Document

Report
Product Portfolio Strategy
mall employer market
S
(two to 50 employees)
Welcome

Streamlining product portfolio changes
due to federal health care reform law.

Horizon EPO is a more attractive
offering for our customers.

Consolidating products to one
company enables us to better manage
risk.
Strategic Purpose

First notification was sent to all affected
Groups and Brokers on 1/30/13.

Groups and Brokers will receive a letter
90 days prior to renewal, starting with
5/1/13 renewals.

Groups and Brokers will also receive a
60-day rate notification letter.
Notifications
Product Mapping
Top 5 HMO products being withdrawn:
Withdrawn Product
Mapped Product
HSA HMO ACCESS CDHRX CPT C30/50 D2500 M5000
HSA Advantage EPO CDHRX CPT C30/50 D2500 M5000
no Blue Card
Horizon HMO ACCESS COIN 100/80 PL D2500 C30/50
M4500
Advantage EPO 100/80 D2500 C30/50 M4500
no Blue Card
HMO ACCESS C25/50 M5000
Advantage EPO 100% C25/50 M5000 no Blue Card
Horizon HMO ACCESS COIN 100/50 PL D2500 C30/50
M5000
Advantage EPO 100/50 D2500 C30/50 M5000
no Blue Card
Horizon HMO ACCESS COIN 100/80 PL D1000 C20/40
M3000
Advantage EPO 100/80 D1000 C20/40 M3000
no Blue Card
Horizon Advantage EPO Key Features
What’s changing:
Horizon HMO to
Horizon Advantage EPO

No change in provider network.

Same underwriting rules.

Split copayments.

PCP selection is encouraged, but not
required. If PCP is not selected, higher
copayment may apply.

Benefits are provided for in-network
services only.

No BlueCard.

Prefix: JGV
 Groups currently within a withdrawn
product must complete a signed
conversion.
Submission Process
 Groups will automatically convert to
the recommended plan if they don’t
submit an electronic conversion.
Effective 1/1/13:
 NEW SMG Advantage EPO HAS
CDHRX100% D2500 M5000 C30-50
New Horizon
Advantage EPO
Plan Designs
Effective 3/1/13:
 SMG Advantage EPO 100 M5000 C20-40
 SMG Advantage EPO 100 M5000 C25-50
 SMG Advantage EPO 100-80 D1000
M3000 C20-40
 SMG Advantage EPO 100-80 D2500
M4500 C30-50
 SMG Advantage EPO 100-50 D2500
M5000 C30-50
Note: Rx benefits will remain the same
but will require submission of an
electronic conversion.
Additional Product
Withdrawals

Additional 13 products withdrawn
effective 5/1/13.

Mapping will be provided under
separate cover.

Combined membership impacted is
1,000.
Questions
Thank you!
Services and products provided by Horizon Blue Cross Blue Shield of New Jersey or Horizon Healthcare of

New Jersey, Inc., each of which is an independent licensee of the Blue Cross and Blue Shield Association.
Horizon Healthcare of New Jersey, Inc. is a subsidiary of Horizon Blue Cross Blue Shield of New Jersey.
The Blue Cross® and Blue Shield® names and symbols are registered marks of the Blue Cross and Blue Shield
Association.
The Horizon® name, symbols and Making Healthcare Work® are registered marks of Horizon Blue Cross
Blue Shield of New Jersey.
© 2013 Horizon Blue Cross Blue Shield of New Jersey, Three Penn Plaza East, Newark, New Jersey 07105-2200.

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