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Horizon BCBSNJ2015 Individual/Small GroupProducts LaunchMEDICAL / PHARMACY / DENTAL / VISION / WELLNESS
Table of Contents Agenda . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2014 IHC Product Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .New 2015 Products Launch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .––––– IHC Marketing Campaign. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Horizon BCBSNJ Small Group Products. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .New 2015 Small Group Product Launch. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .–––2Advance EPO Bronze . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Advance EPO Silver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Patient Centered Advantage EPO Silver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Advantage EPO Gold . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Stand Alone Pediatric Dental IHC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3481620242935406164Patient Centered Advantage EPO Gold . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69Patient Centered Advantage EPO Silver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70Stand Alone Pediatric Dental Small Group Product . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73Horizon Sales Training
Agenda Review of the IHC 2014 products New product offerings for 2015 Advertising/Marketing Campaign – Hispanic Initiative Review of the Small Group 2014 products New product offering for 2015 SAPD product offerings for 2015 Q&A3Horizon Sales Training
2014 IHC Product Review4Horizon Sales Training
Advantage EPO Essentials High deductible/lower 0 copaypremiums Three PCP visits included0% member Preventive services coveredcost share (afterdeductible) For persons under 30All charges Cannot receive subsidiesapply towardMOOP5Horizon Sales Training
Advance EPOGold and Silver PCP selection requiredcopay Referrals required(no deductible) Integrated medical and pharmacymemberbenefitscost share (after Utilizes Managed Care Networkdeductible)Tier 1 Advance network subset of MCNmember Preferred Tier 1 Hospital Networkcost share (after All other hospitals in MCNdeductible) In network benefits onlyTier 266Horizon Sales Training
Advantage EPOBronze and Silver PCP selection optional No referrals required Integrated medical andpharmacy benefits In network benefits onlycopays(Silver-no deductible)(Bronze-after deductible)membercost share(after deductible)Rx included77Horizon Sales Training
New 2015 Products Launch8Horizon Sales Training
Product PortfolioEPOProducts99 Products(37variations)OnMarketplaceEPO &SAPDProducts 10ProductsOffMarketplaceHorizon Sales Training
Off Marketplace ProductsAdvance EPO GoldAdvantage EPO GoldAdvance EPO SilverAdvance EPO Silver 40-70%Advantage EPO SilverPatient Centered Advantage EPO SilverAdvance EPO BronzeAdvantage EPO BronzeAdvantage EPO Essentials-Catastrophic PlanStand Alone Pediatric Dental10Horizon Sales Training
On Marketplace ProductsAdvance EPO GoldAdvantage EPO Gold (3 variations)Advance EPO SilverAdvance EPO Silver 40-70% (6 variations)Advantage EPO SilverPatient Centered Advantage EPO Silver (6 variations)Advance EPO Bronze (3 variations)Advantage EPO BronzeAdvantage EPO Essentials-Catastrophic Plan11Horizon Sales Training
Advance EPO Network2015 ChangesTier 1Tier 2PhysicianHospitalsHospitalsChangesSt. Joseph’s Hospital andMedical CenterSt. Joseph’s Wayne HospitalKimball Medical CenterAnnualre-evaluation of grouppractices (physicians)2015 Horizon Advance EPOParticipation Changes(pdf listing)Our Lady of Lourdes MedicalCenter12St. Mary’s Medical CenterPhysician lettersMember lettersInternal Q&AHorizon Sales Training
