HOSPITAL NETWORK FINDER

HOSPITAL NETWORK FINDER

This listing of OMNIA Health Plan Tier 1 and Tier 2 hospitals is complete as of October 2017. The list is subject to change, so always verify hospital network participation status prior to making your selection. Check for the most current information by:

? Using the online Doctor & Hospital Finder located on our website at doctorfinder ? Contacting the physician, health care professional or department directly ? Calling the Customer Service telephone number listed on your ID card Select the OMNIA Health Plan Tier 1 or Tier 2 hospital that's right for you to maximize your coverage benefit.

Hospital Name AtlantiCare Regional Medical Center Shore Medical Center* Englewood Hospital Hackensack UMC at Pascack Valley (Hackensack Meridian Health) Hackensack University Medical Center (Hackensack Meridian Health) Holy Name Hospital The Valley Hospital St. Luke's Hospital - Quakertown Deborah Heart and Lung Center Lourdes Medical Center of Burlington County Virtua ? Memorial Hospital of Burlington County Cooper Hospital University Medical Center Kennedy Memorial Hospital Our Lady of Lourdes Medical Center Virtua - West Jersey Hospital System Cape Regional Medical Center Inspira Medical Center ? Vineland

* Hospital will be TIER 2 effective 1/1/2018

County Atlantic Atlantic Bergen Bergen Bergen Bergen Bergen Bucks Burlington Burlington Burlington Camden Camden Camden Camden Cape May Cumberland

Tier 1

Tier 2

HOSPITAL NETWORK FINDER

Hospital Name Delaware County Memorial Hospital Clara Maass Medical Center (RWJBarnabas Health) East Orange General Hospital Hackensack UMC at Mountainside (Hackensack Meridian Health) Newark Beth Israel Medical Center (RWJBarnabas Health) St. Barnabas Medical Center (RWJBarnabas Health) St. Michael's Medical Center University Hospital Inspira Medical Center ? Woodbury Bayonne Medical Center (CarePoint Health) Christ Hospital (CarePoint Health) Hackensack UMC Palisades (Hackensack Meridian Health) Hoboken University Medical Center (CarePoint Health) Jersey City Medical Center (RWJBarnabas Health) Meadowlands Hospital Medical Center Hunterdon Medical Center Capital Health System ? Fuld** Capital Health System ? Regional/Hopewell** Robert Wood Johnson ? Hamilton (RWJBarnabas Health) St. Francis Medical Center JFK Medical Center University Medical Center of Princeton at Plainsboro * Raritan Bay Regional Medical Center (Hackensack Meridian Health) Robert Wood Johnson - New Brunswick (RWJBarnabas Health)

** Hospital will be TIER 1 effective 1/1/2018 * Hospital will be TIER 2 effective 1/1/2018

County Delaware, PA Essex Essex Essex Essex Essex Essex Essex Gloucester Hudson Hudson Hudson Hudson Hudson Hudson Hunterdon Mercer Mercer Mercer Mercer Middlesex Middlesex Middlesex Middlesex

Tier 1

Tier 2

HOSPITAL NETWORK FINDER

Hospital Name St. Peter's University Hospital Bayshore Community Hospital (Hackensack Meridian Health) CentraState Medical Center Jersey Shore Medical Center (Hackensack Meridian Health) Monmouth Medical Center (RWJBarnabas Health) Riverview Medical Center (Hackensack Meridian Health) St. Luke's Hospital ? Monroe Chilton Medical Center (Atlantic Health System) Morristown Medical Center (Atlantic Health System) St. Clare's Denville/Dover AI duPont Hospital for Children St. Luke's Hospital ? Anderson St. Luke's Hospital ? Bethlehem Community Medical Center (RWJBarnabas Health) Monmouth Medical Center Southern Campus (RWJBarnabas Health) Ocean Medical Center (Hackensack Meridian Health) Southern Ocean Medical Center (Hackensack Meridian Health) St. Joseph's Hospital and Medical Center St. Mary's ? Passaic Children's Hospital of Philadelphia Crozer-Chester Medical Center Fox Chase Cancer Center Hahnemann University Hospital Hospital of the University of Pennsylvania (UPHS) Jeanes Hospital Pennsylvania Hospital (UPHS)

County

Tier 1

Middlesex

Monmouth

Monmouth

Monmouth

Monmouth

Monmouth

Monroe

Morris

Morris

Morris

New Castle

Northhampton

Northhampton

Ocean

Ocean

Ocean

Ocean

Passaic

Passaic

Philadelphia

Philadelphia

Philadelphia

Philadelphia

Philadelphia

Philadelphia

Philadelphia

Tier 2

HOSPITAL NETWORK FINDER

Hospital Name Presbyterian Hospital (UPHS) Rothman Orthopaedic Specialty Hospital St. Christopher's Hospital for Children Temple University Hospital Thomas Jefferson University and Methodist Division Inspira Medical Center ? Elmer Memorial Hospital of Salem County Robert Wood Johnson ? Somerset (RWJBarnabas Health) Newton Medical Center (Atlantic Health System) Overlook Medical Center (Atlantic Health System) Robert Wood Johnson ? Rahway (RWJBarnabas Health) Trinitas Regional Medical Center Hackettstown Community Hospital (Atlantic Health System) St. Luke's ? Warren

County Philadelphia Philadelphia Philadelphia Philadelphia Philadelphia Salem Salem Somerset Sussex Union Union Union Warren Warren

Tier 1

Tier 2

OMNIA Health Plan members enjoy lower premiums, lower deductibles, lower copayments and lower out-of-pocket costs with OMNIA Tier 1 doctors, hospitals, and other health care professionals, including the OMNIA Health Alliance. Members also have the flexibility to visit any Tier 2 health care professional in our broad Managed Care Network for a higher out-of-pocket cost. OMNIA Health Plan members can receive obstetrics services at any hospital in Burlington and Mercer counties at an OMNIA Tier 1 level of benefits as a benefit exception, even if the hospital is listed as Tier 2.

