Changes to Small Employer Health Plans and SHOP Renewals for 2019
October 17, 2018
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 2019. These changes will become effective when a small employer customer renews into one of the impacted Horizon BCBSNJ health plans.
We are pleased to announce that all small employer OMNIA℠ Health Plans for 2019 will automatically include HorizonbFit, our fitness incentive program. After members enroll in the program, they become eligible to receive a $20 reward for every month in which they make at least 12 visits to any of the 4,000 participating gyms and fitness facilities across the United States. Members can earn up to $240 a year in rewards. Learn more at HorizonbFit.com.
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 2019 must do so through a broker.
2019 Plan Changes
| OMNIA Bronze HSA | 2018 | 2019 |
|---|---|---|
| Behavioral Health/Substance Use Disorder — Office Visit — OMNIA Tier 1 | $50 after deductible | $30 after deductible |
| Home Health Care | 50% after deductible | $30 after deductible |
| Urgent Care Center — OMNIA Tier 1 | $50 after deductible | $75 after deductible |
| Second/Third Surgical Opinion — OMNIA Tier 1 and Tier 2 | No charge | No charge after deductible |
| OMNIA Silver | 2018 | 2019 |
|---|---|---|
| Behavioral Health/Substance Use Disorder — Outpatient Facility — OMNIA Tier 1 | $50 after deductible | $30 after deductible |
| Medical Deductible — OMNIA Tier 1 — Single | $1,000 | $1,250 |
| Prescription Drug Deductible (excluding generics) – OMNIA Tier 1 — Single | $150 | $200 |
| Maximum Out-of-Pocket (MOOP) Limit — OMNIA Tier 1 — Single | $7,350 | $7,900 |
| Maximum Out-of-Pocket (MOOP) Limit — Tier 2 — Single | $7,350 | $7,900 |
| Behavioral Health/Substance Use Disorder — Office Visit — OMNIA Tier 1 | $50 | $30 |
| Home Health Care | $50 after deductible | $30 |
| Urgent Care Center — OMNIA Tier 1 | $50 | $75 |
| Accidental Dental — Outpatient Facility — OMNIA Tier 1 | $50 after deductible | $250 after deductible |
| OMNIA Silver HSA | 2018 | 2019 |
|---|---|---|
| Coinsurance — Tier 2 | 60% | 50% |
| Maximum Out-of-Pocket (MOOP) Limit — OMNIA Tier 1 — Single | $5,500 | $6,650 |
| Maximum Out-of-Pocket (MOOP) Limit — Tier 2 — Single | $6,550 | $6,650 |
| Behavioral Health/Substance Use Disorder — Office Visit — OMNIA Tier 1 | $20 after deductible | $10 after deductible |
| Behavioral Health/Substance Use Disorder — Office Visit — Tier 2 | $50 after deductible | $25 after deductible |
| Home Health Care | 85% after deductible | $10 after deductible |
| Urgent Care Center — OMNIA Tier 1 | $20 after deductible | $40 after deductible |
| Urgent Care Center — Tier 2 | $50 after deductible | $75 after deductible |
| Second/Third Surgical Opinion — OMNIA Tier 1 and Tier 2 | No charge | No charge after deductible |
| OMNIA Gold | 2018 | 2019 |
|---|---|---|
| Prescription Drug Deductible — OMNIA Tier 1 — Single | N/A | $250 |
| Maximum Out-of-Pocket (MOOP) Limit — OMNIA Tier 1 — Single | $3,500 | $4,000 |
| Maximum Out-of-Pocket (MOOP) Limit — Tier 2 — Single | $6,350 | $6,500 |
| Behavioral Health/Substance Use Disorder — Outpatient Facility — OMNIA Tier 1 | $20 after deductible | $10 after deductible |
| Behavioral Health/Substance Use Disorder — Office Visit — OMNIA Tier 1 | $25 | $10 |
| Behavioral Health/Substance Use Disorder — Office Visit — Tier 2 | $50 after deductible | $30 after deductible |
| Home Health Care | $20 after deductible | $10 |
| Urgent Care Center — OMNIA Tier 1 | $25 | $50 |
