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Patient-Centered Programs Deliver Better Care

 

At the end of 2015, more than 800,000 members and over 6,000 doctors were part of Horizon Blue Cross Blue Shield of New Jersey's patient-centered programs. This growth supports our commitment to improving care coordination, reducing unnecessary costs and enhancing the member experience. 

 

 Helping Members Get and Stay Healthy

A number of clinical metrics compared the 2014 claims data of Horizon BCBSNJ members in participating patient-centered doctors' offices to members in traditional practices.

Our results found patient-centered members has a:
6 percent higher rate in improved diabetes control
7 percent higher rate in cholesterol management for patients who have diabetes
3 percent higher rate in breast cancer screenings
Results also showed these members had a:
5 percent lower rate in Emergency Room (ER) visits
8 percent lower rate in hospital admissions
9 percent lower total cost of care

 

OMNIA Health Plans

Horizon's new OMNIA℠ Health Plans give enrolled members the flexibility to use any hospital participating in the Horizon Hospital Network and any participating physician, other health care professional or ancillary provider participating in the Horizon Managed Care Network.

Features of the new OMNIA Health Plans for individuals, families and groups:

  • Primary Care Physician (PCP) selection is not required for members enrolled in OMNIA Health Plans.
  • Referrals are not required for OMNIA Health Plan members. Certain services/supplies do require prior authorization.
  • OMNIA Health Plan members may use any physician or other health care professional from our broad Horizon Managed Care Network and any hospital from the Horizon Hospital Network, but will maximize their benefits and incur lower cost sharing when they use OMNIA Tier 1-designated physicians, other health care professionals, ancillary providers and hospitals.
  • OMNIA Health Plans do not include out-of-network benefits. OMNIA Health Plan members must use physicians and other health care professionals who participate in the Horizon Managed Care Network and hospitals in our Horizon Hospital Network, except in cases of medical emergencies.*

    *OMNIA Health Plans offered to large group employers, National Accounts, ASOs, Labor Accounts and Public Sector Accounts may be customized to include BlueCard (out-of-area) coverage.

  • OMNIA Health Plan members have coverage for eligible preventive services (physical exams, well-child care, immunizations, etc.) with no member cost sharing when these services are provided by a physician or other health care professional within the Horizon Managed Care Network.

OMNIA Health Plans

The following are our standard metallic plan offerings that are available on and off the health insurance exchange for members in the individual consumer and small employer markets.

OMNIA BRONZE

  • Lowest monthly premium and highest out-of-pocket costs compared to other OMNIA Health Plans. Members must use physicians and other health care professionals who participate in the Horizon Managed Care Network and hospitals in the Horizon Hospital Network, except in cases of medical emergencies.
  • Bronze plans, on average, pay for 60 percent of the covered medical expenses; members pay 40 percent.

OMNIA SILVER

  • Mid-level monthly premium and out-of-pocket costs compared to other OMNIA Health Plans. Members must use physicians and other health care professionals who participate in the Horizon Managed Care Network and hospitals in the Horizon Hospital Network, except in cases of medical emergencies.
  • Silver plans, on average, pay for 70 percent of the covered medical expenses; members pay 30 percent.
  • Cost sharing subsidies may be available.

OMNIA SILVER HSA

  • Offered in conjunction with a Health Savings Account (HSA).
  • Mid-level monthly premium and out-of-pocket costs compared to other OMNIA Health Plans. Members must use physicians and other health care professionals who participate in the Horizon Managed Care Network and hospitals in the Horizon Hospital Network, except in cases of medical emergencies.
  • Silver plans, on average, pay for 70 percent of the covered medical expenses; members pay 30 percent.
  • Cost sharing subsidies may be available.

OMNIA GOLD

  • Higher monthly premium and lower out-of-pocket costs compared to other OMNIA Health Plans. Members must use physicians and other health care professionals who participate in the Horizon Managed Care Network and hospitals in the Horizon Hospital Network, except in cases of medical emergencies.
  • Gold plans, on average, pay for 80 percent of the covered medical expenses; members pay 20 percent.

 

To learn more, contact us today.

Phone: (732) 574-8000

E-Mail: mail@insctrs.com 

 

Information courtesy of Horizon Blue Cross Blue Shield of New Jersey

Posted 10:30 AM  View Comments

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