitizer that contains at least 60% alcohol.

? Avoid touching your mouth, nose and eyes.

? Practice social distancing: Do your part to stay 6 feet apart from other people.

? Wear a mouth and nose covering: When you?re out in public wear a cloth mask or other
non-medical face covering.

? Clean and disinfect: Clean high-touch surfaces like door knobs, light switches and countertops.

There is currently no vaccine to protect against COVID-19, and older adults and people with
severe health conditions (like lung disease or diabetes) are at a higher risk for developing serious
complications from COVID-19. If you believe you may have been exposed to someone with
COVID-19, or you are experiencing symptoms, please call your doctor.

We want you to be able to get the care you need, when you need it. That?s why you don?t
need a referral to see in-network specialists. To find an in-network specialist, please visit
horizonNJhealth.com/findadoctor or call Member Services at 1-844-444-4410 (TTY 711),
24 hours a day, seven days a week.

Making it easier to get care ? No referrals!



7Source: cdc.gov

Give yourself and your loved ones the best prevention against preventable diseases by staying
up to date on your vaccines. Protection from vaccines you received as a child can wear off over time,
so you may need boosters, or additional vaccines. Your annual wellness visit is the perfect time to
talk to your Primary Care Provider (PCP) about these recommended vaccines for adults:

Your doctor may also recommend vaccines for hepatitis A, B, meningococcal disease, and human
papillomavirus (HPV). Talk to your doctor today to see if your vaccines are up to date.

Keep your vaccines up to date

Vaccine Protects against Age/How often

Seasonal influenza Flu
Everyone 6 months
and older should get
a flu shot each year.

Tdap or Td
Pertussis (also known as
Whooping Cough), tetanus
and diptheria

Adults 19 years and older,
1 dose Tdap, then Td or
Tdap booster every 10 years.

MMR Measles, mumps and rubella
Adults 19 years and older,
1 or 2 doses depending
if born in 1957 or later.

Pneumoccal (PCV13
and PPSV23) Pneumonia

Adults 65 years and older,
two doses, the second
at least a year after the first.

Shingles Shingles
Adults 50 years and older,
two doses two to six
months apart.

Children follow a different immunization schedule than adults. Be sure
to follow the vaccine schedule recommended by your child?s doctor.



8
Stay active for a healthier you

Regular physical activity can greatly benefit your health. Moving more and sitting less is important
for your overall health and well-being, and it helps you stay at a healthy weight. Exercising keeps your
heart healthy, reduces stress and helps you sleep better. Try to stay active each day.

Physical activity recommendations by age:
Children 3-5 years old
? Physical activity throughout each day

Children and adolescents 6-17 years old
? At least 60 minutes or more of moderate to vigorous physical activity (such as running or soccer)

at least 3 days a week

o Include activities that strengthen muscles and bones such as climbing, gymnastics
or jumping rope

Adults 18-64 years old
? At least 150 minutes a week of moderate intensity activity, such as brisk walking

? At least 2 days a week of activities that strengthen muscles, such as lifting weights or sit-ups

Adults 65 years and older
? At least 150 minutes a week of moderate intensity activity, such as brisk walking

? At least 2 days a week of activities that strengthen muscles, such as lifting weights or sit-ups

? Activities to improve balance, such as standing on one foot

8Source: cdc.gov

If you?ve had an injury or have other health complications,
please talk to your doctor before starting any exercise program.



9
As an MLTSS member, you have access to Member Advocates. Member Advocates make
sure your questions about your MLTSS benefits, services and decisions are answered.
He or she works closely with you, your care team and state representatives to make sure
your needs and goals are being met.

To speak with a Member Advocate, please call 1-844-444-4410 (TTY 711), weekdays,
Monday through Friday, 8 a.m. to 5 p.m., or ask your Care Manager for a Member Advocate
to contact you.

Member Advocates are here to help

All MLTSS members have a set schedule for the in-home services and care they receive.
However, there may be times when a service gets canceled unexpectedly, such as a Personal Care
Assistant who is unable to visit. This is why MLTSS members must work with their Care Manager
to make a backup plan.

A backup plan should include:
? Phone number of the agency or person expected to provide

backup care if the primary person cannot

? Instructions on how the member should report the gap
in care to his or her Care Manager

? Member?s preference for having the backup care provided

The MLTSS Care Manager work with members, their caregivers
and families as well as service providers to make sure a plan can
be developed to address unexpected cancellations. Members
should keep a copy of their backup plan handy.

If a service is unexpectedly canceled, a member should:
? Call his or her Care Manager

? Call Member Services at 1-844-444-4410 (TTY 711)
if you cannot reach your Care Manager.

Do you have a backup plan?

If you don?t already
have a backup plan,

work with
your Care Manger

to create one
as soon as possible.



10

Being a caregiver for your loved one can be challenging at times. Caregivers for Horizon NJ Health
MLTSS members have access to the New Jersey ?Stress-Busting Program for Family Caregivers?
(SBP), at no cost. This is a grant-supported initiative by Rowan University?s New Jersey Institute
for Successful Aging in collaboration with the NJ Division of Aging Services.

For more information on the SBP statewide, please visit state.nj.us/humanservices/doas/
services/stressbusting/.
If you would like to speak to a Horizon NJ Health representative about the SBP for MLTSS
caregivers, please call 1-844-444-4410 (TTY 711) and ask to speak to Sue Bailey or Lisa Barnes.

A stress-busting program for caregivers

If you need transportation to your medical appointments, LogistiCare can help. LogistiCare
coordinates non-emergency transportation to covered medical appointments, at no cost to you.
Scheduling a ride is easy and convenient:

? Call the LogistiCare Reservation Line 48 hours in advance of your appointment toll free
at 1-866-527-9933 (TTY 1-866-288-3133), 8 a.m. to 4:30 p.m., ET.

? Make your reservation online at member.logisticare.com.
? Download the free LogistiCare Trip Manager from the app store on any smartphone,

and schedule your ride via the app.

Do you need a ride to your medical appointment?



11

Chat with a nurse anytime

Nurse Chat is a real-time live online chat tool that lets you chat with a nurse or doctor
for free. Registered nurses are available 24 hours a day, seven days a week and
can help you understand symptoms related to COVID-19, or help with other health
concerns. If the nurse determines a need, he or she can connect you with a doctor
for a video consult.

How to use the Nurse Chat Tool:
? Visit HorizonBlue.Pager.com.
? Answer the questions to determine if your health concern or symptoms are related

to COVID-19 or a different health issue.

? Enter your member ID number, date of birth, phone number and email address.

You can chat about any health concerns related to urgent care, like cough, fever, sore throat,
pink eye and more ? all at no cost to you.



12

Notice of Nondiscrimination Notice of Nondiscrimination


086-19-100 CMC0008179C (0719) An Independent Licensee of the Blue Cross and Blue Shield Association.


Horizon NJ Health complies with applicable Federal civil rights laws and does not discriminate against nor does it
exclude people or treat them differently on the basis of race, color, gender, national origin, age, disability, pregnancy,
gender identity, sex, sexual orientation or health status in the administration of the plan, including enrollment and benefit
determinations. Horizon NJ Health provides free aids and services to people with disabilities (e.g. qualified language
interpreters and information in other formats) and to those whose primary language is not English (e.g. information in
other languages) to communicate effectively with us.


Contacting Member Services
Call Member Services at 1-844-498-9393 (TTY 711) or the phone number on the back of your member ID card, if
you need the free aids and services noted above and for all other Member Services issues.


Filing a Section 1557 Grievance
If you believe that Horizon NJ Health has failed to provide the free communication aids and services or discriminated
against you for one of the reasons described above, you can file a discrimination complaint also known as a Section 1557
Grievance. Horizon NJ Health?s Civil Rights Coordinator can be reached by calling the Member Services number on the
back of your member ID card or by writing to:


Horizon NJ Health
Civil Rights Coordinator
PO Box 10194
Newark, NJ 07101



You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights
Complaint Portal, online at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail at U.S. Department of Health and
Human Services, 200 Independence Avenue, SW, Room 509F, HHH Building, Washington, D.C. 20201 or by phone
at 1-800-368-1019 or 1-800-537-7697 (TDD). OCR Complaint forms are available at
www.hhs.gov/ocr/office/file/index.html.


Language assistance
Si habla espa?ol, tiene a su disposici?n servicios gratuitos de asistencia ling??stica. Llame al 1-844-498-9393 (TTY 711).

?????????????????????????????? 1-844-498-9393?TTY 711?.
??: ???? ????? ??, ?? ?? ???? ??? ???? ? ????.
1-844-498-9393 (TTY 711)??? ??? ????.
ATEN??O: Se fala portugu?s, encontram-se dispon?veis servi?os lingu?sticos, gr?tis. Ligue para 1-844-498-9393
(TTY 711).



UWAGA: Je?eli m?wisz po polsku, mo?esz skorzysta? z bezp?atnej pomocy j?zykowej. Zadzwo? pod numer
1-844-498-9393 (TTY 711).
ATTENZIONE: In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare
il numero 1-844-498-9393 (TTY 711).

?????? ??????? ???????? ????? ??? ?????? ???? ????? ??? ??? :?????? ???? ???? .??????? ??1-844-498-9393 ?????? ???? ???? ???)711.(
PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang
bayad. Tumawag sa 1-844-498-9393 (TTY 711).
????????: ???? ?? ???????? ?? ??????? ?????, ?? ??? ???????? ?????????? ?????? ????????. ???????
1-844-498-9393 (???????? 711).
ATANSYON: Si w pale Krey?l Ayisyen, gen s?vis ?d pou lang ki disponib gratis pou ou. Rele 1-844-498-9393 (TTY
711).




CH? ?: N?u b?n n?i Ti?ng Vi?t, c? c?c d?ch v? h? tr? ng?n ng? mi?n ph? d?nh cho b?n. G?i s? 1-844-498-9393
(TTY 711).
ATTENTION : Si vous parlez fran?ais, des services d'aide linguistique vous sont propos?s gratuitement. Appelez le
1-844-498-9393 (ATS 711).

???? ??? ? ??? ?????? ??? ??? ????? ?? ??? ?? ???? ?? ?? ?? ???? ????? ???? ?? ??? :??????
1-844-498-9393 (TTY 711).