| Urgent Care Center — Tier 2 | $50 after deductible | $75 after deductible |
| Accidental Dental — Outpatient Facility — OMNIA Tier 1 | $20 after deductible | $250 after deductible |
| Prescription Drug Copayment | $10/60%/50%/50% | $10/$40/$75/$75after drug deductible |
| OMNIA Platinum | 2018 | 2019 |
|---|---|---|
| Maximum Out-of-Pocket (MOOP) Limit — OMNIA Tier 1 — Single | $1,750 | $1,900 |
| Maximum Out-of-Pocket (MOOP) Limit — Tier 2 — Single | $2,750 | $3,000 |
| Alcoholism — Outpatient Facility — OMNIA Tier 1 | $15 | No charge |
| Partial Hospitalization — Behavioral Health | $15 | No charge |
| Behavioral Health/Substance Use Disorder — Office Visit — OMNIA Tier 1 | $15 | $10 |
| Behavioral Health/Substance Use Disorder — Office Visit — Tier 2 | $35 | $15 |
| Home Health Care | $15 | $10 |
| Urgent Care Center — OMNIA Tier 1 | $15 | $30 |
| Urgent Care Center — Tier 2 | $35 | $70 |
| Accidental Dental — Outpatient Facility — OMNIA Tier 1 | $15 | $150 |
| Prescription Drug Copayment | $5/90%/70%/70% | $5/$15/$30/$30 |
| Horizon Advantage EPO Gold 100 $25/$45 | 2018 | 2019 |
|---|---|---|
| Behavioral Health/Substance Use Disorder — Office Visit | $45 | $25 |
| Behavioral Health/Substance Use Disorder — Outpatient Facility | $45 | $25 |
| Home Health Care | $45 | $25 |
| Urgent Care Center | $45 | $75 |
| Accidental Dental — Outpatient Facility | $45 | $250 |
| Horizon Advantage EPO Gold 100 $30/$50 | 2018 | 2019 |
|---|---|---|
| Behavioral Health/Substance Use Disorder — Office Visit | $50 | $30 |
| Behavioral Health/Substance Use Disorder — Outpatient Facility | $50 | $30 |
| Home Health Care | $50 | $30 |
| Urgent Care Center | $50 | $75 |
| Occupational Therapy — Outpatient Professional | $30 | No charge |
| Physical Therapy — Outpatient Professional | $30 | No charge |
| Speech Therapy — Outpatient Professional | $30 | No charge |
| Horizon Advantage EPO Gold 100/80 $20/$40 | 2018 | 2019 |
|---|---|---|
| Maximum Out-of-Pocket (MOOP) Limit — Single | $4,500 | $5,500 |
| Behavioral Health/Substance Use Disorder — Office Visit | $40 | $20 |
| Home Health Care | 80% after deductible | $20 |
| Urgent Care Center | $40 | $75 |
| Horizon Advantage EPO Silver 100/70 | 2018 | 2019 |
|---|---|---|
| Deductible — Single | $2,100 | $2,200 |
| Maximum Out-of-Pocket (MOOP) Limit — Single | $7,350 | $7,900 |
| Behavioral Health/Substance Use Disorder — Office Visit | $50 | $30 |
| Imaging — Outpatient Facility | $100 | $100 after deductible |
| Imaging — Outpatient Professional | No charge | No charge after deductible |
| Laboratory/Radiology (non-complex) — Outpatient Facility | $75 | $100 |
| Home Health Care | 70% after deductible | $30 |
| Urgent Care Center | $50 | $75 |
| Horizon Advantage EPO Silver 100/50 | 2018 | 2019 |
|---|---|---|
| Maximum Out-of-Pocket (MOOP) Limit — Single | $7,350 | $7,900 |
| Behavioral Health/Substance Use Disorder — Office Visit | $50 | $30 |
| Home Health Care | $50/50% after deductible | $30 |
| Urgent Care Center | $50 | $75 |
| Outpatient Professional | 50% | 50% after deductible |
| Physical Therapy — Outpatient Professional | $30 | 50% after deductible |
| Occupational Therapy — Outpatient Professional | $30 | 50% after deductible |
| Blood & Blood Products, Blood Transfusions, Blood Testing and Processing | 50% after deductible and $50 | 50% after deductible |
| Imaging – Outpatient Facility | $75 | $100 after deductible |
| Horizon Advantage EPO 100/80 $50 | 2018 | 2019 |
|---|---|---|
| Maximum Out-of-Pocket (MOOP) Limit — Single | $5,750 | $6,500 |
