Insurance

Advocare Payer Plan Guide

Aetna Premier Care Network and Aetna Aexcel Plans

Aetna APCN Network…………PAR, Designated Tier	Advocare specialists…………………PAR, Tier 1	The following 12 specialties are PAR but are not designated as APCN, these are all TIER 3
PCP’s Primary Care & Pediatricians……PAR & Tier 2...…	(outside of the “12 Specialties”)	Cardiothoracic Surgery, Cardiology, Gastroenterology General Surgery, Neurology, Neurosurgery, Orthopedics, Otolaryngology/ENT, OB/GYN, Plastic Surgery, Urology, Vascular Surgery

Aetna Whole Health (part of the 2018 Virtua Employee Plan – Virtua Network; all Advocare providers in ALL NJ counties are included in this plan as Tier 1)

Category 1	Category 2	Category 3
Aetna Medicare Plan	Aetna Managed Choice	Aetna Medicare Plan Open-Access (HMO)
Aetna Select	Aetna	Aetna Health Network Only
Aetna Elect Choice		Aetna Open-Access Elect Choice
Aetna HMO		Aetna Open-Access (HMO)
Aetna Medicare Prime Plan		Open-Access Aetna Select
Aetna Whole Health – Virtua Plan – Tier 1

Category 4	Category 5	Category 6
Aetna Choice POS	Aetna Limited Benefits Insurance Plan	Aetna Voluntary Group Medical Plan (Indemnity Plan)
Aetna Choice POS II	Aetna Open Choice (PPO)	Aetna Traditional Choice
Aetna Health Network Option
Aetna Open-Access Managed Choice

Amerigroup Amerivantage Dual (HMOSNP)
……………………………………………..…….…………………………………………………………………………………………………………………………….……… NONPAR
(must be PAR with Amerigroup in order to participate with Amerivantage Dual HMOSNP)

Advantage….……………………………………………………NON PAR	Hospital Advantage Plan………………………………….NON PAR	Value Network/Value Network Tier 1 plans….. NON PAR
previously called Community Advantage)		(Advocare is NONPAR with any AmeriHealth plan that has “Value” in the name or on the card)

AmeriHealth Regional Preferred Network

……………….……………………………………………………………………………………….……………………………….………………………………………………………..……. PAR

Platinum
IHC Platinum EPO Regional Preferred …..……….………. PAR	IHC Platinum HMO Regional Preferred …..……….…….. PAR	IHC Platinum POS Plus Regional Preferred …………….PAR

Silver
IHC Silver EPO H.S.A Regional Preferred……………….…PAR	IHC Silver EPO Regional Preferred ……………………………PAR	IHC Silver HMO Regional Preferred ……………..…………PAR
IHC Silver POS Plus Regional Preferred ………….……….PAR

Gold
IHC Gold EPO H.S.A Regional Preferred ……………….…PAR	IHC Gold EPO Regional Preferred ..…………………………..PAR	IHC Gold HMO Regional Preferred …………………………PAR

Bronze
IHC Bronze EPO H.S.A Regional Preferred ……………….PAR	IHC Bronze EPO Regional Preferred …………………………PAR

Cigna Choice Fund Open-Access Plus ……………..……… PAR	Cigna Healthcare PPO .……………………….……….…………. PAR	Cigna HMO ……………………..……………………………………... PAR
Cigna Indemnity ……………………………………………..……… PAR	Cigna Local Plus …………………………………………………..…. PAR	Cigna Network ……………………………………………………….. PAR
Cigna Network Open-Access…………………………………….PAR	Cigna Open-Access Plus…………………………………………...PAR	Cigna POS or HMO Open-Access………………………………PAR
Cigna POS………………………………………………….……………..PAR	Cigna PPO…………………………………………………………………PAR

Clover Health Choice (PPO)………………………………………PAR	Clover Health Choice Premier (PPO)…………………………PAR	Clover Health Choice Value (PPO)…………………………….PAR
Clover Health Classic (HMO)…………………………………….PAR	Clover Health Value (HMO)………………………………………PAR

Direct Access Products
Horizon Advantage Direct Access …………………………… PAR	Horizon Direct Access ……………………………………..…….. PAR	Horizon Direct Access Value ..………………………………… PAR
Horizon Direct Access Value Select ……….…………..…… PAR	Horizon Direct Access HSA/HRA ………………………..…… PAR	NJ DIRECT10 ……………………………………………………………PAR
NJ DIRECT15 …………………………………………………………… PAR	NJ DIRECT1525 ……………………………………………..……….. PAR	NJ DIRECT2030 …………………………………………..…..…….. PAR
NJ DIRECT2035 ……………………………………………..……….. PAR	NJ DIRECT HD1500 …………………………………………………. PAR	NJ DIRECT HD4000 ……………………………………..…………. PAR

EPO Products
Horizon Advantage EPO Bronze ……………………………… PAR	Horizon Advantage EPO Silver …………………………………PAR	Horizon Advantage EPO Gold……………………………..…… PAR
Horizon Advantage EPO Essentials …………………………. PAR	Horizon Advantage EPO HSA/HRA ………………….……....PAR	Horizon Patient-Centered Advantage………………..…….PAR
Horizon Patient-Centered Advantage EPO Bronze……PAR	Horizon Patient-Centered Advantage EPO Silver………PAR	Horizon Patient-Centered Advantage EPO Gold……….PAR
OMNIA℠ ……………………………………………………………….…PAR	OMNIA℠ Bronze HSA ……………………………….……………. PAR	OMNIA℠ HSA ………………………………….……………………...PAR
OMNIA℠ Gold ……………………………….…………………….… PAR	OMNIA℠ Platinum …………………………………….…………….PAR	OMNIA℠ Silver ………………………………………….…………….PAR
OMNIA℠ Silver HSA ………………………………………………..PAR