Care Notes
Member Services 1-844-444-4410 (TTY 711), 24 hours a day, seven days a week. horizonNJhealth.com
CARE NOTES is published for members of Horizon NJ Health, 1700 American Blvd., Pennington, NJ 08534. Information in
CARE 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.
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. .
? 2020 Horizon Blue Cross Blue Shield of New Jersey. Three Penn Plaza East, Newark, New Jersey 07105. 086-20-94

ECN00614

horizonNJhealth.com

Horizon NJ Health
1700 American Blvd.
Pennington, NJ 08534



horizonNJhealth.com

Issue 4, 2020Care Notes



2
It?s time for your flu shot ????????????????????????????????????????????????????????? 2
Managing congestive heart failure ????????????????????????????????????????? 3
Coming soon! ?????????????????????????????????????????????????????????????????????????? 3
We?ve made it easier to get care - No more referrals! ?????????? 3
Avoid COVID-19 scams ??????????????????????????????????????????????????????????? 4
Understanding COPD ????????????????????????????????????????????????????????????? 5
Hypertension: Know your numbers ???????????????????????????????????????? 6
An easier way to find providers ?????????????????????????????????????????????? 6
Horizon NJ TotalCare (HMO D-SNP):
All your benefits in one convenient plan ???????????????????????????????? 7
How we protect your private information ?????????????????????????????? 7
Diabetes: Get the facts ??????????????????????????????????????????????????????????? 8
Managing your medication ????????????????????????????????????????????????????? 9
Your opinion matters ?????????????????????????????????????????????????????????????? 9
Changes to covered medicines ???????????????????????????????????????????? 10
Depression: What are the symptoms? ???????????????????????????????????11
Your Member Handbook is a valuable resource ???????????????????12
Use Nurse Chat for your health concerns ?????????????????????????????12
Reminder: You have access to Member Advocates ??????????????12
Look out for health insurance fraud ??????????????????????????????????????13
Notice of Nondiscrimination ??????????????????????????????????????????????????14

It?s time for your flu shot

Vaccines for homebound members
If you are homebound or have major difficulties leaving your home,
you may be able to get your vaccines at home. If you need your vaccines
given at home, please reach out to your Primary Care Provider (PCP),
Care Manager or Member Services.

In this issue

Your health is
important to us?
That?s why our
Member Services
Representatives
are specially
trained to help
you understand
your benefits so
you can reach your
best health. If you
have any questions,
please call us at
1-844-444-4410
(TTY 711).
We?re here for you
24 hours a day,
seven days a week,
365 days per year?

Getting a flu shot every year is your best protection from getting the flu. The flu
is contagious and can cause fever, cough, sore throat, muscle aches and fatigue.
In serious cases, it can cause hospitalization or death.

Flu shots are covered under your plan at no cost to you.
Because of the COVID-19 public health emergency, getting your flu shot this year is more
important than ever. Getting the flu vaccine can help rule out the flu if you get sick, which may
help you get the care you need quicker. While the flu vaccine won?t prevent you from getting
COVID-19, it will reduce your chance of getting the flu or make it less severe if you do get it.
You can get your yearly flu shot at your doctor?s office or at a participating pharmacy.

Do you need the pneumonia vaccine?
Most people only need one pneumonia shot after age 65, but some people may need
a second. Talk to your doctor to see if the pneumonia vaccine is right for you.



Throughout the COVID-19 public health emergency, the U.S. Federal Communications
Committee (FCC) has shared concerns about virus-related scams targeting Americans by phone
and text message. Stay alert to the following types of scams:

? Texts advertising a fake cure or test, often offering financial rewards or free offers/services
to complete these

? Robocalls offering free health supplies, tests or cures

? Contact tracing scam calls to scare people into believing they?ve been exposed to the
virus in an attempt to get their personal information

? Fake warnings that claim Social Security benefits may be suspended due to the pandemic

What you can do:
? Do not respond to calls or texts from unknown numbers.

? Never share your personal or financial information via email, text messages or phone.

? Do not click any links in a text message.

? Never share your personal information, such as your Social Security Number.

? Be cautious if you?re being asked to share your information or make a payment.

? Remember: government agencies will never call to ask for personal information or money.

For information about COVID-19 scams, visit FCC.gov/consumers.
If you think you?ve become a victim of a scam, contact your local law enforcement agency
and file a complaint at FCC.gov/complaints.

43

Avoid COVID-19 scams

Heart failure, also called congestive heart failure, happens if your heart cannot
pump enough blood and oxygen to support the other organs in your body.

Symptoms of heart failure include:
? Shortness of breath

? Trouble breathing while lying down

? Weight gain and/or swelling in the legs, ankles, feet or stomach

? Feeling tired and weak

Early diagnosis and treatment is important for managing heart failure. This includes medication,
a low-salt diet and daily physical activity. If you have heart failure or experience symptoms
related to heart failure, talk to your doctor or Care Manager immediately. It is important that
you follow a treatment plan to keep your heart failure under control.

Source: cdc.gov/heartdisease/about.htm

Managing congestive heart failure

If you lose eligibility for a program or service that has been helpful to
you, Horizon NJ Health will provide you with information or alternative
resources so your care is not interrupted. Please contact your Care
Manager or call Member Services at 1-844-444-4410 (TTY 711).

Remember, you do not need a referral to see in-network specialists. You can find
a complete list of in-network doctors at horizonNJhealth.com/findadoctor or by
calling 1-844-444-4410 (TTY 711), 24 hours a day, seven days a week.

We?ve made it easier to get care ?
No more referrals!

Coming soon!
Our secure member web portal is getting an updated design with a fresh, new look
and feel. Login at horizonNJhealth.com to access your secure member account.
With user-friendly navigation, you can easily change your PCP, request a new
member ID card and more.



5
Understanding COPD

6

Source: lung.org/lung-health-and-diseases/lung-disease-lookup/copd

COPD risk factors include:
? Smoking

? Air pollution

? Breathing secondhand smoke

? Working with chemicals, dust and fumes

? A history of childhood respiratory infection

Symptoms
? Chronic cough

? Shortness of breath

? Feeling tired; unable to exercise

? Wheezing

Hypertension: Know your numbers
Blood pressure measures the pressure of blood pushing against the walls of
your arteries. Your blood pressure is measured using two numbers:

? Systolic: the pressure in your arteries when your heart beats

? Diastolic: the pressure in your arteries when your heart rests between beats

Normal blood pressure is less than 120/80 mmHg.

High blood pressure (hypertension)
If your blood pressure is higher than normal, it is called hypertension. High blood pressure
increases the risk for other health problems, like heart disease, heart attack and stroke.

There are typically no signs or symptoms of high blood pressure. The only way to diagnose
hypertension is to visit your doctor to get your blood pressure measured.

Controlling hypertension
If you have hypertension, there are ways to lower your blood pressure, such as:

? Regular physical activity

? Eating a balanced diet and limiting salt intake

? Maintaining a healthy weight

? Reducing or avoiding alcohol intake

? Not smoking

? Managing stress

There is currently no cure for COPD, but you can maintain a good quality of life with treatment and
lifestyle changes. Talk to your doctor if you think you have COPD or think you are at risk. He or she
can help you find resources and tools to manage the disease.

Chronic obstructive pulmonary disease (COPD) is a long-term disease that affects the lungs.
It includes emphysema and recurring bronchitis. Being diagnosed with COPD can raise a lot
of health concerns, so it is helpful to know what to expect.

Our online Doctor & Hospital Finder makes is easy to find in-network
providers for all your health care needs. Visit horizonNJhealth.com/findadoctor
to watch a quick video on how to find a provider.

An easier way to find providers

Source: cdc.gov/bloodpressure/about.htm

Talk to your doctor about ways to maintain a healthy blood pressure.
Taking action to control your blood pressure will help protect you
from heart disease and stroke.



7 8

Diabetes: Get the facts

How we protect your private information
Horizon NJ Health is required to notify members of the availability of our Notice
of Privacy Practices, which can be found at horizonNJhealth.com/privacy-policy.
This Notice has important information about how Horizon NJ Health uses,
discloses and protects member information, as well as rights that members have
regarding their protected health information (PHI).

Also, Horizon NJ Health complies with applicable federal civil rights laws and does not
discriminate against nor does it exclude people or treat them differently on the basis of
race, color, gender, national origin, age, disability, pregnancy, gender identity, sex, sexual
orientation or health status.

Diabetes is a chronic condition that affects how your body turns food into energy. If you have
diabetes, your body either can?t make enough insulin or can?t use the insulin it makes as well
as it should. If there is not enough insulin or your cells don?t use the insulin that is in your body,
too much blood sugar will stay in your bloodstream. Over time, this can cause serious health
problems, like heart disease, vision loss and kidney disease.

Insulin is a hormone made by your pancreas that helps your body turn the sugar in your
blood stream into energy.
Are you at risk for diabetes?
Learning that you have a high risk of developing type 2 diabetes might sound like bad news,
but with this information, you can take steps now that may prevent or delay diabetes.
Answer these questions to see if you?re at risk.

A total score of 5 or more indicates a high risk for diabetes. If your score is 5 or higher, share your
results with your doctor and ask how you can prevent or delay type 2 diabetes.

Questions Answer Points Score

What?s your age?
Your chance of getting diabetes increases as you grow older.

o 39 or younger
o 40-49
o 50-59
o 60 or older

0
1
2
3

Are you physically inactive most days of the week?
Regular physical activity helps reduce your diabetes risk.

o No
o Yes

0
1

Are you overweight or obese?
Calculate your body mass index at cdc.gov/bmi. Eating a balanced diet and
being active can help you reach and maintain a healthy weight.

o No
o Overweight
o Obese

0
1
2

Are you a male or female?
Men are more likely than women to have undiagnosed diabetes.

o Female
o Male

0
1

If you?re a woman, did you ever have gestational diabetes
(diabetes during pregnancy)?
A history of gestational diabetes increases your risk for type 2 diabetes.

o No or not
applicable

o Yes

0

1

Have you ever been diagnosed with high blood pressure?
A healthy, active lifestyle helps prevent diabetes and high blood pressure.

o No
o Yes

0
1

Are you African American, Hispanic or Latino American, American Indian
or Alaskan Native?
These groups have higher diabetes rates than the general United States population.

o No
o Yes

0
1

Do you have a parent, brother or sister with diabetes?
Your genes affect how prone you are to developing diabetes.

o No
o Yes

0
1

Total Score:

Sources: CDC, cdc.gov/diabetes/index.html; American Diabetes Association, diabetes.org/risk-test

Horizon NJ TotalCare (HMO D-SNP):
All your benefits in one convenient plan

If you are eligible for both Medicare and Medicaid, you may be eligible for Horizon
NJ TotalCare (HMO D-SNP). This plan combines all covered Medicare and Medicaid health
care benefits into one easy-to-use, no-cost plan. In 2021, Horizon NJ TotalCare (HMO D-SNP)
will include:

? $0 copays

? $0 premiums

? No referrals

? A $0 gym membership or home fitness
program

? $375 per quarter on an Over-the-Counter
(OTC) Benefit Card to spend on health
items at participating retail stores

? $250 per quarter to spend on personal
items from our catalog

For more information, call 1-888-328-5736
(TTY 711), 24 hours a day, seven days a week,
or visit HorizonBlue.com/TotalCare.

