New for 2016
OMNIA
SM
Individual Market
Health Plans
Three steps for
health care coverage...
1. Find out if you’re eligible for
financial assistance.
2. Choose the health plan that suits
your needs.
3. Purchase your plan through
HorizonBlue.com.
It’s time to stop putting up with
rising health care costs.
To transform New Jersey from one of the most
expensive states for care to one of the best.
Horizon BCBSNJ, together with patient-focused doctors and hospitals, is
working to revolutionize the delivery of health care in New Jersey by creating
innovative arrangements and health plans to improve care quality and increase
patient satisfaction while reducing costs.
Introducing...OMNIA.
All OMNIA Health Plans feature ...
✓ The lowest premiums we offer*
With lower costs and higher value, OMNIA Health Plan
members save whenever they choose certain doctors,
hospitals or health care professionals.
Why choose OMNIA?
✓ Low or no deductibles
✓ Lower out-of-pocket costs**
✓ No referrals
Our new OMNIA Health Plans are designed to make it easy
and less expensive for you to see certain doctors, hospitals,
and other health care professionals.
✓ Access to New Jersey’s largest
network of doctors and hospitals
OMNIA Health Plans connect you with doctors and hospitals
that have demonstrated their commitment to enhancing the
patient experience, improving care and lowering costs.
*As compared to similar plans. **When using designated
doctors, hospitals and other health care professionals.
HorizonBlue.com/OMNIA
Step 1.
Find out if you’re eligible for financial assistance.
Under the Affordable care act, you may qualify for financial
help from the government.
Premium assistance reduces your monthly cost for coverage, which means you
pay less out of pocket. You may also qualify for:
Cost-sharing subsidies, which lower the amount you have to pay in
deductibles, copayments and coinsurance.
How much financial assistance could I get?*
That depends on your household income and the number of people in
your household.
To see whether you qualify for financial help:
Locate the number of people in your household in the table.
See if your household income falls within the income range listed.
If you have more people in your family, you can get financial assistance if
your income is higher than the amounts shown.
Now log onto HorizonBlue.com/Estimator to help determine your
potential financial assistance.
Write your estimated premium assistance amount
(if any) from HorizonBlue.com/Estimator below.**
*Expenses such as self-employment expenses and certain other types of business expenses, student loan interest, education tuition, and money you put in a retirement or health savings
account, are subtracted from your income. This is like the adjusted income you pay on your taxes.
**This is only an estimate. This estimate does not constitute a promise or offer of financial
assistance from Horizon BCBSNJ to purchase health insurance. The actual amount you may be
eligible for when you apply for an insurance policy on the health insurance Marketplace may vary
based upon age, household income, household size, ZIP code and effective date.
Household
Size
Yearly
Household Income*
1
$11,490 - $45,960
2
$15,510 - $62,040
3
$19,530 - $78,120
4
$23,550 - $94,200
MY ESTIMATED MONTHLY ASSISTANCE:
What’s next?
If you entered an estimated premium assistance amount above, keep it in mind as you review our plans and benefits.
Whether or not you qualify for financial help, keep reading to learn about our health plans and how
to choose the one that’s best for you.
Note: If you’re eligible for Medicaid, Horizon BCBSNJ has other options for you.
Please visit HorizonNJHealth.com or call 1-866-260-5792 to learn more.
HorizonBlue.com/OMNIA
Step 2.
Choose the health plan that suits your needs.
All Horizon Health Plans include essential health benefits.
Our plans are grouped into
four “metallic” tiers so you can
compare your options easily:
✓ OMNIA Health Plans don’t require a Primary Care
Physician or specialist referrals. Members will save more
and have lower out-of-pocket costs when using certain
doctors, hospitals and other health care professionals
designated in our Doctor & Hospital Finder at
HorizonBlue.com/DoctorFinder.
Platinum, Gold, Silver and Bronze.
✓ Advantage EPO Plans don’t require a Primary Care
Physician or specialist referrals. Out-of-pocket costs may be
higher when compared with OMNIA plans in similar
“metal” tiers.
✓ The Essentials Plan is a low-cost, high-deductible option
designed for healthy individuals under age 30.
Higher Premium
More Coverage
More Usage
PLATINUM
Highest
premium,
90% coverage
(you pay 10%)
GOLD
Higher
premium,
80% coverage
(you pay 20%)
These tiers – which are available on all Horizon BCBSNJ plans
except Horizon Advantage EPO Essentials – do not change
what is covered. They only change the percent that will be
reimbursed for your medical expenses in exchange for higher
or lower monthly premiums. In other words, they indicate how
much you pay versus how much Horizon BCBSNJ pays when
you get care.
SILVER
Mid-level
premium,
70% coverage
(you pay 30%)
BRONZE
Low premium,
60% coverage
(you pay 40%)
ESSENTIALS
Low premium,
High
deductible,
100% coverage
after deductible
Lower Premium
Less Coverage
Less Usage
Ask yourself, how much would
you pay for health insurance?
A LOT — You see doctors often, and not only for preventive
care. You may have a chronic condition and/or take maintenance
medications.
