State and State College/University Employees

This presentation is for those who’re eligible for the State Health Benefits Program otherwise known as the SHBP. You may be a new hire, a retiree or someone who would just like information about the Horizon Blue Cross Blue Shield SHBP plans that are available to State and State College & University employees.

The usual question is, what are the differences between the Horizon SHBP 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.

All of our NJ DIRECT and CWA Unity 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. A high deductible version is also available.

And under the NJ DIRECT and CWA Unity 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. Services received from OON providers are not covered unless in the case of an emergency. With the OMNIA plan you have two tiers of network providers. When using a Tier One provider which are 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 Overview which includes a Plan Comparison Chart. The Overview, and more information about the SHBP plans and programs can also be found on our website at HorizonBlue.com/SHBP.

Active employees may be able to compare the estimated annual amount out of their paycheck for the SHBP Horizon plans on the Premium Contribution Calculator on our website. Retirees can check with the NJ Division of Pensions and Benefits.

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 and CWA Unity 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.

And just a reminder that in the OMNIA plan, the providers outside of NJ who are in our network are considered Tier 2.

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 the Horizon medical 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. For plans with out of network benefits, 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. For plans with out of network benefits, if you receive 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.

Lab services can be accessed through our preferred labs 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 and get unlimited access to personalized care, on-site blood work, and basic medications for acute conditions all at no cost! The Direct Primary Care Doctor’s Office is not available to members enrolled in an HMO, High Deductible Health Plan, or to Medicare retirees.

Eligible members who are listed as a First Responder in the pension system can utilize a doctor from FRDOCS and pay a zero dollar copay.

You also have additional programs and resources available under the Horizon plans.

You can receive a $20 incentive for every month you meet the HorizonbFit program requirements. Complete any combination of visiting a fitness facility, working out at home or walking 10k steps and recording it in the system for at least 12 days a month to earn your incentive. Once you have your ID card, you’ll be able to register in the program.

The medical plans provide you with one routine eye exam per calendar year, but the medical plans don’t provide coverage for glasses, contacts, etc. However 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.

Our Behavioral Health team is here to support you 24/7, 365 days a year. You’ll 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 each year and is available to SHBP active employees, and a covered spouse or partner.

You can earn rewards valued at $250 or more by participating.

To earn the reward, you’ll need to complete an online health assessment, complete a biometric screening and earn points in a variety of categories.

You’ll have from November 1st until October 31st to meet the program requirements to earn your reward for each NJWELL year.

Please note that this is a taxable benefit.

You can find details about the NJWELL wellness program on our website.

Horizon Health Guide is our personalized member service experience for all your benefits and care needs. Horizon Health Guide is a high-touch personalized service that provides employees 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 at 800-414-7427.

After you’re enrolled in a Horizon plan, you have access to the Horizon member portal by registering and logging-in at HorizonBlue.com/SHBP to view or print your Horizon ID card, view benefit information, check claim status, and 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 on the Horizon member portal.

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

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

Thank you for viewing this presentation and have a great day!