Additional
Benefits

$0 Cost
for Benefits

Dedicated
Care Manager

$0 Copay
for Prescription

Drugs

No Referrals
Needed

One ID Card

Horizon NJ TotalCare
(HMO D-SNP)



Your opinion matters
We are always looking for ways to provide you with innovative tools to help you
manage your health care and access your plan information. Currently, we are
developing a Horizon NJ Health app that you will be able to use on your mobile phone
or tablet. To get you the most useful tools, we want to know which features you would
want to see on the Horizon NJ Heath app. Send us your suggestions and feedback at
HNJHAnswers@horizonNJHealth.com.

Over-the-counter (OTC) and herbal medicines are medicines you can buy without a prescription
from your doctor. These medicines can help you feel better by treating or preventing health
problems like allergies, constipation, cough and cold, heartburn and many more. While you
don?t need a prescription from your doctor to get these medicines, it is very important to let
your doctor and pharmacist know all OTC and herbal medicines you are currently taking.

These medicines may cause side effects when taken with the medicines your doctor prescribes.
They can also cause other medicines to act differently than intended. If you see more than one
doctor or fill prescriptions at more than one pharmacy, it?s important to tell everyone involved in
your care about all the medicines you are taking, including OTC and herbal medicines.

109

Managing your medication

Changes to covered medicines
Our formulary list, also called a Prescription Drug Listing, is changing. The changes
listed below will be added to our Drug Formulary list at horizonNJhealth.com/
covered_drugs. This list includes an explanation and listing of step therapy,
quantity/age limitations and drugs that require prior authorization (approval).

Please talk with your PCP about these changes. If your PCP decides that, for medical reasons,
you must take a medicine that is not on the formulary list or needs pre-approval, including
a brand name medicine exception, he or she can call us and ask for special permission
(prior authorization) for you to get the medicine. Please note that Horizon NJ Health?s
maximum days? supply limit is 30 days.

Take all medicines ? OTC and prescription ? exactly as the label
says to make sure they are working the best way they can to treat
your condition?

Formulary Change
Description

Brand (Generic)
Drug Name

Alternatives
(if applicable)

Formulary Vesicare (solifenacin) ?

Formulary Zirabev (bevacizumab) ?

Formulary Trazimera (trastuzumab) ?

Formulary Valtoco (diazepam) ?

Formulary Palforzia peanut (Arachis hypogaea)
allergen powder)

?

Formulary Ruxience (rituximab) ?

Formulary Ubrelvy (ubrogepant) ?

Non-Formulary Clindesse 2% Vaginal Cream (clindamycin) Cleocin vaginal cream

Here is a list of recent changes:



11 12

Nurse Chat is a real-time live online chat tool that lets you chat with a nurse or
doctor for free. Registered nurses are available 24 hours a day, seven days
a week. They can help you understand symptoms related to COVID-19, or help
with other health concerns. If the nurse determines a need, he or she can connect
you with a doctor for a video consult.

How to use the Nurse Chat tool:
? Visit HorizonBlue.Pager.com.
? Answer the questions to determine if your symptoms or health concerns are related to

COVID-19 or a different health issue.

? Enter your member ID number, date of birth, phone number and email address.

You can use chat to ask about any health concerns related to urgent care, like cough, fever,
sore throat, pink eye and more ? all at no cost to you.

Your Member Handbook is a valuable resource

Use Nurse Chat for your health concerns

Reminder: You have access to Member Advocates

Depression is a mental health condition that is
more than just feeling down or having a bad day.

If you experience a sad mood that lasts for a
long time or prevents you from doing normal
daily activities, you may have depression.

Symptoms of depression can include:
? Feeling sad or anxious often or

all the time

? Not wanting to do activities that you
used to enjoy

? Feeling irritable, frustrated or restless

? Having trouble falling asleep or
staying asleep

? Eating more or less than usual

? Feeling aches, pains, headaches or
stomach having no appetite problems
that do not improve with treatment

Many Americans are experiencing depression
during the COVID-19 public health emergency.
Common triggers for depression that are coming
about during this public health emergency
can include:

? Fear of getting sick

? Concerns about widespread disease

? Less personal interaction due to social
distancing

? Financial concerns (for example,
unemployment, housing insecurity)

? Reduced access to caregivers

? Worries or fears about returning to the
office or school

If you have experienced one or more of these
symptoms, talk to your doctor immediately.
There are resources and treatment options
available to help you.

Your Horizon NJ Health MLTSS Member Handbook is a complete guide to your plan.
It contains information about your covered benefits and everything else you need
to know as a member. Inside, you will find a variety of topics and important phone
numbers. You can also find information about:

? How to file a grievance or appeal

? Utilization Management (UM) availability and decision making

? Programs available to you

Your Member Handbook is updated annually and you can find it online at
horizonNJhealth.com/handbooks. If you can?t access it online, call Member Services
at 1-844-444-4410 (TTY 711) and ask for one to be sent to you.

All MLTSS members have access to a Member Advocate. This is a person who works with you
to make sure any questions about your MLTSS benefits, services and decisions are answered.
He or she works closely with you, your care team and state representatives to make sure your
needs and goals are being met.

To speak with a Member Advocate, please call 1-844-444-4410 (TTY 711) Monday through Friday,
from 8 a.m. to 5 p.m., or ask your Care Manager for a Member Advocate to contact you.Sources cdc.gov, massgeneral.org/news/coronavirus/depression-on-rise-during-covid-19

Depression: What are the symptoms?



1413

Some common types of health insurance
fraud schemes are:
? Billing for a higher level of service to

get a higher payment

? Billing for services that did not happen

? Changing claims or prescriptions

? Claiming non-covered treatments are
medically-necessary procedures

? Faking a patient?s diagnosis to justify
a test, surgery or other procedure that
is not medically necessary

? Kickbacks or bribes

? Performing unnecessary procedures
to get a payment

Here?s what you can do:
ALWAYS
? Review anything you get in the mail from

Horizon NJ TotalCare (HMO D-SNP), a
doctor or other health care providers.

? Ask for a copy of everything you sign.

? Be suspicious of anyone giving free tests
or screenings if you give them your
member ID card number.

NEVER
? Give your health insurance ID card number

to anyone except your doctor, clinic,
hospital or other health care provider.

? Give your health insurance ID card
number to anyone who calls you without
you asking and offers you free goods or
services (durable medical equipment or
medication).

? Let anyone borrow or use your health
insurance ID card or number.

? Ask your doctor or health care provider for
treatment or care you do not need.

? Sign your name to a blank form.

? Share your medical records or medical
information with anyone except your
doctor, clinic, hospital or other health
care provider.

We will always verify your identity before talking
to you about your benefits or services. This
is an important step we take to protect your
information and guard against fraud.

To report health insurance fraud, call
1-855-FRAUD20 (1-855-372-8320) (TTY 711).

Look out for health insurance fraud

Health insurance fraud is a problem for everyone. You can help identify and prevent it.

Notice of Nondiscrimination Notice of Nondiscrimination

086-19-100 CMC0008179C (0719)An Independent Licensee of the Blue Cross and Blue Shield Association.

Horizon NJ Health complies with applicable Federal civil rights laws and does not discriminate against nor does it
exclude people or treat them differently on the basis of race, color, gender, national origin, age, disability, pregnancy,
gender identity, sex, sexual orientation or health status in the administration of the plan, including enrollment and benefit
determinations. Horizon NJ Health provides free aids and services to people with disabilities (e.g. qualified language
interpreters and information in other formats) and to those whose primary language is not English (e.g. information in
other languages) to communicate effectively with us.
Contacting Member Services
Call Member Services at 1-844-498-9393 (TTY 711) or the phone number on the back of your member ID card, if
you need the free aids and services noted above and for all other Member Services issues.
Filing a Section 1557 Grievance
If you believe that Horizon NJ Health has failed to provide the free communication aids and services or discriminated
against you for one of the reasons described above, you can file a discrimination complaint also known as a Section 1557
Grievance. Horizon NJ Health?s Civil Rights Coordinator can be reached by calling the Member Services number on the
back of your member ID card or by writing to:

Horizon NJ Health
Civil Rights Coordinator
PO Box 820
Newark, NJ 07101



You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights
Complaint Portal, online at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail at U.S. Department of Health and
Human Services, 200 Independence Avenue, SW, Room 509F, HHH Building, Washington, D.C. 20201 or by phone
at 1-800-368-1019 or 1-800-537-7697 (TDD). OCR Complaint forms are available at
www.hhs.gov/ocr/office/file/index.html.
Language assistance
Si habla espa?ol, tiene a su disposici?n servicios gratuitos de asistencia ling??stica. Llame al 1-844-498-9393 (TTY 711).
?????????????????????????????? 1-844-498-9393?TTY 711?.

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1-844-498-9393 (TTY 711)??? ??? ????.
ATEN??O: Se fala portugu?s, encontram-se dispon?veis servi?os lingu?sticos, gr?tis. Ligue para 1-844-498-9393
(TTY 711).

UWAGA: Je?eli m?wisz po polsku, mo?esz skorzysta? z bezp?atnej pomocy j?zykowej. Zadzwo? pod numer
1-844-498-9393 (TTY 711).
ATTENZIONE: In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare
il numero 1-844-498-9393 (TTY 711).

?????? ??????? ???????? ????? ??? ?????? ???? ????? ??? ??? :?????? ???? ???? .??????? ??1-844-498-9393 ?????? ???? ???? ???)711.(
PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang
bayad. Tumawag sa 1-844-498-9393 (TTY 711).
????????: ???? ?? ???????? ?? ??????? ?????, ?? ??? ???????? ?????????? ?????? ????????. ???????
1-844-498-9393 (???????? 711).
ATANSYON: Si w pale Krey?l Ayisyen, gen s?vis ?d pou lang ki disponib gratis pou ou. Rele 1-844-498-9393 (TTY
711).