Horizon Advance 2014/2015 ComparisonAdvance Practitioner Comparison CountsSPECIALTYTOTAL PCPTotal SPECIALIST/ OTHERHEALTHCAREPROFESSIOANLSGRAND TOTAL2014 ADVN5,4812015 82,335Advance Inclusion Percentage ComparisonSPECIALTYTOTAL PCPTotal SPECIALIST/ OTHERHEALTHCAREPROFESSIOANLSGRAND TOTAL2014 ADVN %Included68%2015 ADVN %Included78%% Increase10%59%61%64%67%5%6%Advance 2014 data as of 5/31/2014Advance 2015 data as of 7/02/20141313Horizon Sales Training
HORIZON HOSPITAL NETWORKNJ – 62 Hospitals /77 LocationsPA – 12 Hospitals/13 LocationsNY – 2 Hospitals/2 LocationsDE – 1 Hospital/1 Location14Horizon Sales Training
Introducing .15Horizon Sales Training
Advance EPO Bronze 40 PCPcopay (afterdeductible) PCP selection required Referrals required40%/50% Integrated medical andmember costpharmacy benefitsshare (after Preferred Tier 1 Hospitaldeductible)All copays,Networkdeductibles & In network benefits only coinsurances applyto MOOP1616Horizon Sales Training
Advance EPO BronzeDeductible 2,500/ 5,000Tier 1Out- ofpocket limits 6,600/ 13,200Tier 1PrescriptionSubject toTier 1 deductible50% member cost shareafter Tier 1 2,500/ 5,000Tier 217 6,600/ 13,200Tier 2Applies towardMOOPHorizon Sales Training
Product Strategy Affordable Basic Health Insurance Plan for30 Individuals Access to our extensive network ofproviders and hospitals Great choice for customers not expecting alot of medical expenses18Horizon Sales Training
Introducing .19Horizon Sales Training
Advance EPOSilver 40-70% PCP selection required 40 PCP copay(no deductible) Referrals required Integrated medical andpharmacy benefits30%/50% member In network benefits onlycost share (afterdeductible) Advance Network of ProvidersAll copays Preferred Tier 1 Hospitaldeductibles &Networkcoinsurances applyto MOOP2020Horizon Sales Training
Advance EPOSilver 40-70%Deductible 2,000/ 4,000Tier 1Out- ofpocket limits 5,000/ 10,000Tier 1PrescriptionSubject toTier 1 deductible30% member costshare 2,500/ 5,000Tier 221 6,600/ 13,200Tier 2Applies towardMOOPHorizon Sales Training
Product Strategy On Exchange Basic Silver health plan with acompetitive price point 8 Variations On Exchange with Cost SharingSubsidies Coinsurance and copays slightly higherresulting in reduced premiums22Horizon Sales Training
Introducing .23Horizon Sales Training
Patient Centered AdvantageEPO Silver PCP selection optional No referrals required Integrated medical andpharmacy benefits In network benefits only 20 copay (nodeductible) ifmember selects aPCMH or ACO PCP 30 copay (afterdeductible) if memberselects a non-PCMH orACO PCPAll chargesapply to MOOP2424Horizon Sales Training
Patient Centered AdvantageEPO SilverDeductible 2,000IndividualOut- ofpocket limits 5,000IndividualPrescription 10 copayGeneric(after deductible)40% member cost shareBrand(after deductible) 4,000Family25 10,000Family50% member cost shareNon-formulary(after deductible)Horizon Sales Training
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Product Strategy Provide a personalized and comprehensivehealth care program enabling patients to be“engaged” in their health care Improve reimbursement to support physicians inmanaging and improving health outcomes andoverall patient experience 8 variations On Exchange27Horizon Sales Training
Introducing .28Horizon Sales Training
Advantage EPO Gold PCP selection optional No referrals required Integrated medical andpharmacy benefits In network benefits only29 15 PCP copay(no deductible) 30Specialist copay(no deductible)20%member cost share(after deductible)Horizon Sales Training
Advantage EPO GoldDeductible 1,000IndividualOut- ofpocket limits 4,000IndividualPrescription 10 copayGeneric(no deductible)40% member cost shareBrand(no deductible) 2,000Family30 8,000Family50% member cost shareNon-formulary(no deductible)Horizon Sales Training
