Horizon Blue Cross Blue Shield New Jersey Individual Exchange Products
We’ve been waiting patiently to see what the new products will be for 2014 and there they are. All the information below was taken directly from www.horizonblue.com.
These plans listed below are being offered off the exchange. Either all of these plans or just a few will also be offered on the exchange. The benefits of going on the exchange are that you may qualify for a premium subsidy. Otherwise, its probably best to just go through your broker.
Getting a better deal on your individual coverage
Certain individuals will qualify for a premium subsidy if they purchase their coverage from the exchange. If you think this may be you, please visit healthcare.gov and go through the process. I’m just listing some basic information on who may qualify for a subsidy.
To qualify for the subsidy:
- You must not be eligible for group coverage( or if you are, it must be considered unaffordable) Unaffordable means it will cost you more than 9% of your annual income
- You must meet the income requirements below
Income requirements for subsidy on the exchange:
- $11,490 to $45,960 for individuals
- $15,510 to $62,040 for a family of 2
- $19,530 to $78,120 for a family of 3
- $23,550 to $94,200 for a family of 4
- $27,570 to $110,280 for a family of 5
- $31,590 to $126,360 for a family of 6
- $35,610 to $142,440 for a family of 7
- $39,630 to $158,520 for a family of 8
Remember if you think you will qualify for the subsidy, go to healthcare.gov. Otherwise contact your broker or get quotes directly on the Horizon BCBS website for the plans below. Prices will be identical regardless of you purchase it from.(website, broker, carrier direct, etc…)
Horizon Advance EPO Gold
Our Horizon Advance EPO plans provide access to a variety of doctors, specialists and hospitals. These plans provide integrated medical and pharmacy benefits, including wellness and emergency care. Members must select a Primary Care Physician to coordinate care and provide referrals to specialists who participate with the Horizon Advance EPO product. For non-emergency care, Horizon Advance EPO members can choose to maximize their benefits by using Preferred Tier 1 hospitals. Members can also access other hospital in the Horizon Hospital Network but will have higher out of pocket costs.
- Copay(primary care/specialist) : $15/$30
- Referrals: Yes
- Coinsurance : 80/20
- Deductible(single) : $1000
- Maximum out of pocket(single) : $2,500
- Prescription: $10 Generic | 60/40 Brand | 50/50 Non Formulary
Horizon Advance EPO Silver
Our Horizon Advance EPO plans provide access to a variety of doctors, specialists and hospitals. These plans provide integrated medical and pharmacy benefits, including wellness and emergency care. Members must select a Primary Care Physician to coordinate care and provide referrals to specialists who participate with the Horizon Advance EPO product. For non-emergency care, Horizon Advance EPO members can choose to maximize their benefits by using Preferred Tier 1 hospitals. Members can also access other hospital in the Horizon Hospital Network but will have higher out of pocket costs.
- Copay(primary care/specialist) : $30/ 30% after deductible
- Referrals: Yes
- Coinsurance : 70/30
- Deductible(single) : $1500
- Maximum out of pocket(single) : $5,000
- Prescription: 30% Coinsurance After Deductible
Horizon Advantage EPO Silver
Horizon Advantage Exclusive Provider Organization (EPO) health plans offer members the freedom to use any of the thousands of participating physicians, hospitals and other health care professionals in the Horizon Managed Care Network without referrals. This plan also has access to wellness and discount programs.
Horizon Advantage EPO plans offer:
- Lower premiums with flexible coverage.
- No need to choose a PCP.
- Out-of-network benefits for emergency care.
- Copay(primary care/specialist) : $25/ $50
- Referrals: No
- Coinsurance : 60/40
- Deductible(single) : $2000
- Maximum out of pocket(single) : $6350
- Prescription: $15 Generic | 60/40 Brand | 50/50 Non Formulary
My Video Review of the Advantage EPO Silver Plan from Horizon
Horizon Advantage EPO Bronze
Horizon Advantage Exclusive Provider Organization (EPO) health plans offer members the freedom to use any of the thousands of participating physicians, hospitals and other health care professionals in the Horizon Managed Care Network without referrals. This plan also has access to wellness and discount programs.
Horizon Advantage EPO plans offer:
- Lower premiums with flexible coverage.
- No need to choose a PCP.
- Out-of-network benefits for emergency care.
- Copay(primary care/specialist) : $30 / 50% Coinsurance after deductible
- Referrals: No
- Coinsurance : 50/50
- Deductible(single) : $2500
- Maximum out of pocket(single) : $6350
- Prescription: 50% Coinsurance
Horizon Advantage EPO Essentials
This plan is designed to protect against financial ruin from uninsured medical expenses from hospital stays, surgeries, intensive care, diagnostics and other fees associated with an unexpected major illness.
To keep the premium cost low, the plan includes high deductibles, which means that it does not pay for routine doctor visits, prescription drugs or non-life threatening trips to the emergency room.
This plan may appeal to younger, healthy people who don’t feel they need to pay for frequent medical services but who want the peace of mind that comes with knowing they are covered against financial “catastrophe” if afflicted with a major illness
- Copay(primary care/specialist) : 3 visits per year at 100% – after that you pay 100% up until deductible
- Referrals: No
- Coinsurance : 100% after deductible
- Deductible(single) : $6350
- Maximum out of pocket(single) : $6350
- Prescription: You pay 100% until deductible is reached. You pay nothing after deductible.