CH? ?: N?u b?n n?i Ti?ng Vi?t, c? c?c d?ch v? h? tr? ng?n ng? mi?n ph? d?nh cho b?n. G?i s? 1-844-498-9393
(TTY 711).
ATTENTION : Si vous parlez fran?ais, des services d'aide linguistique vous sont propos?s gratuitement. Appelez le
1-844-498-9393 (ATS 711).

???? ??? ? ??? ?????? ??? ??? ????? ?? ??? ?? ???? ?? ?? ?? ???? ????? ???? ?? ??? :??????
1-844-498-9393 (TTY 711).



horizonNJhealth.com

Horizon NJ Health
1700 American Blvd.
Pennington, NJ 08534

Care Notes
Member Services 1-844-444-4410 (TTY 711), 24 hours a day, seven days a week. horizonNJhealth.com
CARE NOTES is published for members of Horizon NJ Health, 1700 American Blvd., Pennington, NJ 08534. Information in
CARE 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 TotalCare (HMO D-SNP) is an HMO Medicare Advantage Dual Eligible Special Needs plan with a Medicare contract
and a contract with the State of New Jersey Medicaid Program. Enrollment in Horizon NJ TotalCare (HMO D-SNP) depends on
contract renewal. 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.
? 2020 Horizon Blue Cross Blue Shield of New Jersey. Three Penn Plaza East, Newark, New Jersey 07105. (1220) 086-20-116

Y0090_H8298_ECN001431_M



Care Notes

horizonNJhealth.com

Issue 1, 2021

See Page 3: 5 tips to get the most from your plan



Your annual wellness exam: a key part of staying healthy ????? 2
5 tips to get the most from your plan ??????????????????????????????????? 3
Our commitment to quality ???????????????????????????????????????????????????? 4
Do you have an advance directive? ???????????????????????????????????????? 5
Coming soon: the Horizon NJ Health App ??????????????????????????? 5
Important information for members with
behavioral health conditions ??????????????????????????????????????????????????? 6
Our member advocates are here for you ??????????????????????????????? 6
5 ways to prevent falls ???????????????????????????????????????????????????????????? 7
You may be eligible for
Horizon NJ TotalCare (HMO D-SNP) ?????????????????????????????????????? 8
When is Urgent Care the right choice? ?????????????????????????????????? 8
Follow-up care after an Emergency Room (ER) visit ?????????????? 9
Are you at risk for aspiration pneumonia? ????????????????????????????? 9
New name, same service: LogistiCare is now ModivCare ????? 9
5 ways keep your eyes healthy ????????????????????????????????????????????? 10
Member rights and responsibilities ?????????????????????????????????????? 10
We can help you quit smoking or vaping ??????????????????????????????11
COVID-19 vaccine update ??????????????????????????????????????????????????????12
COVID-19 vaccines: what to expect ??????????????????????????????????????13
COVID-19 vaccination megasites in NJ ?????????????????????????????????15
Changes to covered medicines ?????????????????????????????????????????????16
New generics ?????????????????????????????????????????????????????????????????????????17
First aid for seizures ???????????????????????????????????????????????????????????????17
Notice of Nondiscrimination ??????????????????????????????????????????????????18

In this issue

Your health is
important to us?
That?s why our
Member Services
Representatives
are specially
trained to help
you understand
your benefits so
you can reach your
best health? If you
have any questions,
please call us at
1-844-444-4410
(TTY 711)? We?re
here for you
24 hours a day,
seven days a week,
365 days per year?



Your annual wellness exam:
a key part of staying healthy

1. Prevent health problems. Annual wellness exams allow your doctor to review
any changes that have occurred over the last year. Together, you can identify risk
factors that could lead to future health problems.

2. Strengthen the relationship between you and your doctor. People who get
along with their doctors are more likely to go see them, be honest with them and
listen to their advice.

3. Update vaccines. Staying up to date on vaccines is an important way to
prevent diseases.

4. Review medicines. Your doctor will go over all of the medicines you are taking,
including over-the-counter medicine. This will help identify issues such as side
effects or drug interactions.

We make appointments to see our
doctor for many different reasons.
While some of us only go to the
doctor when we are sick, your

Primary Care Provider (PCP) can actually offer
much more. One way to achieve good health
is to have an annual wellness exam. Your PCP
can address any concerns before they become
serious issues down the road.

If you haven?t seen your PCP for an annual
wellness exam in the past year, now is the time
to get that visit on your calendar.

During your visit, talk to your PCP about:
? Your blood pressure

? Preventive screenings you may need,
such as breast cancer, colorectal cancer
and diabetes

? Medications (over-the-counter and
prescriptions) you are taking

? Health concerns or questions you have

? Vaccines you may need

There are no copays for annual wellness exams ?
they are part of your covered benefits.

4 reasons to schedule your annual wellness exam today:

2



43

We work hard to offer you exceptional programs, care management and member services that
go beyond other MLTSS plans. To get the most from your Horizon NJ Health plan:

1. Build a relationship with
your PCP.

The right care starts with your PCP. Your PCP
should:

? Listen carefully to your health concerns

? Help you get access to a specialist

? Explain things in a clear and
understandable way

? Talk to you about any medications you
are taking

If you need to change your PCP for any
reason, please call Member Services at
1-844-444-4410 (TTY 711).

2. Let your personal Care
Manager help you coordinate
all of your health care needs.

You?ll get a Plan of Care with health goals that
are right for you ? with support along the
way so you can reach them. Your Care
Manager will help connect your doctors and
pharmacists and even assist with prior
authorizations (pre-approvals) for any services
you need. To reach a Care Manager, call
1-844-444-4410 (TTY 711), weekdays, 8 a.m.
to 5 p.m.

5 tips to get the most from your plan



4
3. Schedule preventive care visits
and health screenings.

We will send you reminders for preventive
care, like your annual wellness visit and flu
shot. When you get the reminders, make sure
to schedule an appointment with your PCP
or other provider. Staying up to date on your
vaccines and preventive care can save your life.

4. Get appointments with your
doctor quickly and easily.

Your time is valuable. If you?re on time for your
appointment, you should not have to wait too
long to see your doctor. Things to remember:

? When making your appointment, ask to
be the first one seen that day.

? Call us if you need help getting an
appointment with a specialist.

? Ask your doctor?s office to let you know
if they are running late.

5. Access your benefits with our
online tools.

Sign in to our secure member web portal at
horizonNJhealth.com to:

? View your covered benefits

? Enroll in a Disease Management
program

? Request a new member ID card

? Change your PCP

We want to make sure that the care and services you get are appropriate, necessary and
properly administered. That?s why we have a Quality Improvement (QI) program that works
with members and providers to improve the quality of the care and services you receive. We
monitor areas that affect the care our members get, like access to care, screenings and
member satisfaction.

For more information about how Horizon NJ Health?s QI program is improving the care you get,
visit horizonNJhealth.com/quality, or call Member Services at 1-844-444-4410 (TTY 711) and
ask for the Quality Department.

Our commitment to quality

Your voice matters.
You may get a survey in the mail asking about your experience with your health
plan? Please complete this survey to let us know what we?re doing well ?
and help us understand what we can do better?



5
Do you have an
advance directive?

An advance directive is a legal document that lets others know how you want to be cared for
if you become too sick to tell them. If you don?t already have one, you should make one now,
while you are healthy enough to make your own health care decisions.

In New Jersey, there are three kinds of advance directives:
? A proxy directive names the person you want to make your health care decisions for you

when you no longer can. This person must be at least 18 years old.

? An instruction directive gives your wishes and instructions for your own care.
? A combined directive names a person and gives instructions for your care. It is a

combination of a proxy directive and instruction directive.

Before you make an advance directive, you should talk to your doctor about your care options.
For more information and forms, you can visit state.nj.us/health/advancedirective.

Later this year, you will be able to use the Horizon NJ Health App to quickly and
easily access your benefits from your smartphone or tablet. The app will be free to
download. We will let you know when it becomes available.

Until then, make sure you register and sign in to the secure member web portal at
horizonNJhealth.com. You can use the portal to change your PCP, enroll in a Disease
Management Program, request a new member ID card and more!

Coming soon: the Horizon NJ Health App



6
Important information for members with
behavioral health conditions

Do you need help with a medical, substance use disorder or behavioral
health issue?
Seeking help in difficult times is an important step for your health and wellness. Many
providers offer telehealth services to make it easier for patients to get the care they
need from home. If you need care for a medical, substance use disorder or behavioral
health issue, call Member Services at 1-844-444-4410 (TTY 711), and we will help
you find a telehealth provider.

Are you missing important laboratory tests?
Certain medications that are used to treat mental health conditions or substance
use disorders can increase your risk for other health concerns. Laboratory testing can
find problems early and address them in a timely manner. If you are being treated
for any of the conditions below, talk to your health care provider about which tests
you may need.

Adults (18 years and older) being treated for bipolar disorder, schizophrenia
or schizoaffective disorder should be screened for:
? Diabetes ? Cholesterol

Children and teens who are prescribed medications such as haloperidol, risperidone,
aripiprazole, quetiapine, olanzapine, ziprasidone and others should be screened for:
? Blood glucose levels ? Cholesterol

All MLTSS members have access to a Member Advocate. This person works with you to make
sure any questions about your MLTSS benefits, services and decisions are answered. He or
she works closely with you, your care team and state representatives to make sure your needs
and goals are being met.

To speak with a Member Advocate, please call 1-844-444-4410 (TTY 711), weekdays, from
8 a.m. to 5 p.m. ET, or ask your Care Manager for a Member Advocate to contact you.

Our Member Advocates are here for you



7
5 ways to prevent falls

Did you know that falls are the most common cause of injury in older adults?
But, falls can be prevented.

Here are some ways you can prevent falls and stay independent:
1. Talk to your doctor about your medications and any changes you feel in your strength

or balance.

2. Exercise to improve strength and balance, such as doing yoga, Tai Chi or resistance
training.

3. Ask for help carrying groceries and home/yard maintenance.
4. Keep your home safe. Keep floors clear of tripping hazards and install grab bars in

stairwells and the bathroom.

