Horizon HealthCare

Health Care Plans for Employers with 2-50 Eligible Employees

(Eligible employees work 25+ hrs./wk.)

Because no two horizons are the same, Horizon Blue Cross Blue Shield of New Jersey offers a full range of coverage options for you and your employees.


Horizon Advantage Plans

Lower premiums. Flexible coverage. Increased employee cost sharing.

Using in-network services results in lower out-of-pocket costs. Using non-network services results in increased employee cost sharing. The Preferred Provider Organization (PPO) health plan offers the freedom for members to use any of the more than 17,000 participating physicians, hospitals and other health care professionals in the Horizon Traditional Network.

The Direct Access health plans offer the freedom for members to use any of the over 10,000 participating physicians, hospitals and other health care professionals in the Horizon Managed Care Network - without referrals.

The following are the Horizon Advantage Direct Access and Horizon Advantage Preferred Provider Organization benefit designs and links to the corresponding Benefit Highlights that detail the available copayment, deductible and coinsurance options...

  • Employer 51+
  • Health Care Plans for Employers With 51+ Employees
  • We offer a variety of insurance products from PPO to Managed Care to supplements that are designed to suit your organization's health, life, and dental insurance needs.
  • Horizon MyWaySM HSA

This consumer-driven health plan combines a high-deductible health plan with a Health Savings Account (HSA). The high-deductible health plan can either be a Horizon PPO or Horizon Direct Access. In-network preventive care services can be covered at 100 percent. HSA funds can be used to pay for any services or products eligible under Section 213(d) of the Internal Revenue Code. Unused HSA funds are rolled over to the next year, allowing members to save for future health care expenses. HSA funds accrue interest and can be invested in mutual funds once a minimum balance is met. Learn more...

Introducing Horizon MyWaySM HRA Consumer-Driven Health Plan (CDH).

Combines high-deductible Horizon PPO or Horizon Direct Access health plan with an employer-funded Health Reimbursement Account (HRA).

In-network preventive care services are covered at 100 percent. HRA funds can be used to cover deductibles, coinsurance, or other member cost sharing under the Horizon PPO or Horizon Direct Access health plan or all services or products eligible under Section 213 of the Internal Revenue Code. Unused HRA funds can be rolled over to the next year, allowing members to save for future health care expenses. A payment card allows members access to HRA funds quickly and easily at the doctor's office, pharmacy, and hospital.

Horizon Traditional

  • Fee-for-service health plan.
  • Freedom to select any doctor and hospital for medical care.
  • Member handles paperwork.
  • Member submits claims for reimbursements.
  • Annual deductibles and coinsurance may apply.
  • Savings by using the doctors and hospitals that participate with Horizon BCBSNJ, after meeting deductibles and coinsurance.

Horizon PPO

Allows choice of physicians and hospitals without having to choose a Primary Care Physician (PCP). Lower out-of-pocket costs and higher plan benefits when using the 22,000 doctors, hospitals, and other health care professionals participating in the Horizon PPO network.

  • No claims to file when staying in the Horizon PPO network.
  • Out-of-network option offers care from any physician or hospital outside the network in exchange for higher out-of-pocket costs.
  • Wellness and discount programs.
  • Nationwide and worldwide access to medical care through the BlueCard® PPO program. Members have access to the largest health care network in the nation: over 8,175 participating hospitals and more than 802,000 physicians, specialists, and subspecialists.

Horizon Direct Access

Direct access to physicians, specialists, hospitals, and other health care professionals in the Horizon Managed Care Network without referrals. Lower out-of-pocket costs and higher plan benefits by using the 11,000 doctors, specialists, hospitals, and other health care professionals in the Horizon Managed Care Network.

  • No referrals needed for specialist visits.
  • Virtually no claims to file.
  • Wellness and discount programs.
  • Primary Care Physician (PCP) selection optional but encouraged for guidance and managing medical care.
  • For female members, no PCP referral needed for routine gynecological care from more than 300 Ob/Gyns in the Horizon Managed Care Network.
  • Prenatal education and information program available.
  • Out-of-network option offers care from any physician or hospital outside the Horizon Managed Care Network in exchange for higher out-of-pocket
  • costs. Deductibles and coinsurance may apply.
  • Using doctors in our broader, traditional network allows for out-of-pocket savings.
  • Most out-of-pocket costs for care are from licensed, non-network doctors and hospitals.
  • Nationwide and worldwide access to medical care through the BlueCard® PPO program.