Horizon Omnia (Advocare is a Tier 1 Provider)
Omnia RWJBarnabas Health (listed as ‘Inner Circle’)..PAR

Horizon Products
Horizon Access Value …………………………………………….. PAR	Horizon HMO …………………………………………………………. PAR	Horizon HMO Access ……………………………………….…… PAR
Horizon HMO Access HSA MyWay ……………………….… PAR	Horizon HMO Coinsurance/Coinsurance Plus ………….PAR

Medicare Advantage Products
Horizon Blue Value (HMO) ………………………………………PAR	Horizon BCBS Medicare Blue Advantage HMO…NON PAR	Horizon Medicare Blue (PPO)………… ……………………… PAR
Horizon Medicare Blue Access (HMO-POS)…………..….PAR	Horizon Medicare Advantage NJ Direct (PPO)……..…. PAR	Horizon Medicare Blue Group w/Rx ………………………. PAR
Horizon Medicare Blue Patient-Centered w/RX ……….PAR	Horizon Medicare Blue Choice w/RX (HMO) …….……..PAR	Horizon Medigap Plans –
Horizon Medicare Blue Select (HMO-POS)……….NON PAR	Horizon Medicare Blue Value w/RX (HMO) ……………. PAR	BCBSNJ 65, BCBSNJ 65 Select, Super 65 …………………. PAR

Horizon POS, PPO & Indemnity Products
Basic Blue℠ Plan A……………………………………………………PAR	BCBS Service Benefit Plan ………………………………………..PAR	BlueCare® ………………………………………………………………. PAR
BlueCard® PPO ………………………………………………………..PAR	Comprehensive Health Plan …………………………………….PAR	Comprehensive Major Medical ……………………………….PAR
Federal Employee Program® (FEP®)…………………………PAR	Horizon Advantage PPO …………………………………………. PAR	Horizon Basic Health Plan A …………………………………….PAR
Horizon Basic Plan A/50 …………………………………………..PAR	Horizon Comprehensive Health Plan………………………..PAR	Horizon EPO……………………………………………………..……..PAR
Horizon High Deductible Plan C & D…………………………PAR	Horizon High Deductible PPO Plan D………………………..PAR	Horizon MSA Plan C & D………………………………….……….PAR
Horizon MyWay HRA & HSA………………………………..…..PAR	Horizon PPO……………………………………………………………..PAR	Horizon Traditional Plan B, C, D…………………………..……PAR

Horizon NJ Health TotalCare (HMOSNP)………………………………………………………………………………………………………………………………………………………………………………………………………NON PAR

(must be participating with Horizon NJ Health in order to participate with)

IBC & Keystone’s Tiered plans…………………………………PAR	IBC/KHPE Value Network…………………………………NON PAR	Community Advantage Network…………………….NON PAR
(for Keystone Proactive we are Tier 3)		(previously the Cooper Community Advantage Network)

Emblem Health, Humana and GHI only through Qualcare (meaning if the patient presents with a card that has the Qualcare logo on it, you are PAR with these plans):

Qualcare HMO………………………………………………………….PAR	Qualcare Open-Access……………………………………………..PAR	Qualcare POS……………………………………………………………PAR
Qualcare PPO……………………………………………………………PAR
Emblem Health, Humana and GHI card with NO Qualcare logo……………………………………………………………………………………………………………………………………………………………………NON PAR
Oscar Health through Qualcare…………………………………………………………………………………………………………………………………………………………………………………………………………………………….PAR

Champ VA………………………………………………………………..PAR	Tricare…………………………………………………………………….…PAR	Tricare for Life (PPO)……………………………………………..…PAR
Tricare Prime……………………………………………………………PAR	Tricare Standard……………………………………………………….PAR

ALL United Healthcare Medicare plans…………..NON PAR	United Healthcare Community Plan………………...NON PAR	United Healthcare Compass plan……………..……..NON PAR
(including AARP Medicare Complete)

United Healthcare All Savers Plans (part of the UnitedHealthcare Choice Plus Network)………………………………………..…………………………………………………………………………………………..PAR

Golden Rule……………………………………………………………..PAR	Oxford Freedom Open-Access………………………………….PAR	Oxford Garden State POS………………………………………...PAR
Oxford Liberty POS…………………………………………………..PAR	Oxford Navigate HMO………………………………………………PAR	United Healthcare Choice HMO………………….……………PAR
United Healthcare Choice PPO…………………………………PAR	United Healthcare Choice Plus HMO………………………..PAR	United Healthcare Choice Plus PPO………….………………PAR
United Healthcare HMO…………………………………………..PAR	United Healthcare Open-Access…………………….…………PAR	United Healthcare PPO……………………….……………………PAR
United Healthcare Select HMO…………………………………PAR	United Healthcare Select PPO………………………………….PAR

For information on how to obtain insurance coverage for you and/or your family, please visit www.healthcare.gov.

Insurance

Advocare Payer Plan Guide

Aetna

Amerigroup – NOT PARTICIPATING

AmeriHealth – PAR unless otherwise indicated

Cigna

Clover

Horizon Blue Cross Blue Shield of New Jersey

Horizon NJ Health of New Jersey

IBC/Keystone

Qualcare

Tricare

United Healthcare/Oxford

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