5. Have your eyes checked at least once a year.

You may be at a higher risk for falls if you:
? Are overweight ? Have impaired vision or hearing

? Drink alcohol ? Have low levels of vitamin D

? Have arthritis (joint swelling) ? Take medicines that make you drowsy

? Have dementia

Talk to your doctor about your risk for falls and ask if you need to take vitamin D supplements
to improve your bone, muscle and nerve health.

Source: cdc.gov



8
You may be eligible for
Horizon NJ TotalCare (HMO D-SNP)

When is Urgent Care the right choice?

If you are eligible for both Medicaid and Medicare, you can get all your health care benefits
at no cost under one, convenient plan. Horizon NJ TotalCare (HMO D-SNP) offers:

? $0 copays
? $0 premiums
? No referrals
? A $0 gym membership or home fitness program
? $375 per quarter on an Over-the-Counter (OTC) Benefit Card to spend on health items

at participating retail stores

? $250 per quarter to spend on personal items from our catalog
For more information, call 1-888-328-5736 (TTY 711), 24 hours a day, seven days a week, or
visit HorizonBlue.com/TotalCare.

For most medical care, your PCP should be the first person you call. But if you
can?t reach your doctor or need care outside of regular office hours, an urgent care
center can be used for an illness or injury that is not life-threatening.

An urgent care center is a walk-in clinic that offers medical care in a facility outside of a
traditional ER. Urgent care centers have doctors and other health care professionals on site and
most can provide services such as X-rays and laboratory tests. The wait time for care is usually
shorter than at the ER.

Conditions that can be treated in an urgent care center include:
? Eye irritation and redness ? Skin rash and infection

? Fever or flu ? Sprains and strains

? Minor broken bones and fractures ? Urinary tract infection

? Sore throat and cough ? Vomiting, diarrhea or dehydration

Remember, for a life-threatening emergency, such as a heart attack or serious head injury,
you should call 911 or go to the nearest ER.



Aspiration pneumonia happens when food, saliva, liquids or vomit are breathed into lungs
instead of being swallowed into the stomach. Older adults, stroke survivors and people with
conditions like dementia, Parkinson?s disease, multiple sclerosis or cerebral palsy have a higher
risk of getting aspiration pneumonia.

After an Emergency Room (ER) visit, it?s important to follow up with your health care
provider within seven days. This simple step can help prevent another trip to the
ER. To make it easier to get care, many providers are offering telehealth visits. If you
would like help finding a provider, call Member Services at 1-844-444-4410 (TTY
711), 24 hours a day, seven days a week.

LogistiCare, the non-emergency medical transportation vendor for NJ FamilyCare
members, is now ModivCare. You still have access to the same benefits for
non-emergency transportation for medical care, only the name has changed.

If you need to schedule a ride to a doctor?s appointment, you can call 1-866-527-9933
(TTY 1-866-288-3133) or visit ModivCare.com.

Prevent aspiration pneumonia:
? Alternate solid and liquid foods, and

allow some rest between mouthfuls.

? Avoid medicines that may cause
drowsiness, which can increase
difficulties with swallowing or coughing.

? Eat slowly, and take small bites.



? Practice good oral hygiene, especially after
eating, to remove food particles and to help
prevent a buildup of bacteria in the mouth.

? Rest for 30 minutes after eating.

? See a speech therapist or swallow therapist.

? Sit upright when eating.

Sources: MedlinePlus, medlineplus.gov

Are you at risk for aspiration pneumonia?

Follow-up care after an ER visit

New name, same service:
LogistiCare is now ModivCare

9



10

Good vision is important to your overall health. Seeing an eye doctor for routine eye
exams can help find problems early and protect your vision, especially as you age.

To keep your eyes healthy:
1. See an eye doctor once a year ? Your doctor will check for problems like glaucoma and

age-related macular degeneration.

2. Eat a healthy diet ? Choose lots of fruits and vegetables.
3. Maintain a healthy weight ? Exercise and stay active.
4. Wear sunglasses ? Look for sunglasses that block UV-A and UV-B radiation.
5. Give your eyes a break ? If you spend a lot of time on a computer, rest your eyes every

20 minutes.

Routine eye exams are covered under your benefits at no cost to you. If you need help finding
an eye doctor, call 1-844-444-4410 (TTY 711) or visit horizonNJhealth.com/findadoctor.

Are you diabetic? Keeping your blood sugar, blood pressure
and cholesterol under control will help protect your eyes?

You should have a diabetic eye exam every year?

5 ways to keep your
eyes healthy

Member rights and responsibilities
As a Horizon NJ Health member, you have rights, responsibilities and choices
in the care you get. Your member rights and responsibilities can be found in
your Member Handbook and at horizonNJhealth.com/memberrights.



11

If you smoke or vape, quitting will reduce
your risk of heart disease, cancer and other
serious health problems. You will also save
money and feel better.

The thought of quitting may be overwhelming,
or you may not know where to start. We?re
here to help. Horizon NJ Health covers
counseling, prescription medications and
over-the-counter products (like nicotine
patches and gum) to help you stop smoking
or vaping.

You can also get help from:
? NJ Quitline: Design a program that

fits your needs and get support from
counselors. Call 1-866-NJ-STOPS
(1-866-657-8677) (TTY 711), weekdays,
from 8 a.m. to 8 p.m., and Saturday from
11 a.m. to 5 p.m., ET. Get support online
at njquitline.org.

? NJ QuitCenters: Receive professional
face-to-face counseling in individual or
group sessions. Locate a center by
calling 1-866-657-8677 (TTY 711) or
visit quitnet.com.

We can help you quit smoking or vaping

Don?t wait to quit ?
call your doctor today and make a plan!



12

A phased rollout for the COVID-19 vaccine
has begun in New Jersey. The COVID-19
vaccine is covered at no cost to you. To
learn more about COVID-19, the

approved vaccines and information about where you
can get vaccinated, visit covid19.nj.gov.
It is important to continue to protect yourself and
others from COVID-19, even after you get the
vaccine. The Centers for Disease Control and
Prevention (CDC) recommends you:

? Wear a mask: cover your nose and mouth with
a non-medical or cloth mask.

? Practice social distancing: stay six feet apart
from others not in your household.

? Wash your hands frequently: use warm water
and soap for 20 seconds or hand sanitizer with
at least 60% alcohol.

? Stay home and avoid contact with others if
you are sick or start to have symptoms like a
runny nose, cough or fever.

If you have been exposed to someone with
COVID-19, or you are experiencing symptoms, call
your doctor.

COVID-19 vaccine update

A message from Don Liss, MD
Vice President and
Chief Medical Officer,
Horizon Blue Cross Blue Shield
of New Jersey

Horizon NJ Health encourages you
to follow the recommendations
of the CDC and the New Jersey
Department of Health to get a
Food and Drug Administration
(FDA) authorized COVID-19
vaccination. The FDA requires
extensive testing for safety and
effectiveness before vaccines are
used. Until everyone is protected
by vaccination, you should
continue to avoid people who are
sick, social distance, wear a mask
in public and wash your hands
often to avoid spreading infection.



U.S. Department of
Health and Human Services
Centers for Disease
Control and Prevention

What to Expect Handout

Vaccines (shots) are one of the tools we
have to fight the COVID-19 pandemic.

DDiiffffeerreenntt ttyyppeess ooff CCOOVVIIDD--1199 vvaacccciinneess aarree
aavvaaiillaabbllee. Most of these vaccines are given in
two shots, one at a time and spaced apart.
The first shot gets your body ready. The
second shot is given at least three weeks later
to make sure you have full protection. If you
are told you need two shots, make sure that
you get both of them. The vaccines may work
in slightly different ways, but all types of the
vaccines will help protect you.

TThhee vvaacccciinneess aarree ssaaffee. The U.S. vaccine
safety system makes sure that all vaccines
are as safe as possible. All the COVID-19
vaccines that are being used have gone
through the same safety tests and meet the
same standards as any other vaccines
produced through the years. A system in
place across the entire country that allows
CDC to watch for safety issues and make
sure the vaccines stay safe.

To stop this pandemic, we need to use all of our prevention tools. Vaccines are one of the most
effective tools to protect your health and prevent disease. Vaccines work with your body?s
natural defenses so yyoouurr bbooddyy wwiillll bbee rreeaaddyy ttoo ffiigghhtt tthhee vviirruuss, if you are exposed (also called
immunity). Other steps, like wearing a mask that covers your nose and mouth and staying at
least 6 feet away from other people you don?t live with, also help stop the spread of COVID-19.

Studies show that COVID-19 vvaacccciinneess aarree vveerryy eeffffeeccttiivvee at keeping you from getting
COVID-19. Experts also think that getting a COVID-19 vaccine may help keep you from getting
seriously ill even if you do get COVID-19. These vaccines cannot give you the disease itself.

The COVID-19 vaccines: what to expect
Vaccines are one of the tools we have to fight the COVID-19 pandemic.

13



CDC | NCIRD | Facts about COVID-19 vaccines

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hheeaalltthhccaarree wwoorrkkeerr wwiillll bbootthh nneeeedd ttoo wweeaarr mmaasskkss..

CDC recommends that during the pandemic,
people wear a mask that covers their nose and
mouth when in contact with others outside their
household, when in healthcare facilities, and
when receiving any vaccine, including a
COVID-19 vaccine.

SOAP

EEvveenn aafftteerr yyoouu ggeett yyoouurr vvaacccciinnee, you will need to keep wearing a mask that covers your nose
aanndd mouth, washing your hands often, and staying at least 6 feet away from other people you
do not live with. This gives you and others the best protection from catching the virus. Right
now, experts don?t know how long the vaccine will protect you, so it?s a good idea to continue
following the guidelines from CDC and your health department. WWee aallssoo kknnooww nnoott eevveerryyoonnee
wwiillll bbee aabbllee ttoo ggeett vvaacccciinnaatteedd rriigghhtt aawwaayy,, ssoo iitt??ss ssttiillll iimmppoorrttaanntt ttoo pprrootteecctt yyoouurrsseellff aanndd ootthheerrss..

The vaccines may cause side effects in
some people, like sore muscles, feeling
tired, or mild fever. These reactions mean
the vaccine is working to help teach your
body how to fight COVID-19 if you are
exposed. For most people, these side
effects will last no longer than a day or two.
HHaavviinngg tthheessee ttyyppeess ooff ssiiddee eeffffeeccttss ddooeess
NNOOTT mmeeaann tthhaatt yyoouu hhaavvee CCOOVVIIDD--1199. If you
have questions about your health after your
shot, call your doctor, nurse, or clinic. As
with any medicine, it is rare but possible to
have a serious reaction, such as not being
able to breathe. It is very unlikely that this
will happen, but if it does, call 991111 or go to
the nearest emergency room.