| Home Health Care | 80% after deductible | $50 |
| Urgent Care Center | $50 | $75 |
| Cognitive Rehabilitation/Speech/Physical/Occupational Therapy — Office Visit | $30 | $40 |
| Horizon Direct Access® Platinum 100/70 BlueCard | 2018 | 2019 |
|---|---|---|
| Behavioral Health/Substance Use Disorder — Office Visit | $40 | $20 |
| Occupational/Physical Therapy — Outpatient Professional | $20 | No charge |
| Home Health Care | $40 | $20 |
| Urgent Care Center | $40 | $75 |
| Nutritional Counseling (Non-preventive) — Outpatient Facility | No charge | $40 |
| Nutritional Counseling (Non-preventive) – Outpatient Professional |
$40 | No charge |
| Horizon Direct Access Gold 100/80/60 BlueCard | 2018 | 2019 |
|---|---|---|
| Deductible — In-Network | $1,500 | $2,000 |
| Deductible — Out-of-Network | $2,500 | $4,000 |
| Maximum Out-of-Pocket (MOOP) Limit — In-Network — Single | $3,000 | $5,000 |
| Maximum Out-of-Pocket (MOOP) Limit — Out-of-Network — Single | $7,500 | $8,000 |
| Primary Care Visit | $20 | $30 |
| Specialist Visit | $40 | $50 |
| Behavioral Health/Substance Use Disorder — Office Visit | $40 | $30 |
| Home Health Care | 80% after deductible | $30 |
| Urgent Care | $40 | $75 |
| Orthotics & Prosthetics Professional | 80% after $20 copayment | $30 |
| Horizon Direct Access HSA Silver 100/70/60 BlueCard | 2018 | 2019 |
|---|---|---|
| Coinsurance — In-Network | 80% | 70% |
| Maximum Out-of-Pocket (MOOP) limit — In-Network — Single | $6,500 | $6,650 |
| Emergency Room (ER) | Deductible then $100 and 80% | Deductible then $100 and 70% |
| Behavioral Health/Substance Use Disorder — Office Visit | $50 after deductible | $30 after deductible |
| Home Health Care | 80% after deductible | $30 after deductible |
| Urgent Care | $50 after deductible | $75 after deductible |
| Second/Third Surgical Opinion | No charge | No charge after deductible |
| Horizon Advantage EPO HSA Bronze 100 | 2018 | 2019 |
|---|---|---|
| Hospice | No charge after deductible | $100 after deductible |
| Second/Third Surgical Opinion | 50% after deductible | No charge after deductible |
| Horizon HMO Platinum | 2018 | 2019 |
|---|---|---|
| Home Health Care | No charge | $30 |
| Urgent Care Center | $30 | $60 |
| Horizon POS Platinum 100/60 | 2018 | 2019 |
|---|---|---|
| Primary Care Visit | $50 | $30 |
| Behavioral Health/Substance Use Disorder — Office Visit | $50 | $30 |
| Alcoholism — Outpatient Facility | $50 | $0 |
| Home Health Care | $50 | $30 |
| Cognitive Rehabilitation/Speech/Occupational/Physical Therapy — Outpatient Professional |
$30 | No charge |
| Cognitive Rehabilitation/Speech/Occupational/Physical Therapy — Outpatient Facility |
$50 | No charge |
| Well Baby/Child Care (Considered Routine) — Outpatient Facility | $50 | No charge |
| Urgent Care | $50 | $75 |
Small employer customers that offer a health plan that will be modified for 2019 will receive two Summary of Benefits & Coverage documents — one that mirrors their 2018 health plan effective until the time of their renewal, and one for use on and after their renewal that includes the modifications to the plan effective upon renewal.
Beginning November 1, 2018, full Summary of Benefits & Coverage documents for 2019 small group health plans will be available on HorizonBlue.com and when you sign in to Broker Online Services at HorizonBlue.com/brokers.
If you have questions, please contact your Horizon BCBSNJ sales executive or account manager.
Published on: October 31, 2018, 06:22 a.m. ET
Last updated on: May 15, 2020, 07:57 a.m. ET