Marketplace Criteria - Hospitals

OMNIA Health Plan (All Metallic Levels and HSA)
Horizon Advantage EPO (Bronze, Silver and Gold Levels)
Horizon Patient Centered Advantage EPO
Horizon Advantage Direct Access

Currently, all hospitals in the Horizon Hospital Network participate in MarketPlace plans. For participation in all Horizon Blue Cross Blue Shield of New Jersey products, hospitals must meet strict credentialing criteria and be approved for participation by Horizon BCBSNJ's Credentials Committee.

Horizon BCBSNJ's criteria for selecting hospitals for participation in all products includes, but is not limited to:

  • Accreditation achievement by an accrediting organization (such as Joint Commission or Det Norske Veritas)
  • Cost
  • Geographic access per coverage requirements and standards
  • Medicare certification
  • Quality
  • Standards for clinical quality and patient safety
  • State licensure

As a condition of participation in the Horizon Hospital Network for all products, hospitals are also required to participate in Horizon BCBSNJ's Quality Management Program, which contains requirements for evaluation of patient satisfaction.

OMNIA Health Plan (All Metallic Levels and HSA)

Members in our OMNIA Health Plans may seek treatment at all Horizon Network Hospitals. Horizon Network Hospitals must meet strict credentialing criteria for participation including, but not limited to, quality, cost, geographic location, and accreditation. In this Plan, members can reduce their out-of-pocket costs by selecting a Tier 1 Hospital. OMNIA Health Plan members selecting care at a Tier 1 hospital will incur lower out-of-pocket costs.

Horizon Advantage EPO (Bronze, Silver and Gold Levels)

Members in our Horizon Advantage EPO Plan may seek treatment at all Horizon Network Hospitals. Horizon Network Hospitals must meet strict credentialing criteria for participation including, but not limited to, quality, cost, geographic location, and accreditation.

Horizon Patient-Centered Advantage EPO

Members in our Horizon Patient Centered Advantage EPO Plan may seek treatment at all Horizon Network Hospitals. Horizon Network Hospitals must meet strict credentialing criteria for participation including, but not limited to, quality, cost, geographic location, and accreditation.

Horizon Advantage Direct Access

Members in our Horizon Advantage Direct Access Plan may seek treatment at all Horizon Network Hospitals. Horizon Network Hospitals must meet strict credentialing criteria for participation including, but not limited to, quality, cost, geographic location, and accreditation.