Source: cdc.gov/coronavirus/vaccines

14



covid19.nj.gov/vaccine

Let?s Get Vaccinated

Rowan College of South Jersey
1400 Tanyard Rd, Sewell

Gloucester County

Open Date: OPEN

Health Partner: County Health

covid19.nj.gov/vaccine

NJ Convention and Exposition Center
Edison

Middlesex County

Open Date: OPEN

Health Partner: RWJBarnabas

rwjbh.org/covid19vaccine

Rockaway Townsquare
ockaway301 Mt. Hope Ave, R

Morris County

Open Date: OPEN

Health Partner: Atlantic Health

health.morriscountynj.gov/vaccination

Moorestown Mall
400 NJ-38, Moorestown

Burlington County

Open Date: OPEN

Health Partner: Virtua

virtua.org/vaccine

Racetrack at Meadowlands
1 Racetrack Drive, East Rutherford

Bergen County
Open Date: OPEN
Health Partner: Hackensack

hackensackmeridianhealth.org/covid19/meadowlands/

Atlantic City Convention Center
1 Convention Boulevard, Atlantic City

Atlantic County

Open Date: OPEN

Health Partner: AtlanticCare

vaccination.atlanticare.org

Lot M

COVID-19 Vaccination Megasites in NJ

15



16

Changes to covered medicines
There are recent changes to our formulary list, also called a preferred drug list (see box). The
changes found in this list will be added to our Drug Formulary list at horizonNJhealth.com/
covered_drugs. This list includes an explanation and listing of step therapy, quantity/age limitations
and drugs that require prior authorization (approval). Paper copies are available upon request.

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. Please note that Horizon
NJ Health maximum days supply limit is 30 days.

Covered Change Description Brand (Generic) Drug Name Alternatives (if applicable)

Covered Insulin Lispro Kwikpen 75/25 ?
Covered Focalin XR (dexmethylphenidate ER) ?
Covered Onfi (clobazam) tablets ?
Covered Otovel (ciprofloxacin/fluocinolone) ?
Covered Jelmyto (mitomycin) ?
Covered Koselugo (selumetinib) ?
Covered Tabrecta (capmatinib) ?
Covered Retevmo (selpercatinib) ?
Covered Rhinocort Allergy (budesonide) ?
Covered Lyrica Solution (pregabalin) ?
Covered Lunesta (eszopiclone) ?
Covered Ambien CR (zolpidem ER) ?
Covered Rapaflo (silodosin) ?
Covered Micardis (telmisartan) ?
Covered Tricor 48mg (fenofibrate) ?
Covered Avsola (infliximab-axxq) ?
Covered Evrysdi (risdiplam) ?
Covered Oriahnn (elagolix, estradiol, and norethindrone acetate) ?
Covered Enspryng (satralizumab-mwge) ?
Covered Dojolvi (triheptanoin) ?
Not Covered Cipro HC (ciprofloxacin/hydrocortisone) generic Ciprodex

Not Covered Cortisporin (neomycin/polymixin/hydrocortisone) suspension generic Cortisporin solution

Here is a list of recent changes:



17

First aid for seizures
Seizures can happen quickly and usually last a few minutes. Once a seizure starts,
there isn?t much you can do to stop it. But, there are things you can do to protect
the person from harm until their seizure stops.

If someone is having a seizure, you should:

? Call 911, and check to see if the person
has a medical alert bracelet.

? Ease them to the floor, if possible.

? Give them room. Keep other people
back.

? Clear hard or sharp objects, like glasses
and furniture, away from the person.

? Cushion their head, if possible.

? Loosen clothing around their neck, if you
can safely do so.

? If you can remember, time when the
seizure starts and when it ends.

? After the movements stop, gently place
the person on their side, if you can, or
turn their head to the side.

? Stay with the person until the seizure
ends or until medical help arrives.

? Once the seizure stops, speak calmly,
reassure the person and explain to them
what happened.

? Do not try to hold the person down or
stop their movements.

? Do not put anything in their mouth ?
you could damage their teeth, or they
may bite you. They can?t swallow their
tongue during a seizure.

If you have seizures or care for someone who
does, talk with your doctor. There may be
medication you can take for your condition.

Sources: American Epilepsy Society, aesnet.org,
cdc.gov/epilepsy/about/first-aid.htm

New generics
Horizon NJ Health is committed to providing the most up-to-date information
regarding new generics that are available, and we encourage using generic products
prior to using brand name products, when appropriate. Generic drugs are the same
as brand name drugs in quality, strength, purity and stability, as required by the Food
and Drug Administration.

The following generic drug is currently on the market or expected to be on the market within
the next three (3) months.

Generic Name Brand Name

Lubiprostone Amitiza



18

Notice of Nondiscrimination Notice of Nondiscrimination

086-19-100 CMC0008179C (0719)An Independent Licensee of the Blue Cross and Blue Shield Association.

Horizon NJ Health complies with applicable Federal civil rights laws and does not discriminate against nor does it
exclude people or treat them differently on the basis of race, color, gender, national origin, age, disability, pregnancy,
gender identity, sex, sexual orientation or health status in the administration of the plan, including enrollment and benefit
determinations. Horizon NJ Health provides free aids and services to people with disabilities (e.g. qualified language
interpreters and information in other formats) and to those whose primary language is not English (e.g. information in
other languages) to communicate effectively with us.
Contacting Member Services
Call Member Services at 1-844-498-9393 (TTY 711) or the phone number on the back of your member ID card, if
you need the free aids and services noted above and for all other Member Services issues.
Filing a Section 1557 Grievance
If you believe that Horizon NJ Health has failed to provide the free communication aids and services or discriminated
against you for one of the reasons described above, you can file a discrimination complaint also known as a Section 1557
Grievance. Horizon NJ Health?s Civil Rights Coordinator can be reached by calling the Member Services number on the
back of your member ID card or by writing to:

Horizon NJ Health
Civil Rights Coordinator
PO Box 820
Newark, NJ 07101



You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights
Complaint Portal, online at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail at U.S. Department of Health and
Human Services, 200 Independence Avenue, SW, Room 509F, HHH Building, Washington, D.C. 20201 or by phone
at 1-800-368-1019 or 1-800-537-7697 (TDD). OCR Complaint forms are available at
www.hhs.gov/ocr/office/file/index.html.
Language assistance
Si habla espa?ol, tiene a su disposici?n servicios gratuitos de asistencia ling??stica. Llame al 1-844-498-9393 (TTY 711).
?????????????????????????????? 1-844-498-9393?TTY 711?.

??: ???? ????? ??, ?? ?? ???? ??? ???? ? ????.
1-844-498-9393 (TTY 711)??? ??? ????.
ATEN??O: Se fala portugu?s, encontram-se dispon?veis servi?os lingu?sticos, gr?tis. Ligue para 1-844-498-9393
(TTY 711).

UWAGA: Je?eli m?wisz po polsku, mo?esz skorzysta? z bezp?atnej pomocy j?zykowej. Zadzwo? pod numer
1-844-498-9393 (TTY 711).
ATTENZIONE: In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare
il numero 1-844-498-9393 (TTY 711).

?????? ??????? ???????? ????? ??? ?????? ???? ????? ??? ??? :?????? ???? ???? .??????? ??1-844-498-9393 ?????? ???? ???? ???)711.(
PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang
bayad. Tumawag sa 1-844-498-9393 (TTY 711).
????????: ???? ?? ???????? ?? ??????? ?????, ?? ??? ???????? ?????????? ?????? ????????. ???????
1-844-498-9393 (???????? 711).
ATANSYON: Si w pale Krey?l Ayisyen, gen s?vis ?d pou lang ki disponib gratis pou ou. Rele 1-844-498-9393 (TTY
711).

CH? ?: N?u b?n n?i Ti?ng Vi?t, c? c?c d?ch v? h? tr? ng?n ng? mi?n ph? d?nh cho b?n. G?i s? 1-844-498-9393
(TTY 711).
ATTENTION : Si vous parlez fran?ais, des services d'aide linguistique vous sont propos?s gratuitement. Appelez le
1-844-498-9393 (ATS 711).

???? ??? ? ??? ?????? ??? ??? ????? ?? ??? ?? ???? ?? ?? ?? ???? ????? ???? ?? ??? :??????
1-844-498-9393 (TTY 711).



horizonNJhealth.com

Horizon NJ Health
1700 American Blvd.
Pennington, NJ 08534

Care Notes
Member Services 1-844-444-4410 (TTY 711), 24 hours a day, seven days a week. horizonNJhealth.com
CARE NOTES is published for members of Horizon NJ Health, 1700 American Blvd., Pennington, NJ 08534. Information in
CARE 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 TotalCare (HMO D-SNP) is an HMO Medicare Advantage Dual Eligible Special Needs plan with a Medicare contract
and a contract with the State of New Jersey Medicaid Program. Enrollment in Horizon NJ TotalCare (HMO D-SNP) depends on
contract renewal. 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.

? 2021 Horizon Blue Cross Blue Shield of New Jersey. Three Penn Plaza East, Newark, New Jersey 07105. (0321) 086-21-27

Y0090_H8298_ECN002567_M



horizonNJhealth.com

Care NotesIssue 3, 2021




Your health is
important to us.
That?s why we?re
here to help you
understand your
benefits so you can
reach your best
health. If you have
any questions,
please call us at
1-844-444-4410
(TTY 711), 24 hours
a day, seven days
a week, 365 days
per year.

It?s Time for Your Flu Shot ............................................................ 2

Vaccines for Homebound Members ............................................. 2

Breast Cancer Screening Can Save Your Life ............................... 3

Don?t put off Your Colorectal Cancer Screening ......................... 4

Annual Privacy Notice ................................................................... 4

Horizon Neighbors in Health is Here to Help You ....................... 5

Have You Scheduled Your Diabetes Screenings? ........................ 6

We Make it Easy to Get Care - No Referral Needed! .................. 6

Horizon NJ TotalCare (HMO D-SNP):
Even Better Benefits in 2022 ........................................................ 7

Understanding COPD ................................................................... 8

Changes to Covered Medicines ................................................... 9

New Generic Drugs .................................................................... 10

Health Insurance Fraud: How to Identify and Prevent It ............ 11

Are You Depressed? Know When to Get Help. ......................... 12

There?s a Right Way ? and a Wrong Way ? to Take Medicine .... 13

What You Should Know About Opioids. .................................... 14

Access to Your Plan Information Anytime .................................. 15

Information on Leaving a Nursing Facility .................................. 15

Our Member Advocates are Here for You ................................. 16

How to Choose a Personal Representative ................................ 16

Are You Prepared for an Emergency? ........................................ 17

Reporting Abuse, Neglect or Exploitation................................. 18

What to Know About Scheduling Your Appointments .............. 19

In This Issue







2
It?s Time for Your Flu Shot
Getting a flu shot every year is your best protection from the flu. Everyone 6 months of
age and older should get a flu shot. In serious cases, you can be hospitalized and even
die from the flu. It?s important to protect yourself and the people around you.