Product Strategy Premium Gold Plan allowing members access toour extensive network of providers with noreferrals True 80% coinsurance plan with lower copaysand deductibles for in network services Access to our managed care network ofhospitals (no tiers)31Horizon Sales Training
Advantage EPO Essentials 2015 6,600/ 13,200 deductible &MOOP Three PCP visits included Preventive services covered For persons under 30 Not subsidy eligible 0 copay0% member costshare (afterdeductible)All charges applytoward MOOP3232Horizon Sales Training
Details of Individual On/Off Marketplace ProductsAdvance EPOGoldAdvance EPOSilverAdvance EPOSilver 40/70%Advance EPOBronzeAdvantage EPOGoldAdvantage EPOSilverPatient CenteredAdvantage EPO SilverAdvantage EPOBronzeAdvantage EPOEssentialsPCP alOptionalReferrals RequiredYesYesYesYesNoNoNoNoNoDeductible Individual 1,000 Tier 1 2,000 Tier 2 1,500 Tier 1 2,500 Tier 2 2,000 Tier 1 2,500 Tier 2 2,500 Tier 1 2,500 Tier 2 1,000 2,000 2,000 2,500 6,350Deductible Family 2,000 Tier 1 4,000 Tier 2 3,000 Tier 1 5,000 Tier 2 4,000 Tier 1 5,000 Tier 2 5,000 Tier 1 5,000 Tier 2 2,000 4,000 4,000 5,000 12,700Copay (PCP/Specialist) 15 PCP 30 Specialist 30 PCP30% Specialist 40 PCP(after deductible)40% Specialist(after deductible) 15 PCP 30 Specialist 25 PCP 50 Specialist 20 PCMH/PCP 30 non-PCMH/PCP(after deductible)30% Specialist(after deductible) 30 PCP(after deductible)50% Specialist(after deductible) 0Cost Share(after deductible)20% Tier 140% Tier 230% Tier 150% Tier 230% Tier 150% Tier 240% Tier 150% Tier 220%40%30%50% 0MOOP Individual 2,500 Tier 1 4,000 Tier 2 5,000 Tier 1 6,350 Tier 2 5,000 Tier 1 6,600 Tier 2 6,600 Tier 1 6,600 Tier 2 4,000 6,350 5,000 6,,350 6,,600MOOP Family 5,000 Tier 1 8,000 Tier 2 10,000 Tier 1 12,700 Tier 2 10,000 Tier 1 13,200 Tier 2 13,200 Tier 1 13,200 Tier 2 8,000 12,700 10,000 12,00 13,200Prescription(generic/brand/non-formulary) 10/40%/50%No deductible30% after Tier 1deductible30% after Tier 1deductible50% after Tier 1deductible 10/40%/50%No deductible 15/40%/50%No deductible 10/40%/50%after deductible50% afterdeductible0% afterdeductible33 40 PCP(no deductible)30% Specialist(after deductible)Horizon Sales Training
Guide to Selecting 2015 Individual PlansListen For: See doctors often; may have a chroniccondition; take medications regularlyConsider: Gold and Silver plans with higher premiumsbut lower deductibles and OOP costsYesWould youpay more forgreaterflexibility?Listen For: Annual checkup and preventative care; rarelysee doctors; do not take medications regularlyA LotHow muchmedical care doyou typicallyuse?Not MuchNoConsider: Silver and Bronze plans with lower premiumsbut higher deductibles and OOP costsNoAre you underthe age of 30?Consider: Advantage Plans that do notrequire referrals to see specialists.Larger number of PCPs and SpecialistsConsider: Advance Plans with lower OOP costs. PCPreferrals are needed to see a specialistYesConsider:Essentials Planwith a lowpremium but highdeductible and noco-payment forfirst 3 PCP visitsper yearAdvance EPOGoldAdvance EPOSilverAdvance EPOSilver 40/70%Advance EPOBronzeAdvantageEPO GoldAdvantageEPO SilverPatient CenteredAdvantage EPOSilverAdvantage EPOBronzeAdvantageEPOEssentialsPCP/Referrals RequiredYesYesYesYesNoNoNoNoNoDeductible Individual (T1/T2) 1,000/ 2,000 1,500/ 2,500 2,000/ 2,500 2,500/2,500 1,000 2,000 2,000 2,500 6,600Deductible Family (T1/T2) 2,000/4,000 3,000/ 5,000 4,000/ 5,000 5,000/ 5,000 2,000 4,000 4,000 5,000 13,200 40 PCP(after deductible)40% Specialist(after deductible) 15 PCP 30Specialist 25 PCP 50Specialist 20 PCMH/PCP 30 non-PCMH/PCP(after deductible)30% Specialist(after deductible) 30 PCP(afterdeductible)30% Specialist(afterdeductible) 0Copay (PCP/Specialist) 15 PCP 30 Specialist 30 PCP30% Specialist 40 PCP(no deductible)30% Specialist(after deductible)Cost Share (T1/T2)20%/40%30%/50%30%/50%40%/50%20%40%30%50% 0MOOP Individual (T1/T2) 2,500/ 4,000 5,000/ 6,350 5,000/ 6,600 6,600/ 6,600 4,000 6,350 5,000 6,350 6,600MOOP Family (T1/T2) 5,000/ 8,000 10,000/ 12,700 10,000/ 13,200 13,200/ 13,200 8,000 12,700 10,000 12,700 13,20034Horizon Sales Training