Horizon POS

  • Freedom to choose care in and out of network.
  • Out-of-pocket savings when using in-network option.
  • Wellness and discount programs.
  • Virtually no claim forms to file.
  • Member pays applicable copayment each time covered benefits are accessed within the network with Primary Care Physician (PCP) referral.
  • Members choose PCPs from our Managed Care Network of more than 3,000 family practitioners, general practitioners, and internists.
  • PCPs coordinate all health care, including referrals to 6,700 specialists in the Horizon Managed Care Network and 71 hospitals in our Horizon

Hospital Network.

For female members, no PCP referral needed for routine gynecological care from more than 300 Ob/Gyns in the Horizon Managed Care Network. Prenatal education and information program. Out-of-network option offers care from any physician or hospital outside the Horizon Managed Care Network in exchange for higher out-of-pocket costs.

Horizon HMO

  • Low out-of-pocket expenses.
  • Wellness and discount programs.
  • Virtually no claim forms to file.
  • Member pays copayment at time of service.
  • Members choose Primary Care Physicians (PCPs) from our Managed Care Network of more than 3,000 family practitioners, general practitioners, and internists.
  • PCPs coordinate all health care, including referrals to 6,700 specialists in the Horizon Managed Care Network and 71 hospitals in our Horizon

Hospital Network.

For female members, no PCP referral needed for routine gynecological care from more than 300 Ob/Gyns in the Horizon Managed Care Network. Prenatal education and information program. HMO Blue USASM provides coverage when away on a business trip, vacation, or for a child away at college.

Prescription

Prescription ID card program with low copayments for generic and brand-name drugs at participating pharmacies or through mail-order service. More than 98 percent of New Jersey's pharmacies participate in the program.

Coverage when traveling through the more than 50,000 participating pharmacies nationwide. Using nonparticipating pharmacies requires up-front payments of full prescription amounts and submission of reimbursement forms.

Horizon H.S.A. How it Works

HSAs were established by the Medicare Modernization Act of 2003 with an effective date of January 1, 2004. HSAs are available to individuals with a qualified, high-deductible health insurance plan. The health insurance plan is paired with a savings account to cover eligible medical expenses not covered by the health insurance plan.

How do you use your HSA funds?

HSA funds can be used for any of the following:

  • Save for future medical expenses.
  • Help bridge the gap to benefits until they meet the annual health plan deductible.

HSA funds are portable, which means that you can access your account regardless of a change of employer, age, marital-status changes, future medical coverage, or state of residence. HSA funds roll over from year to year.

Who funds the HSA?

Both you and your employer can contribute to an HSA. Contributions to HSAs are 100 percent tax deductible. Although HSA contributions must stop when you enroll in Medicare, you can continue to access your HSA balances. Annually, your HSA can be funded up to the lower amount of the deductible or the maximum specified by law.

HSA Investment Option

Each HSA is held in an interest bearing account. Once the account reaches a balance determined by our financial institution, there is the option to invest the dollars in a variety of mutual funds.

Accessing HSA Funds

There are two convenient ways in which you can access HSA dollars:

  • A Horizon MyWay VISA/Debit Card
  • Checks

You can access your account information via the phone and the Web.

How to Enroll in Horizon MyWay HSA

Included in the ACS/Mellon Member Welcome Kit. ACS/Mellon Bank will manage your Health Savings Account. When you complete these forms, ACS/Mellon will be able to open an HSA on your behalf. These forms include:

  • Master Signature Card
  • Beneficiary Designation Form

Horizon BCBSNJ Welcome Information

After enrollment, you will receive welcome information from both Horizon BCBSNJ and others which may include the following:

  • Horizon BCBSNJ ID card
  • Horizon MyWay HSA Member Handbook

ACS/Mellon Welcome Kit

The ACS/Mellon Welcome Kit will include the following materials:

  • Welcome Letter
  • Master Signature Card/Beneficiary Designation Form
  • Privacy Policy Statement
  • Deposit Agreement
  • Supplemental Agreement
  • Fee Sheet

Return Envelope

Be sure to return your Master Signature Card ASAP. Once we receive the Master Signature Card, you will receive the following:

  • Horizon MyWay Visa/Debit Card
  • Mellon Checkbook

Eligible vs. Noneligible

If you are covered by a qualified, high-deductible health plan, you are eligible to open a Horizon MyWay HSA. If you are covered under another nonqualified, high-deductible health plan, you are not eligible. For example: If you are covered by your spouse's plan that is not a qualified, high-deductible health plan, you are not eligible, even if your spouse's group has its own qualified, high-deductible health plan.