You can get a flu shot at your doctor?s office or local, participating pharmacy. Visit
horizonNJhealth.com/findadoctor to find a pharmacy near you, or call Member Services
at 1-844-444-4410 (TTY 711), 24 hours a day, seven days a week.

Do You Need a Pneumonia Vaccine?
Most people only need one pneumonia shot after age 65, but some people may need a second
shot. Talk to your doctor to see if the pneumonia vaccine is right for you.

COVID-19 Vaccine
All Americans age 12 and older can get the COVID-19 vaccines.* It?s your best protection against
severe disease and hospitalization from COVID-19.

*Children ages 12 and older can only get the Pfizer COVID-19 vaccine.

If you?re homebound, or have major difficulties leaving your home, you may be able
to get your vaccines at home. Reach out to your Primary Care Provider (PCP). If you
need additional care coordination, please call your Care Manager or Member Services
at 1-844-444-4410 (TTY 711).

Vaccines for Homebound Members




3
Source: Centers for Disease Control and Prevention, cdc.gov

Breast cancer is the second most common cancer in women. The good news is that
a mammogram can detect cancer early, and early detection can save your life. All
women ages 50 to 74 should get a mammogram every two years. The decision to start
screening before 50 years old is based on your individual health and medical history.
Talk to your doctor today.

If you have any concerns that are preventing you from getting your mammogram, please call the
Horizon Healthy Journey line toll free at 1-844-754-2451 (TTY 711), weekdays, from 8:30 a.m.
to 5 p.m., Eastern Time (ET).

Routine mammograms are covered at no cost to you.

Breast Cancer Screening can Save Your Life

1 in 8 women will develop breast cancer in their lifetime




4
Don?t put off Your Colorectal Cancer Screening
Colorectal cancer is the third most common cancer diagnosed in both men and women
in the United States. The best way to diagnose colorectal cancer early is through
preventive screenings.

Screening for colorectal cancer usually starts at age 45. Talk to your doctor about your risk and the
best screening options available for you.

If you have any questions, please call the Horizon Healthy Journey line toll free at 1-844-754-2451
(TTY 711), weekdays, from 8:30 a.m. to 5 p.m., ET.
Source: American Cancer Society

Annual Privacy Notice
We want you to know how we use and protect your health information, and the rights
you have regarding your Protected Health Information (PHI). Read our Privacy Practices

To request a printed copy of our Notice of Privacy Practices, call Member Services
at 1-844-444-4410 (TTY 711).





5
Horizon Neighbors in Health is Here
to Help You

Managing your health and day-to-day challenges can be tough, especially if you don?t
know where to go for help. But you can get care and support with Horizon Neighbors
in Health, a partnership between Horizon Blue Cross Blue Shield of New Jersey and
several hospitals and doctors across New Jersey.

Horizon Neighbors in Health is free with your Horizon NJ Health plan and offers support right
in your neighborhood.

How it Works
A local Community Health Worker and a Personal Health Assistant will work with you to develop
a program personalized for you. Based on your goals, you may get help with:

? Coordinating and scheduling medical appointments

? Finding transportation, healthy foods, child care, employment and housing

? Setting and achieving your health goals

? Finding community resources, life coaching and skill building opportunities

? Understanding how your Horizon NJ Health benefits work

How can We Help You?
Everyone needs a helping hand sometimes, and Horizon Neighbors in Health is here for you.
If you?re interested, please email HorizonNeighborsInHealth@HorizonBlue.com.

Do You Want to get Your High School Diploma?
Horizon Neighbors in Health: Education Works can help you study for and get your diploma ?
at no cost to you! For more information, call 1-800-682-9094 x52076 (TTY 711), weekdays, from
9 a.m. to 5 p.m., ET, or email EducationWorks@HorizonBlue.com.





6
Have You Scheduled Your Diabetes Screenings?
If you have diabetes, it?s important that you get regular screenings to maintain your
health and avoid serious health issues.

Ask your doctor about these important screenings:
? Hemoglobin A1C: Measures your average blood sugar over the last three months.

It helps you and your doctor manage your diabetes. This test should be done every three
to six months.

? Kidney function test: Called a urine microalbumin test, it checks for protein in your urine
to see how well your kidneys are working. This test should be done once a year.

? Diabetic retinal eye exam: Different from your routine eye exam, it looks for damage
to the eye caused by high blood sugar. This test should be done once a year.

We want you to be able to get the care you need, when you need it. That?s why
you don?t need a referral to see in-network specialists. To find an in-network
specialist, please visit horizonNJhealth.com/findadoctor or call Member Services
at 1-844-444-4410 (TTY 711), 24 hours a day, seven days a week.

We Make it Easy to Get Care ?
No Referral Needed!




7
Horizon NJ TotalCare (HMO D-SNP):
Even Better Benefits in 2022

If you?re eligible for both Medicaid and Medicare, now is the time to enroll in
Horizon NJ TotalCare (HMO D-SNP). The 2022 benefits are better than ever!

Here?s what?s new for 2022:
? An increased Over-the-Counter (OTC) Benefit Card with a credit of up to $1,560 a year

($390 every three months) to use on health items at select retail stores and online.

? More retailers added, so you?ll have even more places to use your card.

? Farm-fresh produce delivered to your door with FarmBoxRx, if you qualify.

You also get these extra benefits at no cost to you:
? Up to a $1,000 credit ($250 every quarter (three months) to spend on items from our

OTC Benefit Catalog

? Online doctor and therapist visits (telehealth) from home using your phone, tablet
or computer

? Home delivery of meals for up to 14 days following a qualifying hospital stay

? Fitness and exercise programs

? 24/7 Nurse Line to get answers to your health questions from anywhere

? A dedicated Care Manager to coordinate all your health care needs

To get more information and to see if you?re eligible, call 1-888-328-5736 (TTY 711),
24 hours a day, seven days a week, or visit HorizonBlue.com/TotalCare.




8
Understanding COPD
Chronic Obstructive Pulmonary Disease (COPD) is a group of lung diseases that
cause breathing-related problems, including emphysema and chronic bronchitis.

Symptoms of COPD include:
? Frequent coughing or wheezing

? Excess phlegm or mucus

? Shortness of breath

? Trouble taking a deep breath

There is currently no cure for COPD, but you can maintain a good quality of life with treatment
and lifestyle changes. Talk to your doctor if you think you have any symptoms of COPD.

Source: CDC, cdc.gov/copd/basics-about.html




9
Our Prescription Drug Listing, also called a formulary, is changing. The most
up-to-date listing is posted online at horizonNJhealth.com/covered_drugs.
The listing will tell you if your medicine needs prior authorization (approval),
step therapy (trying less expensive options before ?stepping up? to medicines
that cost more) or has quantity/age limitations. Here is a list of recent changes:

Changes to Covered Medicines

Covered Change Description Brand (Generic) Drug Name Alternatives (If Applicable)

C D ?

?

?

?

?

?

?

?

?

?

?

?

Please talk with your PCP about these changes. If your PCP decides that, for medical reasons,
you must take a medicine that is not on the formulary or needs pre-approval, including a brand
name medicine exception, your PCP can call us at 1-800-682-9094 x81016 (TTY 711) and
ask for special permission (prior authorization) for you to get the medicine. Under your
Horizon NJ Health plan, you can get up to a 30-day supply of your medicine, if needed.

TBD




10

We encourage using generic drugs before using brand name drugs, when appropriate.
Generic medicines are the same as brand name medicines in quality,
strength, purity and stability, as required by the U.S. Food and Drug Administration.

The following generic medicines are currently on the market or expected to be on the
market within the next three (3) months.

New Generic Drugs

Generic Name Brand Name

D T

TBD



11

Health Insurance Fraud: How to Identify
and Prevent It

Health insurance fraud is a problem that affects everyone. The good news is that if you
know how to spot it, you can help prevent it.

Common types of health insurance fraud schemes:
? Billing for a higher level of service to get a higher payment

? Billing for services that did not happen

? Changing claims or prescriptions

? Claiming non-covered treatments are medically necessary when they are not

? Faking a patient?s diagnosis to justify a test, surgery or procedure that is not medically necessary

? Performing unnecessary procedures to get a payment

What you can do:
ALWAYS
? Review anything you get in the mail from Horizon NJ Health, your doctor or other providers.

? Ask for a copy of everything you sign.

? Be suspicious of anyone offering to give you free tests or screenings if you give them your
member ID number.

NEVER
? Give your health insurance ID card number to anyone except your doctor, clinic, hospital

or other health care provider.

? Give your health insurance ID card number to anyone who calls you without you asking
and offers you free goods or services, like durable medical equipment or medicine.

? Let anyone borrow or use your health insurance ID card or number.

? Ask your doctor or health care provider for treatment or care you do not need.

? Sign your name to a blank form.

? Share your medical records or medical information with anyone except your doctor, clinic,
hospital or other health care provider.

We will always verify your identity before talking to you about your benefits and services.
This is an important step we take to protect your information.

To report health insurance fraud, call 1-855-FRAUD20 (1-855-372-8320) (TTY 711).
For information about COVID-19 scams, visit FCC.gov/consumers.




12

Are You Depressed? Know When to Get Help.
Depression is a more than just feeling down or having a bad day. It is a mental
health condition that can keep you from doing normal daily activities and cause
you to feel sad for a long time. During the COVID-19 pandemic, many people are
experiencing depression.

