Saint Peter’s NJ, Horizon reach agreement on Omnia Health Plans

Horizon BCBSNJ is an independent licensee of the Blue Cross and Blue Shield Association serving more than 3.8 million members. Horizon Blue Cross Blue Shield of New Jersey, the state’s oldest and largest health insurer is a tax-paying, not-for-profit health service corporation, providing a wide array of medical, dental, vision and prescription insurance products and services. Learn more at Horizon BCBSNJ is an independent licensee of the Blue Cross and Blue Shield Association serving more than 3.6 million members. “We’re excited to work with Saint Peter’s to expand models of care and reimbursement that have proven effective at improving health care quality, affordability, and convenience for our members. Horizon BCBSNJ will also unveil new health plans next month.

“Horizon is pleased that the Court has refused this effort by St. Peter’s to change the implementation of Horizon’s OMNIA Health Plans,” Horizon said in a statement. “This is good news for the thousands horizon bcbs tier 1 hospitals of individuals who have purchased OMNIA Health Plans to date. They can rest easy over the holidays knowing their new, lower-cost OMNIA Health Plan coverage will be effective come January 1, 2016.”

Emergency and Urgent Care

If you’re homebound but need medical services, Horizon BCBSNJ has Horizon Care@Home, which provides at-home physical therapy, nursing and other care. The plan, in partnership with the post-acute care company CareCentrix, can also provide medical equipment, including diabetic supplies, home infusion therapy and orthotics and prosthetics. In addition, Horizon BCBSNJ and its subsidiaries offer Medicare Advantage, Medicare Supplement and Medicaid plans, and supplemental plans including accident insurance, coverage outside New Jersey, and pet insurance. OMNIA plans come with bronze, silver and gold options, per ACA rules. Bronze has the lowest premiums and highest out-of-pocket costs. The bronze plan is best if you don’t expect to have a lot of medical expenses.

In addition, monthly premiums would be 25 percent lower than non-tiered plans. Under the OMNIA plans, customers who choose to go to Tier 1 providers will pay lower out-of-pocket costs than those who go to Tier 2 providers. The new OMNIA Silver Value plan is our most affordable Silver plan. Your clients will continue to enjoy competitive prices, access to the broad Horizon Managed Care Network, and comprehensive benefits with low copays and no deductible when using OMNIA Tier 1 Primary Care Physicians. Understanding these and other healthcare coverage keywords can make managing the financial aspects of your child’s care easier. Blue Cross Blue ShieldSome Blue Cross Blue Shield plans with Blue Card access may participate with CHOP and its affiliated providers. Contact your BCBS plan to find out if your plan considers the specific CHOP provider to be in-network.

+ Patients

If you meet the Tier 2 deductible first, Horizon will then consider any applicable Tier 1 deductible to have also been met. Horizon Blue Cross Blue Shield of New Jersey plans to transfer management of member chiropractic care and physical therapy to another company. CentraState recently announced a clinical affiliation with Atlantic Health System focusing on specific service lines that will further advance value-based care initiatives.

According to once-confidential documents NJ Advance Media obtained after filing a lawsuit, Horizon did not select tier 1 hospitals based on lower costs or quality measures. A consultant’s report shows Horizon chose the largest hospital systems even when smaller competitors scored better on quality measures or offered lower prices. Attorneys for Saint Peter’s said the tier 2 designation would cost the hospital millions of dollars a year and threaten its long-term survival. The lawsuit cast Horizon as a Goliath that was interested in partnering with only the big hospital chains at the expense of community hospitals — many of them Catholic, serving low-income patients. Horizon contended it chose the most cost-efficient hospitals that were proficient in population health management and preventing illness.

Horizon BCBSNJ launches education effort on the OMNIA Health Alliance

Along with its subsidiaries, Horizon BCBSNJ provides a range of services, from prescription drug coverage to dental and vision insurance to individual and employer plans, both locally and nationally. HealthMarkets Insurance Agency, Inc. is licensed as an insurance agency in all 50 states and DC.

Members purchasing the new health plans will have access to all of Horizon BCBSNJ’s current hospitals and physicians, the largest networks in the state, at essentially the same level of benefits they have today. The new health plans, however, will offer lower premiums and the ability for members to save significant out-of-pocket costs by using select Tier 1 hospitals and doctors. “Omnia Health Plans empower our members to achieve their best health, give them more control of their out-of-pocket expenses, and include every doctor and hospital in Horizon’s managed care network.” Horizon BCBSNJ is an independent licensee of the Blue Cross and Blue Shield Association serving more than 3.6 million members. The new OMNIA Gold HSA BlueCard plan includes the flexibility of a Health Savings Account with out-of-state BlueCard® coverage. Your small business clients will continue to enjoy low costs with leading providers in New Jersey. Members will incur no additional costs once their deductible is met when they use OMNIA Tier 1 doctors, hospitals and other health care professionals.

What Health Insurance Does Horizon BCBSNJ Offer?

Horizon created the OMNIA plans offering a two-tier system that enabled patients to save money if they used “tier 1” hospitals, which included Robert Wood Johnson University Hospital, https://adprun.net/ but not Saint Peter’s, located a mile away in New Brunswick. Patients could still use Saint Peter’s and other “tier 2” hospitals but they would pay additional out-of-pocket expenses.