Horizon OMNIA Plans
Horizon Blue Cross released their new set of plans as of January 1, 2016 and they have created a ton of press, both good and bad. I won’t go over the criticisms of the plan, but I will cover what patients and business owners need to know before enrolling in one of the Horizon BCBS Omnia plans.
*The short summary is that these are great plans that everyone should look at to save money in premiums and out of pocket costs at their providers.
Horizon BCBS Omnia Explained
Blue Cross released these plans with their major goal of providing some lower priced plans for consumers and encouraging quality of care with financial incentives to your doctors. They hand selected certain providers that have proven success of providing good low cost care and other metrics they decided were important. Some of the goals that were established were; lowering re-admissions to the hospital, infections and other costly issues that can arise through normal course of care. So if you needed surgery and have to be readmitted to the hospital in a month because of complications, the provider would not get any incentives for that. If your doctor does the perfect job every time with no infections, no re-admissions etc.. that provider would receive a financial bonus. Its good for you and the doctors. (As an aside, you would think that would be the goal anyway but…. that’s a story for another day)
The Horizion Omnia network continues to be confusing to people and I can certainly understand why. All of the literature that Horizon has put out is basically just patting themselves on the back for their great new product and how great the hospitals are and other things that don’t really help with understanding the plan.
The hospitals in the Omnia plans are IDENTICAL to the normal Horizon Managed care network. So if you had HMO, Advantage, POS or EPO, your hospitals have not changed… What has changed is what Tier structure those hospitals fall into. The Omnia plans use a Tier structure so you pay less at Tier 1 providers than you would at Tier 2.. If your provider is Tier 2, you can still visit those doctors but it will be higher cost.
Depending on if you are in a small group plan or large group, the Tiers will be slightly different. In South Jersey, there is a large difference. Atlanticare is Tier 1 for Midsize market and Tier 2 for small group. Shore Memorial hospital is Tier 1 for small group and Tier 2 for midsize.
Find your doctor:
Go to HorizonBlue.com and use their provider finder.
When you are doing your search, make sure you select the plan that you have in the drop down list.
Midsize and Large Group:
Small Group and Individual:
Select Omnia Silver, Omnia Bronze etc…
Omnia Deductible and Max Out of Pocket
With the exception of the Bronze and H.S.A, the Omnia plans do not have deductibles for Tier 1 providers. You will also notice that there are different maximum out of pockets listed for each Tier.
If you see a Tier 1 provider, that service will accumulate towards your Tier 1 Max and deductible if it applies. Those costs will also cross accumulate to your Tier 2 max.
If you see a a Tier 2 provider, those costs ONLY count towards Tier 2.. They do not cross accumulate back to Tier 1.
Omnia Frequently Asked Questions – FAQ
- Do I need to select a primary care doctor?
- Nope, although you will pay the lower copay.
- Do I need referrals?
- No, they are all no referral plans
- Can I go out of network?
- No, this is in network only unless it is an emergency
- How are prescriptions covered?
- Prescriptions are all Tier 1
- How is urgent care covered?
- From what I have seen, all urgent care centers are Tier 1 for 2016. Even if the hospital is Tier 2..
- Do I get BlueCard nationwide access?
- The midsize plans do have BlueCard attached, but the small group and individual plans do not.
- My doctor says they don’t take Omnia, now what?
- Double check this.. Many people think that if the provider is not Tier 1, they aren’t part of the network. This is not true. Always double check with the website and ask for clarification. Get help from your broker with this.
- How is it fair that Horizon can pick and choose the Tier 1 hospitals?
- This is one of the criticisms on the plans and we will see what happens. There are many people fighting this.
- What if Horizon is told they can’t sell these plans anymore because it is not fair in how they selected their providers?
- If this does happen, Horizon will likely change the plans at renewal and you will need to select a new plan. Not much different than what they have been doing.
- I’m interested in learning more, what do I need to do?
- You can reach out to me anytime and I will review the plans and prices with you.
- What is the best Omnia Plan?
- I’m going to ignore the benefits and base my decision on the best value. Of all the plans I’ve reviewed, I like the H.S.A option and is what I personally own. The out of pocket limit is much lower than the other plans for their Tier 1 providers at $3500 annually.