Horizon Blue Cross Blue Shield of New Jersey is an independent licensee 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 and OMNIASM is a service mark of Horizon Blue Cross Blue Shield of New Jersey. ? 2017 Horizon Blue Cross Blue Shield of New Jersey, Three Penn Plaza East, Newark, New Jersey.

Horizon Blue Cross Blue Shield of New Jersey 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. Spanish (Espa?ol): Para ayuda en espa?ol, llame al 1-866-660-6528. Chinese ()

1-866-660-6528.

C101_201709

Three Penn Plaza East Newark, NJ 07105-2200

Notice of Nondiscrimination

Horizon Blue Cross Blue Shield of New Jersey 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 BCBSNJ 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 1-800-355-BLUE (2583) (TTY/TDD 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 BCBSNJ 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 BCBSNJ'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 BCBSNJ ? 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, electronically through the Office for Civil Rights Complaint Portal, available at , 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 1-800-537-7697 (TDD)

OCR Complaint forms are available at ocr/office/file/index.html.

CMC0008179_A (0817)

An Independent Licensee of the Blue Cross and Blue Shield Association.

If you need help understanding this Horizon Blue Cross Blue Shield of New Jersey information, you have the right to get help in your language at no cost to you. To talk to an interpreter, please call 1-866-660-6528 during normal business hours.

Spanish (Espa?ol): Si necesita ayuda para comprender esta informaci?n de Horizon Blue Cross Blue Shield of New Jersey, usted tiene el derecho de obtener ayuda en su idioma sin costo alguno. Para hablar con un int?rprete, s?rvase llamar al 1-866-660-6528 durante el horario normal de trabajo.

Chinese () (Horizon Blue Cross Blue Shield of New Jersey) 1-866-660-6528

Korean (): Horizon Blue Cross Blue Shield of New Jersey . 1-866-660-6528 .

Portuguese (Portugu?s): Se precisar de ajuda para entender estas informa??es da Horizon Blue Cross Blue Shield of New Jersey, voc? tem o direito de receber gratuitamente assist?ncia no seu idioma. Para falar com um int?rprete, ligue para: 1-866-660-6528 no hor?rio normal de trabalho.

Gujarati (

):

,

,

1-866-660-6528

Polish (Polski): Jeeli potrzebujesz pomocy, aby zrozumie informacje planu Horizon Blue Cross Blue Shield of New Jersey, masz prawo poprosi o bezplatn pomoc w jzyku ojczystym. Aby skorzysta z pomocy tlumacza, zadzwo pod numer 1-866-660-6528 podczas normalnych godzin pracy.

Italian (Italiano): Se vi serve aiuto per capire queste informazioni della Horizon Blue Cross Blue Shield of New Jersey, avete diritto ad assistenza gratis nella vostra lingua. Per parlare con un interprete, siete pregati di telefonare al numero 1-866-660-6528 durante le normali ore d'ufficio.

Tagalog (Tagalog): Kung kailangan mo ng tulong sa pag-unawa nitong impormasyon ng Horizon Blue Cross Blue Shield of New Jersey, may karapatan kang humingi ng tulong sa iyong wika nang walang gastos sa iyo. Upang makipag-usap sa isang taga-interpret, mangyaring tumawag sa 1-866-660-6528 sa loob ng karaniwang mga oras ng negosyo.

CMC0008602 (0916)

An Independent Licensee of the Blue Cross and Blue Shield Association.

Russian ( ): , Horizon Blue Cross Blue Shield of New Jersey, . 1-866-660-6528 .

Haitian Creole (Krey?l ayisyen): Si ou bezwen ?d pou konprann enf?masyon sou Horizon Blue Cross Blue Shield of New Jersey, ou gen dwa pou jwenn ?d nan lang natifnatal ou gratis. Pou pale av?k yon ent?pr?t, tanpri rele nimewo 1-866-660-6528 pandan l? n?mal biznis.

Hindi ( ):

1-866-660-6528

Vietnamese (Ting Vit): Nu cn c gi?p hiu r? th?ng tin n?y ca Horizon Blue Cross Blue Shield of New Jersey, qu? v c? quyn c gi?p bng ng?n ng ca m?nh min ph?. Xin gi s 1-866-660-6528 trong gi l?m vic n?i chuyn vi ngi th?ng dch.

French (Fran?ais): Si vous avez besoin d'assistance pour comprendre ces informations au sujet de Horizon Blue Cross Blue Shield of New Jersey, vous avez le droit d'obtenir de l'aide dans votre langue, sans aucun frais. Pour parler avec un interpr?te, veuillez appeler le 1-866-660-6528 pendant les heures normales de bureau.

Navajo (Din?):

1-866-660-6528

Horizon Blue Cross Blue Shield of New Jersey 1-866-660-6528

Arabic 1-866-660-6528

( ) Urdu

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