Description: The article is about bcbs login. This is an introduction to the Horizon BCBS Omnia plan. New OMNIA Health Plans offer significantly lower premiums for access to the largest network in New Jersey. You can learn more details about Omnia plan in this article.
This is Mike from new jersey insurance plans, today I’m going to go over the horizon omnia plans, the omnia plans were rolled out for January 2016, they’re available to individuals and all small group clients, they’ve done a lot of fanfare and there has been a lot of fluff in their marketing, it’s hard to understand what the plans are and how they work.
Today I’ll go over to the exempt details so we can get to what people care about which are how the plan will work and how that will affect them. I brought up a PDF guide that they’ve made, this is for the individual market, I’m going to quickly see how one of the plans works so you can understand the differences in these plans versus some of the other plans.
You can see different tiers. The horizon plans use the horizon managed care network which is their full network, there is no change in network, the change is about how things are covered within that network. They’ve segmented it out between tier 1 and tier 2, I don’t know how they determine these tiers, they haven’t told anyone about that, that’s not a big deal, it doesn’t matter for us.
We need to know what the differences are. They’ve selected certain providers and hospitals and designated notice tier 1, if you see a tier 1 provider, you do not need a referral for your trip, but if you see a tier 1 provider, you’ll have lower deductible co-payment amount, in this case is their platinum plan.
It’s a five dollar copay at a primary care and $15 at a specialist. If we compare that to tier two, the same provider will be fifteen dollars for a primary care or $35 for a specialist. Tier 2 is fifteen, the big differences tend to come in with the deductibles and hospital stays, there is no deductible for the hospital for tier 1.
But tier two is deductible. If you go into Atlanta care tier one and you pay a three hundred per day copay at the hospital, regardless of the charge, you’re paying three hundred per day on this platinum plan.
If that Hospital happens to be a Tier two, you’ll find that your thousands are deductible, you’ll pay thirty percent coinsurance up to the maximum out-of-pocket. Tier 2 is $2, 500. Depending on where you go, that will determine how much you pay and what your liability is for a stay.
The confusing part is how it works between tier 1 and tier 2 with the maximum amount of pockets. The maximum out-of-pocket is the total of your co-pays or coinsurance as your deductible for that calendar year, any approved service you pay goes towards your max pocket.
If you pay, tier 1 will carry over to tier 2. If you use a tier 2 provider and pay five dollar co-payment, that will contribute towards the max amount of pocket for tier two. The opposite reverse is not true. This is where you have to be careful in figuring everything out.
If you went to a hospital and hit your maximum out-of-pocket of $2, 500 and everything was tier two, you have zero liability for the rest of the year. But you could still potentially pay another $1, 500 on tier one, they do not across accumulate going from tier 2 to tier 1 but they will do across accumulate from tier 1 to tier 2, it’s an important difference on the plans, you have to be careful with how to use the plan.
You need to make sure that you can stay within the same tier or try to stay to your left for everything. How do you figure out what doctors are on the different tiers? They’re providing fiber so I will bring up that web page.
At the top, you’ll click find a doctor, this is an important difference when finding your hospitals and doctors. The mid-size market is 50 plus or 100 plus, they also have AMIA, it’s a slightly different network. If you’re in a midsize plan, you would probably have to ask your benefits administrator, if that’s the case, you will select this one. This is for 50 plus or 100 plus midsize large group market.
The tearing will be a little bit different. If you’re a small group and you have an employee base up to 250, you will select one of these. If you have a small group and you’re in the poor plan, you can choose another one. You need to put in your zip code. That’s a quick review of the new army plans for horizon blue cross, if you have any questions, you can always give me a call, I will answer any questions for you.