Stand Alone Pediatric DentalIHC Product35Horizon Sales Training
SAPD Review The ACA continues to mandate anyone purchasing insurance OffMarketplace must purchase a Marketplace certified SAPD planwhether they have children or not 36The IHC Group SAPD products have been modified to per ACArequirements for 2015Horizon Sales Training
Horizon Young GrinsPPO Low PlanDescription37BenefitsDeductible (Preventive, Diagnostic)IndividualFamily 0 0Deductible (Basic, Major)IndividualFamily 100 200Benefit Period MOOP (Basic, Major and Ortho)IndividualFamily 350 700Co-Insurance/Co-incentive Plan offeredN/APreventive/DiagnosticPeriodic Oral EvaluationProphylaxisFluorideX-RaysLab and TestsSealants Application100% (Once/6 months)100% (Once/6 months)100% (Once/6 months)100% (Once/6 months)100%100%Horizon Sales Training
Horizon Young GrinsPPO Low PlanDescriptionBenefitsBasicEmergency PalliativeSpace Maintainers80%80% (When appropriate)Surgical ExtractionsSimple ExtractionsImpacted Teeth80%80%80%Oral SurgeryAnesthesia80% (When appropriate)Amalgam Restorations80%Composite Restorations80%PeriodonticsScaling and Root PlanningGingivectomyPeriodontal MaintenanceOsseous Surgery3880% (Once/1 year)80% (Once/3 years)80% (Once/6 months)80% (Once/3 years)Horizon Sales Training
Horizon Young GrinsPPO Low PlanDescriptionEndodonticsRoot Canal Therapy-Anterior and BicuspidRoot Canal ns50% (Once/5 r Prosthetics50% (Once/5 years)50% (Once/7.5 years)50% (Once/6 months)50%Orthodontics(medically necessary)50% (Pre-authorization required)39Horizon Sales Training
IHC Marketing Campaign40Horizon Sales Training
2015 IHC Marketing Objectives and TargetsObjectives: Uninsured(incl.Hispanic)Achieve Significant net new membership growthExpand our leading IHC market shareSignificantly increase engagement & acquisition of new Hispanic e PlanHispanic Marketing ProgramBroker41 Channel Support41Horizon Sales Training
2015 IHC Marketing StrategyOverview1 BuildAwarenessAdvertising in mass media channels to build an emotional connection andawareness of the brand so it is top of mind for consumers seeking health insurance.2 Generate LeadsUse digital, social, direct marketing and community events to drive interestamong NJ consumers to seek specific information on Horizon’s individualheath insurance products.3 Engage at RetailLeverage on the ground presence at grassroots events, retail, and call centers to: (a)educate consumers on health insurance products in general and Horizon’s productsin particular (b) clarify the enrollment process, including identifying subsidy vs.Medicaid eligibility; and (c) encourage consumers to enroll in a Horizon product4 Enroll/Renew42Actively engage and support prospective customers in the enrollment processthrough telesales or in person enrollment activity at events and retail settings;provide the same support for renewing customers.Horizon Sales Training
Consumer Pain PointsCONFUSION“When the new healthcare law came out I had a lot of questions. There was a lot ofconfusion .I was stressing and worrying so much that I was literally getting sick.”Jenna, New Horizon BCBSNJ MemberAFFORDABILITY“I was healthy, but here I am getting sick, knots in my gut, just trying to find goodaffordable health insurance. It was making me very anxious and I felt lost.”John, New Horizon BCBSNJ MemberCOMPLEXITY“For me, the confusion was less on the side of the new healthcare law and more ofwhat is the deal with all of these insurance companies and all of these differentpolicies . Matthew, New Horizon BCBSNJ Member43Horizon Sales Training
