Local Government Employee Plans

In this presentation we’ll be exploring the New Jersey State Health Benefits Program plans offered by Horizon Blue Cross Blue Shield to eligible Local Government employees and their eligible covered dependents.

We sometimes refer to the State Health Benefits Program as the SHBP.

As an eligible active SHBP Local Government employee, your applicable plan choices will be shown in the SHBP Enrollment system.

The usual question is, what are the differences between the Horizon medical plans?

Most of the differences are in how much you pay out of your pocket as you receive eligible services throughout the year and how much you pay out of your paycheck or pension check.

All of our NJ DIRECT plans cover the same eligible services AND you can receive services outside of New Jersey. They also use the same provider network and you don’t need to select a primary care physician or get referrals to see specialists. Two high deductible plans are also available.

And under the NJ DIRECT plans, please remember that you typically save money out of your pocket when using an in-network provider for eligible services. When using an out-of-network provider, you’re responsible for paying: out-of-network deductible before the plan pays; coinsurance which is a percentage of the reasonable and customary allowance; and the difference between what the out-of-network provider bills and the reasonable and customary allowance.

Our OMNIA Tiered Network plan covers eligible services received from in-network providers. With the OMNIA plan you have two tiers of network providers. When using a Tier One provider located in New Jersey, you’ll pay a lower cost share than when using a Tier Two provider. Tier Two providers are located in New Jersey and nationwide but you’ll pay a higher cost share than when using a Tier One provider in New Jersey.

With our HMO plans you can receive eligible services from in-network providers in New Jersey and the counties that border New Jersey in Pennsylvania, Delaware and New York. You must select a primary care physician and get referrals to see specialists.

For details about your cost-share as you receive eligible services under each of the plans, please refer to the SHBP Member Guidebook and other helpful information found on our website at HorizonBlue.com/SHBP.

Active employees can also compare the estimated annual amount out of their paycheck for the medical plans on the Premium Contribution Calculator on our website if your employer uses Chapter 78 for contribution purposes. Please check with your employer to see if a different negotiated arrangement applies and for the appropriate prescription option.

To find an in-network provider where you typically pay less out of your pocket, you can visit our website at HorizonBlue.com/SHBP.

If you’re looking for in-network care outside of New Jersey, enter the provider’s location, and for the NJ DIRECT plans use plan prefix NJX, or for the OMNIA plan use plan prefix NJO. You’ll have access to our BlueCard PPO network with over 1.3 million providers participating nationwide, and you’ll also have access to the Global Core network for providers located outside the U.S.

Please note that HMO plans don’t include nationwide or worldwide coverage except in the case of an emergency. However there is an Away From Home Care program that may apply. Please see our website for more information.

With all of our plans, you have access to medical and behavioral telemedicine services at the touch of a button through the HorizonBlue App unless you are covered by a Medicare plan as primary. And you can also ask your doctor if you can talk to them via video, chat or phone. When receiving telemedicine services from an in-network doctor, you may have an in-network cost share. If you receive telemedicine services from a provider that’s not in our network, you’re responsible for the out-of-network deductible, coinsurance, and any amount billed above the reasonable and customary allowance.

You also have access to in-network Retail Health Centers where on-site board-certified nurse practitioners can prescribe medications, and diagnose and treat common ailments like colds or seasonal allergies.

Additionally, you have access to a nationwide network of Urgent Care Centers when you need medical care to treat wounds, sprains and other conditions that need immediate attention but aren’t life-threatening. If you use an in-network Urgent Care Center you’re only responsible for your low in-network cost share.

Lab services can be accessed through our preferred labs nationwide with LabCorp and Quest.

Eligible immunizations can be received from an in-network physician or at one of our participating New Jersey pharmacies.

Eligible members can join a Direct Primary Care Doctor’s Office with R-Health, Everside Health, or Sanitas and get unlimited access to personalized care, on-site blood work, and basic medications for acute conditions all at no cost! Please note that the Direct Primary Care Doctor’s Office is not available to members enrolled in an HMO, High Deductible Health Plan, or to Medicare retirees.

More information can be found on our website at HorizonBlue.com/SHBP.

You also have additional programs and resources available under our plans.

You can receive a $20 incentive for every month you meet the HorizonbFit program requirements

You can receive discounts on wellness products like vitamins, gyms, eyeglasses and more when you register through Blue365.

Members have access to My Health Manager where you can create a Personal Health Record, take an Online Health Assessment and receive feedback on how to improve or maintain your health and more.

In addition we have health and wellness programs and resources available for Maternity Management through Precious Additions.

Members have access to free digital health and wellness coaching programs for management of diabetes, hypertension, musculoskeletal conditions like back, knee, hip, neck and shoulder pain, weight management, and tobacco cessation with Livongo, HingeHealth, Wondr and COYL.

You also have access to second opinions on serious medical issues. You can consult with top doctors around the country with no out-of-pocket cost from Grand Rounds.

Please visit our website for more information about all of the programs and services available.

Our Behavioral Health team is here to support you 24/7, 365 days a year at 800-991-5579. You have access to urgent care within 24-48 hours, transition management, ambulatory follow-up, telehealth, support and education.

We also have virtual behavioral telehealth solutions to provide you with support through self-directed virtual services supporting your emotional well-being; virtual medication assisted treatment for those experiencing substance use disorders; virtual therapy and coaching for members experiencing depression, anxiety and stress associated with behavioral and medical co-morbidities like diabetes and heart disease.

Check out our website at HorizonBlue.com/shbp for details on all of our various programs, resources, services and more.

The NJWELL wellness program runs from November 1st to October 31st and is available to SHBP active employees, and a covered spouse or partner.>

Earn rewards valued at $250 or more by participating.

Program details of the NJWELL wellness program can be found on our website.

Horizon Health Guide is our personalized service for all your benefits and care needs. Horizon Health Guide is a high-touch personalized service that provides members with a single point of contact to access health care and benefits; it integrates service and care management to meet all types of care needs, and seamlessly connects you to relevant resources and programs to get you the answers you need.

You can reach out to a Horizon Health Guide Monday through Friday from 8am to 6pm Eastern Time by calling 800-414-7427.

After you’re enrolled in a Horizon plan, you have access to the Horizon member portal by logging-in at HorizonBlue.com/SHBP to view or print your Horizon ID card, view benefit information, check claim status, see who’s covered on your plan, and please remember to update Coordination of Benefits information for each covered dependent every year. You can also use the 24/7 Nurse Chat, receive telemedicine services 24/7, find in-network providers and schedule an appointment.

And after you’ve registered on the member portal, you’ll be able to download the free HorizonBlue App by texting GetApp to 422-272 on your smartphone for quick and easy access to your information.

We’ve come to the end of this presentation. You can find current information about the Horizon SHBP plans, programs, resources, services, and more at HorizonBlue.com/shbp or by contacting a Horizon Health Guide at 800-414-7427.

Thank you.