Employer 2-50
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...
Horizon MyWaySM HSA
Horizon MyWay HSA is a consumer-driven health plan that combines a qualified high-deductible health plan and a Health Savings Account (HSA). The health plan can either be a Horizon PPO or Horizon Direct Access plan. Funds in the HSA can be used to pay for eligible medical expenses not covered by the health plan. Unused HSA funds roll over to the next year, allowing members to save for future health care expenses. Learn more... Horizon BCBSNJ Basic Health Plan A*
This is a fee-for-service health benefits plan under which you and your employees can receive limited (30 inpatient days per year) hospital coverage at a lower cost than other, more comprehensive health benefits plans. This plan is for individuals who want the security of basic hospital coverage in case of unforeseen illness or injury.
NOTE: Some coverage offered under our other traditional plans is not covered by Plan A. Please review your benefits certificate carefully.  Horizon BCBSNJ Comprehensive Health Plan B*
This comprehensive fee-for-service health benefits plan provides more comprehensive coverage than Basic Health Plan A. Choose from annual deductibles of $250, $500, or $1,000 with a 60% coinsurance based on allowable charges for eligible services. You and your employees always have freedom to select your own doctors and hospitals. However, using one of our Horizon Traditional Network physicians keeps your out-of-pocket expenses low. (*SEH Plan B.) Horizon BCBSNJ Comprehensive Health Plan C*
This comprehensive fee-for-service health benefits plan covers you at a higher percentage than Plans A or B; all at a competitive monthly rate. Under Plan C, choose from annual deductibles of $250, $500, or $1,000 with a 70% coinsurance. You and your employees can use any physician you choose. Using one of our Horizon Traditional Network physicians keeps your out-of-pocket expenses low. (*SEH Plan C.) Horizon BCBSNJ Comprehensive Health Plan D*
This comprehensive fee-for-service health benefits plan covers you at a higher percentage than Plans A, B, or C; all at a very competitive rate. Under Plan D, choose from annual deductibles of $250, $500, or $1,000 with an 80% coinsurance. You and your employees can use any physician you choose. Using one of our Horizon Traditional Network physicians always keeps your out-of-pocket expenses low. (*SEH Plan D.) Horizon BCBSNJ Comprehensive Health Plan E*
This comprehensive fee-for-service health benefits plan gives you a higher percentage of coverage than Plans A, B, C, or D. Plan E has an annual deductible of $150 with a 90% coinsurance. You and your employees can use any physician you choose. Using one of our Horizon Traditional Network physicians always keeps your out-of-pocket expenses low. (*SEH Plan E.) Horizon BCBSNJ PPO*
Horizon PPO is our Preferred Provider Organization plan. Your employees have the choice of more than 24,800 physicians and specialists in our Horizon PPO Network and 73 hospitals in more than 82 locations. If an employee uses our network physicians, he or she receives a higher level of coverage; if an employee chooses an out-of-network physician or hospital, the employee pays a higher share of the costs. Various plan designs are available. Some offer doctor's office visits without a deductible. (*SEH Plans B, C, and D in a Preferred Provider Organization format with Office Riders, depending on plan choice.)
Horizon HMO Access
Horizon HMO Access provides direct access to network specialists without a referral. Employees select a Primary Care Physician (PCP) from our Horizon Managed Care Network of more than 17,800 doctors and specialists in the state and enjoy the freedom to coordinate their needs without a referral. Members may not self-refer to PCP-type providers; they must use their selected PCP. (Horizon HMO is issued by Horizon Healthcare of New Jersey, Inc., a subsidiary of Horizon Healthcare Services, Inc.) Horizon HMO Access Coinsurance
This health maintenance organization plan allows members to access any primary care provider and any specialist provider without a referral. In addition, selecting a Primary Care Physician is optional. A Primary Care Physician may still coordinate medical care, but members do not need a referral to access specialists. Members in these plans pay a copayment for services received in the practitioner's office, and are subject to deductible and coinsurance for most services received outside of the practitioner's office. The Horizon Managed Care Network includes more than 10,000 participating providers. Members have the security of comprehensive coverage, and virtually no claim forms to fill out - all at a competitive monthly rate. Horizon BCBSNJ offers an HMO Access Coinsurance plan to provide your clients with comprehensive health benefits. This is a no-referral plan.
