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Changes to Small Employer Health Plans and SHOP Renewals for 2018

October 26, 2017

Applies to: Small Employer market (on and off the Small Business Health Options Program [SHOP])

Horizon Blue Cross Blue Shield of New Jersey has updated its small employer health plan portfolio for 2018. The charts in this Brief Notes provide information about the changes for 2018. These changes will become effective when a small employer customer renews into one of the Horizon BCBSNJ health plans listed in this Brief Notes.

In addition to the health plan changes, small employer customers that want to purchase or renew a health plan on the Small Business Health Options Program (SHOP) for 2018, must do so through a broker. Small employer customers that purchased on SHOP in 2017 will receive a letter advising of this change.

2018 Plan Changes

OMNIA Bronze HSA 2017 2018
Maximum Out-of-Pocket (MOOP) limit – OMNIA Tier 1
Single
$7,150 $6,550
Maximum Out-of-Pocket (MOOP) limit – Tier 2
Single
$7,150 $6,550
Hospital – Inpatient professional 50% after deductible 100% after deductible
Lab/Radiology – Freestanding No charge No charge after deductible

 

OMNIA Silver 2017 2018
Medical deductible – OMNIA Tier 1 $0 $1,000
Prescription drug deductible – OMNIA Tier 1 (excluding generics) not applicable $150
Maximum Out-of-Pocket (MOOP) limit – OMNIA Tier 1
Single
$7,150 $7,350
Maximum Out-of-Pocket (MOOP) limit – Tier 2
Single
$7,150 $7,350
Emergency Room (ER) – OMNIA Tier 1 $100 copayment and $900 ER deductible $100 copayment before medical deductible
Emergency Room (ER) – Tier 2 $100 copayment and deductible and 50% coinsurance $100 copayment before medical deductible
Lab/Radiology (non-complex) – Outpatient facility – OMNIA Tier 1 $0 $50 after deductible
Mental Health & Substance Abuse – Outpatient facility – OMNIA Tier 1 $0 $50 after deductible
Prescription drug copayment $15/50%/50%/50% $15/50% after deductible/ 50% after deductible/50% after deductible

 

OMNIA Silver HSA 2017 2018
Deductible – OMNIA Tier 1 $1,500 $1,800
Maximum Out-of-Pocket (MOOP) limit – OMNIA Tier 1
Single
$3,600 $5,500
Emergency Room (ER) – OMNIA Tier 1 Deductible and $100 copayment and 90% coinsurance Deductible and $100 copayment and 85% coinsurance
Emergency Room (ER) – Tier 2 Deductible and $100 copayment and 70% coinsurance Deductible and $100 copayment and 85% coinsurance
Coinsurance – OMNIA Tier 1 90% 85%
Coinsurance – Tier 2 70% 60%

 

OMNIA Gold 2017 2018
Deductible – OMNIA Tier 1 $0 $500
Emergency Room (ER) – OMNIA Tier 1 $100 copayment $100 copayment before deductible
Emergency Room (ER) – Tier 2 $100 copayment and deductible and 70% coinsurance $100 copayment before deductible
Lab/Radiology (non-complex) – Outpatient facility – OMNIA Tier 1 $0 $20 after deductible
Mental Health & Substance Abuse – Outpatient facility – OMNIA Tier 1 $0 $20 after deductible

 

OMNIA Platinum 2017 2018
Primary Care Physician (PCP) copayment – OMNIA Tier 1 $5 $10
Maximum Out-of-Pocket (MOOP) limit – OMNIA Tier 1 $1,500 $1,750
Maximum Out-of-Pocket (MOOP) limit – Tier 2 $2,500 $2,750
Emergency Room (ER) – Tier 2 $100 copayment and deductible and 70% coinsurance $100 copayment

 

Horizon Advantage EPO Gold 100 $25/$45 2017 2018
Skilled nursing facility copayment $500/day $0/day

 

Horizon Advantage EPO Gold 100 $30/$50 2017 2018
Skilled Nursing Facility copayment $500/day $0/day

 

Horizon Advantage EPO Gold 100/80 $20/$40 2017 2018
Deductible $1,000 $1,200
Maximum Out-of-Pocket (MOOP) limit
Single
$4,000 $4,500

 

Horizon Advantage EPO Silver 100/70 2017 2018
Deductible $1,500 $2,100
Maximum Out-of-Pocket (MOOP) limit
Single
$7,000 $7,350
Prescription drug copayment $20/$50/$75/$75 $25/$50/$75/$75

 

Horizon Advantage EPO Silver 100/50 2017 2018
Maximum Out-of-Pocket (MOOP) limit
Single
$6,000 $7,350
Lab/Radiology (non-complex) – Outpatient facility copayment $50 $75
Prescription drug copayment $15/60%/50%/50% $15/50%/50%/50%

 

Horizon Advantage EPO 100/80 $50 2017 2018
Deductible $250 $500
Emergency Room (ER) $100 copayment and 80% coinsurance $100 copayment and deductible and 80% coinsurance

 

Horizon Direct Access® Platinum 100/70 BlueCard 2017 2018
Skilled nursing facility copayment $250/day $0/day
Outpatient facility fee (ASC) $100 $150

Small employer customers that offer a health plan that will be modified for 2018 will receive two Summary of Benefits and Coverage documents – one for the health plan that is currently in effect, and one effective at the time of the group’s renewal.

Beginning November 1, 2017, full Summary of Benefits and Coverage documents for the 2018 small group health plans will be available on HorizonBlue.com and when you sign in to Broker Online Services at HorizonBlue.com.

If you have questions, please contact your Horizon BCBSNJ sales executive or account manager.

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Published on: October 31, 2017, 08:46 a.m. ET
Last updated on: May 15, 2020, 12:00 p.m. ET