Benefits-at-a-Glance Plan Summaries
Pompton Lakes School District

For a quick overview of your plan benefits, see below. If you need more detail about your plans, refer to the Plan Booklets page for help.   

Horizon BCBSNJ Medical:
Simplified Benefits Comparison
NJEHP Medical / Prescription Plan Benefits Overview
Vision Plan Summary
Direct Access Plan Summary / SBC
EPO Plan Summary / SBC
OMNIA Plan Summary / SBC
NJEHP Plan Summary

Horizon BCBSNJ Prescription:
Prescription Drug Comparison
NJEHP Horizon BCBSNJ Prescription Drug Plan Summary
Horizon BCBSNJ Pharmacy Program Flyer
Horizon BCBSNJ Pharmacy Online Resources Flyer
AllianceRx Walgreens Prime Home Delivery Flyer

Delta Dental: Dental Plan Summary

Horizon BCBSNJ Vision: refer to your medical booklet at the Plan Booklet webpage. Note, if you are enrolled in the Horizon OMNIA plan, see below for details about the Pediatric Vision benefit:

- David Vision administers the Pediatric Vision benefit on behalf of Horizon BCBSNJ.

- This is an in-network benefit; members must visit a provider in the Davis Vision network to have services covered.

- Dependents up to age 19 are eligible for the benefit.

- Benefits renew every 12 months.

- A routine eye exam, including dilation, is available with $0 copay.

- The Davis Vision collection of frames is included with this benefit.

- If a member obtains frames elsewhere, there is a maximum allowance of $150 for frames or contacts.

- The benefit includes clear plastic, single-vision, lined bifocal, trifocal, or lentiular lenses.

- Present your Horizon medical ID card to the in-network provider, who will call Davis Vision to confirm eligibility.

- Go to www.davisvision.com/members and insert Client Code 3164 to access the Member Portal.

- Search for in-network providers, find benefits and forms, and more at the Member Portal.