It’s a common question among many, especially those with insurance policies in the obamacare marketplace: Is the BCBS Horizon Omnia in NJ just a fancy name for Obamacare Marketplace Insurance? Here are some things you should know about the answer.
OMNIA plans are not sold to Medicare beneficiaries
Horizon Blue Cross Blue Shield of New Jersey (Horizon) is one of the largest health insurance companies in the state of New Jersey. It offers individual and family coverage plans, prescription drugs, dental plans and worker compensation. With a rating of “A” from Standard and Poor’s, Horizon has earned the “Brand Excellence for Innovation” award from the Blue Cross Blue Shield Association.
OMNIA is a tiered health plan developed by Horizon. The plan is designed to steer customers toward providers in the preferred tier. This results in lower deductibles and copays if consumers use a Tier 1 provider. However, this strategy also puts hospitals serving the poor at a disadvantage.
After the Omnia plan was introduced, Horizon reported a 450,000-member gain in the third year. But the plan’s structure is expected to continue to harm some hospitals and lawmakers in the long run.
The OMNIA plan is available through employers, state employees, and individuals who buy their own insurance. It offers three different plans – bronze, silver and gold. Bronze plans offer the smallest premiums, but require the most out-of-pocket costs. Silver plans pay 70% of covered medical expenses, and gold plans pay less than 30% out-of-pocket costs.
The Omnia plan was created in response to the high costs of health care in New Jersey. Insurance premiums in the state have been climbing at a slower rate than the national average. In response, Horizon has said that OMNIA will help it deliver on its goal of lowering the cost of healthcare in New Jersey.
Premiums increased by just 2 percent for a 40-year-old non-smoker
The new Horizon BCBSNJ health insurance offering is just a fancy name for Obamacare marketplace insurance. As a result, the insurance premiums in New Jersey are on the rise. However, unlike most states, it is not the only insurer in the area. There are half a dozen other insurers competing for business in New Jersey.
To make matters worse, Christie has shown little interest in the ACA. He vetoed a bill to create a state-run health insurance exchange in 2012. Similarly, he vetoed a bill to expand Medicaid. His hands-off approach to the ACA has left the heavy lifting to health insurance brokers and navigators. This, paired with his decision to sign off on the smallest possible budget, has had a negative impact on New Jersey’s economy.
When the news broke that Horizon BCBSNJ had made a splashy announcement, New Jersey’s hospitals were quick to make their voices heard. Two of the biggest hospital systems in the state – Hackensack University Medical Center and Saint Barnabas Medical Center – demanded explanations. One system, Holy Name Hospital, announced that it had settled a lawsuit brought by Horizon. Among other things, the hospital would be paid more by Horizon for patients.
While it is no secret that Horizon BCBSNJ is the largest insurer in New Jersey, it has been slow to roll out innovations. In early 2017, the company reported 238,000 people enrolled in OMNIA plans.
Lawsuits against OMNIA
Horizon is New Jersey’s largest health insurer. It also administers public health plans for about 800,000 government workers. However, it recently came under fire for premium increases over 20 percent. Now, a group of hospitals has filed suit against Horizon. Specifically, they claim that Horizon illegally excluded them from its discounted insurance plans.
They argue that Horizon’s choice of the largest hospital systems instead of the smallest was an unfair process. And they argue that the process used to approve the OMNIA plan violated the terms of network agreements.
The suit aims to cast Horizon as Goliath. It claims that Horizon failed to provide the plaintiffs with sufficient advance notice of its new network. Moreover, Horizon allegedly improperly marketed its tier 1 hospitals as better than its tier 2 hospitals.
The plaintiffs commissioned anti-OMNIA billboards across northern New Jersey. They also allege that Horizon violated agreements by failing to give the plaintiffs 60 days’ advance notice of its OMNIA plan. Despite the lawsuit, the company remains committed to its tiered health plan and hopes to prevail on the merits.
Horizon’s tiered plan includes a new product called OMNIA Health Alliance. This new product was born out of Horizon’s desire to lower the cost of healthcare in New Jersey.
According to Horizon, the OMNIA Health Alliance was conceived as a way to improve patient care. In early September, Horizon announced that it would form a partnership with six other health systems.