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Treiman Family Medicine

Insurance

Advocare Payer Plan Guide

Aetna

Aetna Premier Care Network and Aetna Aexcel Plans
Aetna APCN Network…………PAR, Designated Tier
PCP’s Primary Care & Pediatricians……...…PAR & Tier 2
 
 
Advocare specialists…………………PAR, Tier 1
(outside of the “12 Specialties”)
 
The following 12 specialties are PAR but are not designated as APCN, these are all TIER 3
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 – NOT PARTICIPATING

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

AmeriHealth – PAR unless otherwise indicated

Advantage….……………………………………………………NON PAR
(previously called Community Advantage)
Hospital Advantage Plan………………………………….NON PAR Value Network/Value Network Tier 1 plans….. NON PAR
(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

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

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  

Horizon Blue Cross Blue Shield of New Jersey

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 of New Jersey

Horizon NJ Health TotalCare (HMOSNP)………………………………………………………………………………………………………………………………………………………………………………………………………NON PAR
(must be participating with Horizon NJ Health in order to participate with)

IBC/Keystone

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

Qualcare

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

Tricare

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

United Healthcare/Oxford

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