Specified disease coverage, hospital indemnity, vision, dental, accident, and disability do not count as other coverage. If you can be claimed as a dependent on another person's tax return, you are not eligible. If you are enrolled in Medicare, you are not eligible to contribute to an HSA. You can, however, still use accumulated funds. Horizon MyWay HRA

Horizon MyWay HRA pairs a high-deductible health plan with a Health Reimbursement Arrangement (HRA) to cover eligible medical expenses. Once the deductible is met, your health care expenses are paid according to the terms of your medical plan. With Horizon BCBSNJ, in-network preventative care services are covered at 100 percent. HRA funds can be used to cover deductibles, coinsurance or other cost sharing under the Horizon PPO or Horizon Direct Access health plan. Unused HRA funds may rollover to the next year if your employer elects that option. For your convenience, your employer can choose to offer a payment card, which allows you to access funds quickly and easily at the doctor's office, pharmacy, and hospital.

Horizon MyWay HRA has three main components:

  • A high-deductible health plan, such as Horizon Direct Access or Horizon PPO
  • A Health Reimbursement Arrangement
  • Tools and resources to help members make informed decisions about health care and related spending Horizon MyWay FSA

Unreimbursed Medical and Dependent Care Flexible Spending Accounts

The Unreimbursed Medical and Dependent Care Spending Accounts are a tax-advantaged way to pay for out-of-pocket health care expenses, and work-related daycare expenses. This benefit allows you to reimburse yourself for eligible expenses with "pre-tax" dollars, which means that you get a tax deduction for these expenses before you ever file your tax return. You don't pay federal income or Social Security taxes on this money and, in most states, you don't pay state taxes either.

Authorized by the IRS, these accounts let you set aside money from your salary before taxes are withheld. As you incur health care expenses or daycare expenses throughout the year, you submit a claim for those expenses, and are reimbursed with tax-free dollars from your account(s).

The Unreimbursed Medical Spending Account reimburses you for out-of-pocket health care expenses for medical, dental, vision, or hearing expenses.

The Dependent Care Spending Account reimburses you for dependent daycare expenses you incur in order to allow you (or you and your spouse) to work.

When you use these accounts, your taxable income is reduced, therefore you will pay less in income taxes.

How The Accounts Work

You decide during the annual open enrollment period to elect in the Unreimbursed Medical and/or the Dependent Care Spending Account. This is how it works:

  • You estimate the amount you will spend on out-of-pocket health care expenses and/or daycare expenses during the year.
  • You decide how much you wish to set aside into your Unreimbursed Medical and/or Dependent Care Spending Account.
  • The amounts you wish to set aside into your account(s) will be deducted from your paycheck in equal amounts each pay period on a "pre-tax" basis.

As you receive services and incur health care expenses or daycare expenses throughout the year, you submit a claim for the expenses, and are then reimbursed from your account(s).

You may file claims as often as you wish — weekly, monthly, etc.

Any dollars left over in your account at the end of the year are forfeited. Therefore, you should contribute only what you know you will spend on predictable expenses. There is a run-off period (typically 3 months) following the end of the plan year for employees to submit expenses incurred in the previous year.

The Tax Advantage

The advantage of the Flexible Spending Accounts is that you don't pay federal income or Social Security taxes on this money before it goes into your account, and you don't owe taxes on it when it is paid out to you. In most states, you don't pay state taxes either.* By participating in the Unreimbursed Medical and/or Dependent Care Spending Accounts, you will lower your taxable income, which means less income taxes.

State taxes are not exempt in New Jersey for the Unreimbursed Medical and Dependent Care Spending Accounts. State taxes are not exempt in Pennsylvania for the Dependent Care Spending Account.

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