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OMNIA Silver
Plan Summary
Plan Type EPO
Metal Level Silver
Office Visit for Primary Doctor
Find Doctors 		$30 Copay
Office Visit for Specialist $50 Copay
Office Visit for Other Practitioner (Nurse, Physician Assistant) $50 Copay
Annual Deductible Individual: $1,600
Separate Prescription Drugs Deductible $250 per person | $500 per group
Coinsurance 0%
Retail Prescription Drugs Generic Drugs: $20 Copay;
Preferred Brand Drugs: 50% Coinsurance after deductible;
Non-Preferred Brand Drugs: 50% Coinsurance after deductible;
Specialty Drugs: 50% Coinsurance after deductible;
Annual Out-of-Pocket Limit Individual: $9,200
Includes deductible
Lifetime Maximum Unlimited
Health Savings Account (HSA) Eligible No
Out-of-Network Coverage Emergency Care Only 
Out-of-Country Coverage No.
Office Visit
Primary Care Physician Required Yes
Specialist Referrals Required No
Preventive Care Coverage
Periodic Health Exam No Charge
Periodic OB-GYN Exam No Charge
Well Baby Care No Charge
Emergency and Urgent Care
Emergency Room $100 Copay with deductible, then 20% Coinsurance after deductible
Emergency Ambulance Services No Charge after deductible
Urgent Care Facility $75 Copay
Prescription Drug Coverage
Retail Prescription Drugs Generic Drugs: $20 Copay;
Preferred Brand Drugs: 50% Coinsurance after deductible;
Non-Preferred Brand Drugs: 50% Coinsurance after deductible;
Specialty Drugs: 50% Coinsurance after deductible;
Separate Prescription Drugs Deductible $250 per person | $500 per group
Mail Order Prescription Drugs N/A
Mail Order Supply N/A
Outpatient Coverage
Outpatient Surgery Outpatient Surgery Physician/Surgical Services:
$0 Copay after deductible
Outpatient Facility Fee:
$175 Copay after deductible
Outpatient Lab/X-Ray Outpatient Lab:
$100 Copay after deductible
X-rays:
$100 Copay after deductible
Imaging (CT and PET scans, MRIs) $100 Copay after deductible
Outpatient Mental Health $30 Copay after deductible
Outpatient Substance Abuse $30 Copay after deductible
Outpatient Rehabilitation Services (PT, OT, ST) $50 Copay after deductible, limited to 30 Visit(s) per Year
Inpatient Coverage
Hospitalization Inpatient Hospital Services:
$500 Copay per Day after deductible, A copay is required for up to 5 days
Inpatient Physician and Surgical Services:
No Charge after deductible
Skilled Nursing Facility $500 Copay per Day after deductible, A copay is required for up to 5 days
Inpatient Mental Health $500 Copay per Day after deductible, A copay is required for up to 5 days
Inpatient Substance Abuse $500 Copay per Day after deductible, A copay is required for up to 5 days
Home Healthcare $15 Copay
Maternity Coverage
Pre & Postnatal Office Visit $50 Copay
Labor & Delivery Hospital Stay $500 Copay per day after deductible, A copay is required for up to 5 days
Pediatric Services
Dental Checkup for Children Not Covered
Vision Screening for Children No Charge, limited to 1 Visit(s) per Year
Eye Glasses for Children No Charge, limited to 1 Item(s) per Year
Major Dental Coverage (Pediatric) Not Covered
Additional Coverage
Chiropractic Coverage $30 Copay, limited to 30 Visit(s) per Year
Durable Medical Equipment 50% Coinsurance after deductible
Hospice $50 Copay after deductible
Major Dental Coverage (Adult) Not Covered
Vision Coverage (Adult) Not Covered
Out-of-Network Coverage
Out-of-Network Authorization Required N/A
Out-of-Network Annual Deductible N/A
Out-of-Network Annual Coinsurance N/A
Out-of-Network Annual Out-of-Pocket Limit N/A
Additional Information
A.M. Best Rating NR as of 06/12/2025
Electronic Signature for Application Available Yes
Details and documents about this plan
View Plan Brochure Exclusions and Limitations

Important notices and disclaimers

  • The information shown here is a summary of benefits for informational purposes only. Review the official plan documents (such as evidence of coverage, plan brochure, or insurance policy) for a detailed description of coverage benefits, limitations, and exclusions. Only the terms and conditions of coverage benefits listed in the policy are binding.
  • The benefits listed may be contingent on your use of physicians, hospitals, and services within the specific insurance company's provider network.
  • The Copayment, Deductible, and Coinsurance amounts are your share of the costs for covered benefits. These amounts are subject to change.
  • Each insurance carrier may have unique Notices, Disclaimers, and Fees. Please check below for information regarding the plans and carriers you selected.
  • The quotes or rates shown above are estimates only. Your premium is subject to change based on the optional benefits you selected, if any, and other relevant factors, such as changes in rates that take effect before your coverage start date. The insurance company always determines your actual premium. Insurance companies reserve the right to change the terms of a policy upon proper notification.
  • The Summary of Benefits & Coverage can be found at healthcare.gov. A paper copy of this Summary of Benefits & Coverage is available upon request by calling our toll free number. Click here to view the Uniform Glossary of Coverage and Medical Terms.

Carrier specific notices, disclaimers and fees

  • eHealthInsurance is an independent agency authorized to sell health plans in New Jersey through Horizon Healthcare of New Jersey, Inc. and Horizon Blue Cross Blue Shield of New Jersey. Horizon Healthcare of New Jersey, Inc. and Horizon Blue Cross Blue Shield of New Jersey are independent licensees of the Blue Cross and Blue Shield Association serving residents of New Jersey.
  • Horizon Blue Cross Blue Shield of New Jersey issues coverage start dates on any day of the month for EPO and Direct Access plans, but we/eHI must receive paper application 4 days prior to requested effective date. Therefore, your effective date will be four days from the date your paper application is received by eHI.