Matthew44Horizon Sales Training
John45Horizon Sales Training
Lazzaro46Horizon Sales Training
Melissa47Horizon Sales Training
Print Advertising48Horizon Sales Training
Out-of-Home Advertising49Horizon Sales Training
MEDIA PLANMid-November – February 15, 2015Key Counties for Uninsured and HispanicEssex, Hudson, Camden, Union, Ocean, Middlesex, Passaic and Bergen.Channels: Cable n Sales Training
2015 IHC Marketing StrategyOverview1 BuildAwarenessAdvertising in mass media channels to build an emotional connection andawareness of the brand so it is top of mind for consumers seeking health insurance.2 Generate LeadsUse digital, social, direct marketing and community events to drive interestamong NJ consumers to seek specific information on Horizon’s individualheath insurance products.3 Engage at RetailLeverage on the ground presence at grassroots events, retail, and call centers to: (a)educate consumers on health insurance products in general and Horizon’s productsin particular (b) clarify the enrollment process, including identifying subsidy vs.Medicaid eligibility; and (c) encourage consumers to enroll in a Horizon product4 Enroll/RenewActively engage and support prospective customers in the enrollment processthrough telesales or in person enrollment activity at events and retail settings;provide the same support for renewing customers.51Horizon Sales Training
Targeted Direct Mail52Horizon Sales Training
DRTV TV Spots53Horizon Sales Training
DRTV Market Coverage & Proposed Networks 13 of 21 NJ counties in NY MarketBergen HudsonSussexMiddlesex UnionHunterdonEssex PassaicWarrenOceanMonmouth SomersetMorris8 of 21 NJ counties in Philadelphia Market Camden Atlantic Burlington Cumberland Mercer Cape May Gloucester SalemHISPANIC STATIONS54Horizon Sales Training
2015 IHC Marketing Strategy Overview1 BuildAwarenessAdvertising in mass media channels to build an emotional connection andawareness of the brand so it is top of mind for consumers seeking health insurance.2 Generate LeadsUse digital, social, direct marketing and community events to drive interestamong NJ consumers to seek specific information on Horizon’s individualheath insurance products.3 Engage at RetailLeverage on the ground presence at grassroots events, retail, and call centers to: (a)educate consumers on health insurance products in general and Horizon’s productsin particular (b) clarify the enrollment process, including identifying subsidy vs.Medicaid eligibility; and (c) encourage consumers to enroll in a Horizon product4 Enroll/RenewActively engage and support prospective customers in the enrollment processthrough telesales or in person enrollment activity at events and retail settings;provide the same support for renewing customers.55Horizon Sales Training
Mall / Retail56Horizon Sales Training
Insurathons Concentrated period of time where we focus allmarketing and promotional activity– 12/5 – 12/15– 2/5 – 2/15 Expanded hours and presence PR & Social Media opportunities57Horizon Sales Training
Hispanic Outreach & Digital Activities58Horizon Sales Training
Hispanic Billboard59Horizon Sales Training
Creative ThemeEducational leadershipFriendly expertsTechnology made humanAnswers and understanding.Not just service genuine caringWhat switchers aren’tgetting from their planCaptures hearts and minds60Horizon Sales Training
Horizon BCBSNJ Small GroupProducts61Horizon Sales Training
