By Brian Meade, Public Sector Account Manager
What’s on employees’ minds when it comes to health insurance? With more employers choosing one of Horizon’s new OMNIA℠ Health Plans, many employees want to know how to get the most out of their new plan and how to take advantage of the savings an OMNIA Health Plan can offer. With these plans, members benefit from Horizon BCBSNJ’s innovative approach to health care, giving members the flexibility to use our entire network of providers while taking greater control of their out-of-pocket costs.
Here are the six most common questions from employees about OMNIA:
Will I save money by choosing an OMNIA Health Plan?
Yes! Members choosing an OMNIA Health Plan will generally pay lower premiums than they would for a Horizon plan that offers similar benefits. And members who choose to use OMNIA Tier 1 physicians and hospitals will maximize their benefits while incurring lower cost sharing obligations. When members use OMNIA Tier 1 providers, they have no or low deductibles, and they will spend the least out-of-pocket.
What’s different about OMNIA?
There’s a lot that’s the same between OMNIA Health Plans and others we offer, including the ability to see any physician or other health care professional from our broad Horizon Managed Care Network. But there are a few key differences. OMNIA members:
- +Do not need to choose a Primary Care Physician (PCP). However, a PCP can help coordinate members’ care with other providers.
- +Do not need a referral to see in-network doctors.
- +Do not have out-of-network benefits for nonemergency care. However, when traveling outside of New Jersey, members and their covered dependents with BlueCard PPO® benefits are covered for care from out-of-state in-network doctors, hospitals or other health care professional nationwide. For OMNIA members with BlueCard coverage, those visits are treated the same in terms of cost-sharing as if a member visited a Tier 2 provider.
Will I still be able to see my same doctor?
Yes. If members have been seeing a doctor in the Horizon Managed Care Network prior to joining an OMNIA Health Plan, they will be able to see that same doctor afterwards. That’s because OMNIA Health Plans use the same provider network. Members have access to 45,000 doctors and 82 hospitals across New Jersey and Pennsylvania. If your current doctor is a Tier 1 phsychian, you can drastically lower your out-of-pocket costs, which means you can see your same doctor for less.
Why is my employer encouraging the move to an OMNIA Health Plan?
Employers and Horizon BCBSNJ share the same goal: providing high-quality health care that’s affordable and offers a superb patient experience – the so-called “triple aim” of health care. How?
- +The OMNIA Health Alliance provides leading physicians and facilities working together to reduce medical costs, improve preventive care and better control chronic health conditions.
- +By using OMNIA Tier 1 doctors, hospitals, and other health care professionals, members can dramatically lower their out-of-pocket costs.
- +OMNIA providers are rewarded for delivering high quality results, so members can be confident that their needs align with the care they receive.
If my costs may go down with an OMNIA Health Plan, does that mean I’ll receive less care?
No. Members can take advantage of the same Horizon Managed Care Network used by other plans, and all of Horizon’s in-network doctors provide high quality careand meet significant quality measures. OMNIA Tier 1 doctors and hospitals, however, have joined Horizon in committing to reduce the cost of health care by improving quality and coordination to give our members a better overall experience.
I’ve heard OMNIA described as a “value-based” health plan. What does that mean?
OMNIA Health Plans are built around the OMNIA Health Alliance, a first of its kind partnership in New Jersey that brought Horizon together with leading health systems and physician groups to work together on behalf of patients. OMNIA focuses on keeping our members healthy - not just helping them when they are sick. And it rewards doctors and hospitals for providing better care, not just more care. By working together, Horizon and our OMNIA partners are changing the way health care works in New Jersey to empower our members to achieve their best health. You can learn more about the OMNIA Health Alliance here.