Horizon BCBSNJ HMO*
This Managed Care plan gives your employees the security of low out-of-pocket expenses, comprehensive coverage, and virtually no claim forms to fill out; all at a competitive monthly rate. Employees choose a Primary Care Physician (PCP) from our Horizon Managed Care Network of more than 17,800 doctors and specialists in the state. PCPs manage medical care and refer employees to specialists and hospitals. (*Horizon HMO is issued by Horizon Healthcare of New Jersey, a subsidiary of Horizon Healthcare Service, Inc.)
Horizon BCBSNJ HMO 100/80*
Horizon HMO 100/80 is the first HMO plan of its kind in New Jersey. This managed care plan is a coinsurance and deductible plan with a competitive monthly rate. Unlike most HMOs, this new plan requires the payment of a deductible and coinsurance in addition to copayments for eligible medical care and services.
Employees choose a Primary Care Physician (PCP) from our Horizon Managed Care Network of more than 17,800 doctors and specialists in the state. Some plans require referrals to hospitals and specialists. Your employees pay either a copayment when receiving services rendered in their doctor's office or 80-percent coinsurance when receiving certain out-of-office services. This means that payment depends on whether services are rendered in the doctor's office or an outside facility. (*Horizon HMO is issued by Horizon Healthcare of New Jersey, a subsidiary of Horizon Healthcare Service, Inc.)
Horizon BCBSNJ HMO 100/50*
Horizon HMO 100/50 is the first HMO plan of its kind in New Jersey. This managed care plan is a coinsurance and deductible plan with a competitive monthly rate. Unlike most HMOs, this new plan requires the payment of a deductible and coinsurance in addition to copayments for eligible medical care and services.
Employees choose a Primary Care Physician (PCP) from our Horizon Managed Care Network of more than 17,800 doctors and specialists in the state. Some plans require referrals to hospitals and specialists. Your employees pay either a copayment when receiving services rendered in their doctor's office or 50-percent coinsurance when receiving certain out-of-office services. This means that payment depends on whether services are rendered in the doctor's office or an outside facility. (*Horizon HMO is issued by Horizon Healthcare of New Jersey, a subsidiary of Horizon Healthcare Service, Inc.)
Horizon BCBSNJ POS*
You and your employees have the freedom to use the Horizon Managed Care Network of physicians or choose physicians and hospitals outside the network. In-network employees select a Primary Care Physician (PCP) to coordinate their needs. By going out-of-network, employees may encounter higher out-of-pocket expenses and more paperwork. $0 copayment options are available. (*SEH Plan C and Plan D in a Point-of-Service format.)
Horizon BCBSNJ Direct Access*
This open-access product provides you and your employees with direct access to practitioners without a referral and with network benefits. Though we encourage employees to select a PCP to coordinate medical care, they do not have to select a PCP. Employees have the freedom to choose physicians from our Horizon Managed Care Network and hospitals from our network or go to physicians and hospitals outside the network. By going out-of-network, employees may encounter higher out-of-pocket expenses. Employers can choose from various plan designs to meet their budget and benefit needs. Some options include $0 copayments for all doctor's office visits.
(*SEH Plans C and D in a Point-of-Service format with Office Rider Access, depending on plan choice.)
Horizon BCBSNJ Pharmacy Services
Horizon BCBSNJ's Pharmacy Services include a prescription ID card program with low cost sharing 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. *The information on these pages is a summary of the benefits coverage, terms, conditions, and exclusions contained in Horizon Healthcare Services policies/contracts. In the event of a conflict between the information contained on these pages and the actual terms of a policy or contract, the terms of the policy or contract will prevail.
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