Review of 2014Implementation of new broker portalGrandmotheringLaunch of two new Patient Centered Advantage EPO plans62Horizon Sales Training
New 2015 Small GroupProduct Launch63Horizon Sales Training
Horizon’s Small GroupMedical Product PortfolioDAEPOHSA648 orizon Sales Training
Small Group Off Exchange ProductsMedical ProductAdvantage Direct Access 100/70Advantage Direct Access 100/80/60Advantage EPO 100% C20/40Advantage EPO 100% C30/50Advantage EPO 100/80Advantage EPO 100/70Advantage EPO 100/50PCMH Advantage EPO 100/50HSA Advantage Direct Access 100/80/60HSA Advantage EPO 100% C30/50Patient Centered Advantage EPO Bronze40/50%/50%Patient Centered Advantage EPO Silver20/30/70%Patient Centered Advantage EPO Gold 5/20/4065In NetDed * 1,500 1,000 1,500 2,000 2,000 1,500 2,000PCP/SpecCopay ERIn Net MOOP OON CoinBlue Card In Net CoinYes100% 20/ 40 3,00070%Yes100%/80% 20/ 40 100/ded/coin 3,00060%Option100% 20/ 40 5,000Option100% 30/ 50 5,000Option 100%/80% 20/ 40 100/ded/coin 4,000Option 100%/70% 30/ 50 100/ded/coin 6,000Option 100%/50% 30/ 50 100/ded/coin 6,000No100%/50% 30/ 50 100/ded/coin 6,000Yes100%/80% 30/ 50 6,00060%Option100% 30/ 50 100/ded 6,350 40/50% afterded/50% afterNo100%/50% 2,500ded 100/ded/coin 6,350 20/ 30 afterded/70% afterNo100%/70% 2,000ded 100/ded/coin 5,000No100%/80% 1,000 5/ 20/ 40 100/ded/coin 4,000-OON Ded OON MOOP 1,500 6,000 2,500 8,000 3,000 8,000-Packaged RX 10/ 25/ 50 15/ 40/ 75 15/ 40/ 75 15/60%/50% 10/ 25/ 50 15/ 40/ 75 15/60%/50% 15/60%/50%60% CDHRX50% CDHRXMetallic lverBronze-- 25/ 50/ 75(after ded)Bronze-- 10/ 35/ 70(after ded)Silver-- 10/60%/50% GoldHorizon Sales Training
Small Group On Exchange ProductsAdvantage Direct Access 100/80/60Advantage EPO 100% C20/40Advantage EPO 100/80Advantage EPO 100/70HSA Advantage EPO 100% C30/50YesNoNoNoNo100%/80%100%100%/80%100%/70%100% 1,500 1,000 1,500 2,000 20/ 40 100/ded/coin 3,000 20/ 40 5,000 20/ 40 100/ded/coin 4,000 30/ 50 100/ded/coin 6,000 30/ 50 100/ded 6,350Patient Centered Advantage EPO Silver20/30/70%No 40/50% afterded/50% after100%/50% 2,500ded 100/ded/coin 6,350 20/ 30 afterded/70% after100%/70% 2,000ded 100/ded/coin 5,000Patient Centered Advantage EPO Gold 5/20/40No100%/80% 1,000 5/ 20/ 40 100/ded/coin 4,000Patient Centered Advantage EPO Bronze40/50%/50%66No60%-- 2,500-- 8,000- 15/ 40/ 75 15/ 40/ 75 10/ 25/ 50 15/ 40/ 7550% CDHRXGoldGoldGoldSilverBronze- 25/ 50/ 75(after ded) Bronze--- 10/ 35/ 70(after ded) Silver--- 10/60%/50% GoldHorizon Sales Training
Introducing .67Horizon Sales Training
Patient Centered Advantage EPO Gold PCP selection optional No referrals required Integrated medical and pharmacybenefits In network benefits only 20% member cost share No Blue Card68 5 copay (nodeductible) ifmember selects aPCMH or ACO PCP 20 copay (nodeductible) if memberselects a non-PCMH orACO PCP 40 copay (nodeductible) if no PCPis selectedHorizon Sales Training
Patient Centered Advantage EPO GoldDeductible 1,000IndividualOut- ofpocket limits 4,000IndividualPrescription 10 copayGeneric(no deductible)40% member cost shareBrand(no deductible) 2,000Family69 8,000Family50% member cost shareNon-formulary(no deductible)Horizon Sales Training
Product Strategy Patient Centered Advantage EPO product expands thePatient Centered Medical Home offering and its capabilitiesto the Small Group market Horizon BCBSNJ has paired our Patient Centered MedicalHome capabilities with our Advantage EPO productfeatures in order to achieve a more competitive price pointin the marketplace70Horizon Sales Training
PCMH Member Advantages Patient-centered services benefit those who requirepreventive care, and for patients who have chronicconditions or extra health care needs Support for practice-employed care coordinators toachieve improvements in patient care for high-riskpatients. The care coordinator subsidy is given for the firsttwo years. Providers are eligible to receive outcome basedpayments for delivering high-quality care71