Symptoms of depression:
? Feeling sad or anxious often or all the time

? Not wanting to do activities that you used to enjoy

? Feeling irritable, frustrated or restless

? Trouble falling asleep or staying asleep

? Eating more or less than usual

? Aches, pains, headaches, no appetite or stomach problems that do not improve with treatment

? Trouble concentrating, remembering details or making decisions

? Feeling tired, even after sleeping well

? Feeling guilty, worthless or helpless

? Thinking about suicide or hurting yourself

If you have experienced one or more of these symptoms, talk to your doctor immediately.
There are resources and treatment options available to you.

Source cdc.gov




13

There?s a Right Way ? and a Wrong Way
? to Take Medicine

Following your doctor?s orders for taking your medicines is important for your health.
This means getting your prescriptions filled and taking your medicines on time,
and understanding the directions.

Here are tips to help you take your medicines correctly and safely:
? Talk to your doctor. If your medicine has side effects that bother you, your doctor may

be able to change your medicine or dose.

? Understand the instructions. Ask your doctor or pharmacist to explain the timing and dose
of your medicines. You should also ask how long you should take a medicine.

? Set daily routines. Take your medicines at the same time as other daily tasks, like eating
a meal or brushing your teeth.

? Keep your medicine where you?ll notice it. For example, if you need to take a medicine
with food in the morning, put the medicine where you usually eat breakfast.

? Use a pill container. Choose a container that has compartments labeled with the days
of the week and time of day.

? Use a schedule. Create a list of your medicines, how often you take them and any special
directions. Keep the list nearby so you can use it if you have questions.

Always talk to your doctor or pharmacist if you have any questions about your medicines.
They are there to help you get the care you need.

Source: U.S. Food and Drug Administration
https://www.fda.gov/drugs/special-features/why-you-need-take-your-medications-prescribed-or-
instructed





What You Should Know About Opioids
Opioids are prescription medicines used treat severe pain. Common types are
oxycodone, hydrocodone, morphine and fentanyl. If taken as told by your doctor,
opioids can be a safe way to treat chronic (long-lasting) or acute (temporary, due to a
surgery, accident or infection) pain. But, since opioids affect the brain, they can become
very addictive in a short amount of time.

If Your Doctor Prescribes an Opioid:
? Only take as directed and follow the directions on the prescription bottle.

? If your pain gets better, call your doctor to see if you can safely stop taking the medicine.

? Make sure your doctor knows about all other medicines you are taking.

? Do not mix opioids with alcohol or other drugs such as benzodiazepines or muscle relaxants,
before discussing with your doctor.

? Make sure the medicine is stored in a safe place where it cannot be found by others, especially
children or pets.

What can be Used for Pain Other Than Opioids?
? For pain that is not severe or if you are concerned about taking opioids, ask your doctor

about other options such as:

? Pain relievers such as acetaminophen, ibuprofen or naproxen

? Applying heat or ice to the affected area

? Topical medicines such as lidocaine or capsaicin

If you are no longer taking your medicine, it?s important to dispose of it correctly
right away so other people ? such as family, friends or visitors ? do not find it:
? Find a local drug take-back program (such as at your local pharmacy or police station).

? Ask about a mail-back program at your local pharmacy.

If the prior choices are unavailable, flush it down the toilet as directed by the Food and Drug
Administration (FDA).

Sources:
CDC
Federal Occupational Healthy United States Department of Health and Human Services

14







Access to Your Plan Information Anytime

Information on Leaving a Nursing Facility

Once you register at horizonNJhealth.com, you get 24/7 access to your plan
information.

Sign in to:
? Change your PCP

? Enroll in a Disease Management program

? Request a new member ID card

? And much more!

If you are leaving a nursing facility, your Care Manager will work closely with you to
assess your needs on an ongoing basis and maintain a Plan of Care. Your Care Manager
will identify your goals, arrange care and support, and provide information about local
resources to help you live as independently as possible. They will also help you with
housing, education and employment, when applicable, so you can take care of yourself.

15




Our Member Advocates are Here for You
All MLTSS members have access to a Member Advocate. This person works with
you to answer any questions about your MLTSS benefits, services and decisions.
They work closely with you, your care team and state representatives to make sure
your needs and goals are met.

To speak with a Member Advocate, please call 1-844-444-4410 (TTY 711), weekdays, from
8 a.m. to 5 p.m. ET, or ask your Care Manager to have a Member Advocate contact you.

A Personal Representative is someone you choose to work with us on your behalf to
handle your health care and benefits when you don?t feel well enough to do so on your
own. They can handle all phone calls and written communications about your benefits.
If you have a Personal Representative, you will still have all your rights.

To choose a Personal Representative:
? Download a Request for Personal Representative Form at horizonNJhealth.com/personalrep.

? Mail your completed form to the address provided.

Your Personal Representative can be your spouse, child, relative, family friend, lawyer or someone
chosen by the court. You can change your Personal Representative at any time. If you have any
questions about choosing a Personal Representative, you can talk to your Care Manager.

How to Choose a Personal Representative

16




Are You Prepared for an Emergency?
It may be hard to think about, but a disaster can strike at any time. The best way to
protect yourself during an emergency or natural disaster is to be prepared. You can
start by creating a plan with your family or caregivers. Other resources are available
to help you:

NJ Register Ready is New Jersey?s Special Needs Registry for Disasters
? A free, confidential program that can help you get to safety during a major emergency,

like a hurricane.

? Register if you have physical or cognitive limitations, language barriers or do not have
transportation.

? To register, visit RegisterReady.NJ.gov or call 2-1-1 (TTY 711).

NJ 2-1-1
? Connects people in need with services that can help.

? Links emergency management agencies with the public during a community emergency.

? Visit nj211.org or call 2-1-1 (TTY 711).

Federal Emergency Management Agency (FEMA)
? Works with local governments to prepare for and recover from disasters.

? New Jersey is part of FEMA?s Region II.

? Visit fema.gov.

Office of Emergency Management (OEM)
? Works with the state police, Emergency Management Organizations and state agencies to

develop programs to help New Jersey before, during and after a disaster.

? Works with the governor to let residents know when a state of emergency exists.

? Visit ready.nj.gov.

17







Reporting Abuse, Neglect or Exploitation
No one wants to think about a loved one being hurt, but many adults are victims of
abuse each year. If you think your loved one is being abused, neglected or exploited,
report it right away to his or her Care Manager and the appropriate state agency.

Adult Protective Services (APS)
New Jersey APS has offices in each of the 21 counties. Make a report to the county APS office
or to the New Jersey Division of Aging Services senior hotline at 1-800-792-8820 (TTY 711).

Facility-based complaints and investigation
The Office of the Ombudsman for the Institutionalized Elderly handles reports of abuse and
neglect in people ages 60 and older living in institutional settings such as nursing homes,
assisted living facilities and other long-term health care facilities.

? Call: 1-877-582-6995 (TTY 711), 24 hours a day, seven days a week
? Email: ombudsman@ltco.nj.gov

? Write: The Office of the Ombudsman
PO Box 852
Trenton, NJ 08625-0852

? Fax: 1-609-943-3479
The New Jersey Division of Health Facility Survey and Field Operations investigates complaints
against health care facilities to ensure they are providing the right care. This includes nursing
homes, assisted living residences, comprehensive personal care homes, adult medical day care
and other licensed acute and long-term care facilities.

? Call: 24-hour toll-free hotline: 1-800-792-9770 (TTY 711)
? Online: web.doh.state.nj.us/fc/search.aspx

? Write: New Jersey Department of Health
Division of Health Facility Survey and Field Operations
PO Box 367
Trenton, NJ 08625-0367

18





19

What to Know About Scheduling Your
Appointments

Your access to care is important. We have the following appointment scheduling
standards to ensure you can get the care you need when you need it.

When you arrive for your doctor?s office, your doctor should see you within 45 minutes. If you
have any issues with getting an appointment according to these guidelines, please call Member
Services at 1-844-444-4410 (TTY 711).

Medical appointments
Service Scheduling Standards
Emergency services Immediately
Urgent care Within 24 hours
Symptomatic acute care Within 72 hours
Routine care Within 28 days
Specialists Within four weeks or sooner, as medically indicated
Urgent specialty care Within 24 hours of request
Baseline physicals for new
adult members

Within 180 calendar days of enrollment

Baseline physicals for new child
members and adult members
of Division of Developmental
Disabilities (DDD)

Within 90 days of enrollment or in accordance with Early
and Periodic Screening, Diagnostic and Treatment (EPSDT)
guidelines

Prenatal care Within three weeks of a positive pregnancy test (home or
laboratory), within three days of identification of a high-risk
pregnancy, within seven days during first and second trimester
and within three days in third trimester

Routine physicals Within four weeks for school, camp, work or similar type physicals
Lab and radiology services Within three weeks for routine care and 48 hours for urgent care
Initial pediatric appointments Within three months of enrollment
Dental appointments
Emergency dental treatment No later than 48 hours, based on condition
Urgent care Within three days of request
Routine care Within 30 days of request
Mental health/substance use disorder appointments
Emergency service Immediate; urgent care within 24 hours
Routine care Within 10 days of request



Horizon NJ Health
1700 American Blvd.
Pennington, NJ 08534

horizonNJhealth.com

Care Notes
Member Services 1-844-444-4410 (TTY 711), 24 hours a day, seven days a week.
CARE NOTES is published for members of Horizon NJ Health, 1700 American Blvd., Pennington, NJ 08534. Information in
CARE 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 TotalCare (HMO D-SNP) is an HMO Medicare Advantage Dual Eligible Special Needs plan with a Medicare contract
and a contract with the State of New Jersey Medicaid Program. Enrollment in Horizon NJ TotalCare (HMO D-SNP) depends on
contract renewal. 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 Blue Shield Association. The Blue Cross? and Blue Shield? names and symbols are registered
marks of the Blue Cross Blue Shield Association. The Horizon? name and symbols are registered marks of Horizon Blue Cross
Blue Shield of New Jersey.
? 2021 Horizon Blue Cross Blue Shield of New Jersey. Three Penn Plaza East, Newark, New Jersey 07105. (0921) XXX-XX-XX
For a printed copy of this newsletter, please call Member Services at 1-844-444-4410 (TTY 711).

Y0090_H8298_ECN004550A_M

If you lose eligibility for a program or service that has been helpful to
you, Horizon NJ Health will provide information or alternative resources
so your care is not interrupted. Please talk to your Care Manager or
call Member Services at 1-844-444-4410 (TTY 711).

Getting Help in Your Language
If you need help understanding this information, you have the right to get help in your language
at no cost to you.

Nondiscrimination Policy
Read about Horizon NJ Health?s nondiscrimination policy.