I WANT TO:
Keep my costs as low as possible or pay more if I could save overall.
CONSIDER: Platinum, Gold or Silver plans with higher
premiums, but lower deductibles and out-of-pocket costs.
NOT MUCH — You get an annual checkup and preventive care,
but rarely see doctors otherwise.
How often do I use
health care services?
CONSIDER: Silver or Bronze plans with lower premiums, but higher deductibles and out-of-pocket costs; Essentials
plan (under age 30 only or if you meet hardship criteria as
defined by the Marketplace).
HorizonBlue.com/OMNIA
Step 3.
Get ready to enroll.
Remember! Open enrollment starts November 1, 2015
and ends on January 31, 2016.
Make enrollment easier.
Gather these items in advance:
❏ Your individual or household income (a recent W-2 or pay stub.)
❏ Whether health coverage is available from any household member’s employer
Information about any health insurance you or any household member may currently
have. Something that has the policy number on it is all you need.
❏ Personal information of everyone who will be on your plan
❏ Full Legal Name
❏ Birth Date
❏ Social Security Number
There are four ways you can sign up:
Online at HorizonBlue.com Your fastest, most convenient option, available
24 hours a day.
Call your broker or call 1-866-260-5792 to speak to one of our
enrollment specialists.
In-person assistance at retail and local events. Visit Events.HorizonBlue.com
By downloading and filling out an enrollment form
Visit HorizonBlue.com/form-individual-enrollment to download a form
and instructions (you will not be eligible for financial assistance from the
government if you choose this method to enroll).
Need a different language?
Spanish (Español): Para obtener asistencia en Español, llame al 1-866-660-6661.
Tagalog (Tagalog): Kung kailangan ninyo ang tulong sa Tagalog tumawag sa
1-866-260-5792.
Chinese (中文): 如果需要中文的帮助，1-866-260-5792.
Navajo (Dine): Dinek’ehgo shika at’ohwol ninisingo, kwiijigo holne’ 1-866-260-5792.
Additional language translation services and Text Telephone (TTY) service for the
hearing-impaired are available at no additional cost.
HorizonBlue.com/OMNIA
All Horizon BCBSNJ health insurance plans include certain
Horizon Wellness programs and discounts at no additional cost.
Horizon Wellness offers living programs, savings programs and
practical tools to help you be happy and healthy.
Living: Programs and support for better health beyond the doctor’s office.
PRECIOUS ADDITIONS®
Features include:
Our PRECIOUS ADDITIONS
program provides free
maternity services, both
before and after giving birth.
› Maternity Health Coaching
› Prenatal Class Reimbursement
› Text4Baby Health Information
› Specialized Case
Management Services
› Pregnancy Guide and
Children’s Health Guide
› “Baby Blues” versus Post
Partum Depression
› “Benefits of Breastfeeding”
Guidance
More Living Programs: Complex Case Management, Exercise Program, Stress Management Program, Mental Health Services,
Nutrition Program, Weight Management Program, Chronic Care Program, Health Topics, Emotional Health Program
Tools: Trackers, calculators and more to make life easier and healthier.
24/7 NURSE LINE
We can help you:
Have a health-related question?
Our 24/7 Nurse Line is ready
with answers, any time, from
anywhere, around the clock. You
can get trusted, doctor-approved
information, tips and guidance
from an experienced, caring
registered nurse.
› Decide if the Emergency
Room, a doctor visit or self-care
is right for your needs
› Get tips on nutrition and exercise
to help you maintain a
healthy weight
› Learn more about a diagnosis*
› Learn about health screenings
and immunizations
› Explore the risks, benefits and
possible outcomes of treatment
options
*Our nurses cannot provide a
diagnosis over the phone, but they
will help you decide what to do next.
More Tools: Hospital Advisor, Online Health Records, Symptom Checker, Weight Tracker
Savings: Ways to spend less money on the things that help you get healthy.
HEALTHY DISCOUNTS
Saving money never felt so
healthy! Presenting the next
generation Blue365® —a fresh
take on our valued member
discount program. Blue365 has
a brand-new look, a range of
new features, and even greater
discounts from top national and
local retailers on fitness gear, gym
memberships, family activities,
healthy eating options, and
much more.
Visit Blue365deals.com/
HorizonBCBS to find deals on:
› Fitness
› Healthy eating
› Living
› Personal care
› Wellness
For more information, please visit us at
HorizonBlue.com/OMNIA or call 1-866-260-5792
Monday through Friday, 8 a.m. to 8 p.m., ET.
Horizon Blue Cross Blue Shield of New Jersey is an independent licensee of the Blue Cross and Blue Shield Association. The Blue Cross® and Blue Shield® names and symbols, and Blue365®,
are registered marks of the Blue Cross and Blue Shield Association. The Horizon® name and symbols and Precious Additions® are registered marks, and OMNIASM is a service mark, of
Horizon Blue Cross Blue Shield of New Jersey. ©2015 Horizon Blue Cross Blue Shield of New Jersey, Three Penn Plaza East, Newark, New Jersey 07105.
HorizonBlue.com/OMNIA