Patient Centered StatisticsQuality Measures 5 percent higher rate in improved diabetes control (HbA1c) 3 percent higher rate in breast cancer screenings 11 percent higher rate in pneumonia vaccinationsCost and Utilization Indicators 23 percent lower rate in hospital inpatient admissions 12 percent lower rate in Emergency Room (ER) visits 9 percent lower cost of care for diabetic patients 6 percent lower total cost of care72
Stand Alone Pediatric DentalSmall Group Product73Horizon Sales Training
Stand Alone Pediatric DentalOverview: Stand-Alone Pediatric Dental (SAPD) product is offered OffExchange for the Small Group market in order to be in compliancewith Health Care Reform (HCR) federal and state mandates Horizon will be offering one SAPD product effect January 1, 2015:Horizon Young Grins, a plan with in network benefits only. National Grid available for out of state in network providers74Horizon Sales Training
Stand Alone Pediatric DentalSmall Group Product Requirements - New Sales and SAPD Moving from offering two SAPD products in 2014 to one withinthe Small Group market. Horizon Young Grins Plus is being withdrawn and will no longerbe an option at the time of renewal. Groups will be automatically converted to the Young Grinsproduct upon renewal75Horizon Sales Training
Small Group Product RequirementsNew Sales33 Free-Standing Dental Plans are available for new D2191D161D217176PRODUCT NAMEDENTAL COMPANION POLICY WITH SEALANTSPPO ACCESS PLAN (SMALL GROUP ONLY)PPO 50/ 1500 100/80/50 WITH WAITDOP 50/ 1500 100/80/50 NO WAIT NATGRID DOP 50/ 1500 100/80/50 W/WAIT NATGRID DOP 50/ 1500 100/80/50 W/WAIT NATGRID PPO 50/ 1500 100/80/50 NO WAITDOP 50/ 1500 100/80/50 NO WAIT NATGRID DENTAL COMPANION POLICY W/O SEALANTSDOP 50/ 1500 100/100/50 W/WAIT NATGRID DOP 50/ 1500 ORTHO 750 W/WAIT NATGRID PPO ACCESS 10-50 NJPPO 50/ 1000 100/80/50 WITH WAITDOP 50/ 1500 ORTHO 750 NO WAIT NATGRID DOP 50/ 1500 ORTHO 750 NO WAIT NATGRID DOP 50/ 1000 100/80/50 W/WAIT NATGRID DOP 50/ 1000 100/80/50 NO WAIT NATGRID 7D2314D2548D165PRODUCT NAMEPPO 50/ 1500 100/80/50 ORT- 750 NO WAITPPO 50/ 1000 100/80/50 NO WAITDOP 50/ 1500 100/100/50NO WAIT NATGRID DOP 50/ 1500 ORTHO 750 W/WAIT NATGRID DOP 50/ 1000 100/80/50 W/WAIT NATGRID DOP 25/ 1500 100/80/50 W/WAIT NATGRID DOP 25/ 1500 100/80/50 NO WAIT NATGRID PPO 25/ 1500 100/80/50 WITH WAITDOP 25/ 1500 100/80/50 W/WAIT NATGRID DOP 50/ 1500 ORT 1000 NO WAIT NATGRID PPO 50/ 1500 100/80/50 ORT- 750 W/WAITDOP 50/ 1000 100/80/50 NO WAIT NATGRID DOP 50/ 1500 100/100/50 NO WAIT NATGRID DOP 25/ 1500 100/80/50 NO WAIT NATGRID DOP 50/ 1500 100/80/60 NO WAIT NATGRID DOP 50/ 1500 100/100/50 W/WAIT NATGRID Horizon Sales Training
Pediatric Vision There is NO Horizon adult vision plan, but there is an adult visionscreening that is part of the wellness annual check up There is a Horizon Vision Benefit for persons under the age of 19Description77BenefitsEye examination, inclusive of dilationOnce per calendar yearSpectacle lensesOnce per calendar yearFrames, inclusive of fashion levelUp to 125, Once/calendar yearContact lens evaluation, fitting and follow-upOnce/calendar yearContact lenses in lieu of eyeglasses (pre-approval required)Once/calendar yearHorizon Sales Training
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30 Horizon Sales Training Advantage EPO Gold Deductible 1,000 4,000 Individua l 2,000 Family Out- of-pocket limits Individual 8,000 Family Prescription 10 copay Generic (no deductible) 40% member cost share Brand (no deductible) 50% member cost share Non-formulary
