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Blue Cross Blue Shield Of Nj - Health Insurance by Blue Cross Blue Shield of NJ

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Blue Cross Blue Shield of NJ is the largest health insurance provider in the state, with over 3.5 million members. The company is headquartered in Newark and has more than 4,700 employees to take care of all facets of business. It is the only non-profit corporation for healthcare services in New Jersey. Blue Cross Blue Shield of NJ develops and manages quality affordable healthcare insurance and related products for both private and public markets. Both group plans and individual plans are available in a network of over 35,800 physicians and 72 hospitals.

Horizon Blue Cross Blue Shield of NJ was founded in 1932 as the Associated Hospitals of Essex County, Inc. Four years later, the plan was offered statewide and was known as the Hospital Service Plan of New Jersey. In 1960, state employees began to be enrolled in Blue Cross and Blue Shield. When Hospital Service Plan of New Jersey and Medical-Surgical Plan of New Jersey merged in 1986, the resulting company became Blue Cross Blue Shield of NJ. Twelve years later, in 1998, the company added the word “Horizon” before the existing company name and began a corporate restructuring process that would make Horizon Blue Cross Blue Shield of NJ what it is today.

Horizon Blue Cross Blue Shield of NJ is headed by President and CEO William J. Marino and 15-member board of directors. In 2009, they posted total revenues of $8.3 billion and capital reserves of $1.7 billion.

Several awards of recognition have been earned by Horizon Blue Cross Blue Shield of NJ. Some of those awards include the following:

  • New Jersey HMO Performance Report – Top Ranking
  • NCQA – Excellent Status
  • Standard & Poor – A Rating
  • New Jersey Business and Industry Association – Award for Excellence
  • Technology Managers Forum – Best Practice Award
  • Biotech Medical Management Association – Leadership in Healthcare Award
  • Communicator Awards Program – Excellence in Communication

Eight basic individual and family plans are offered by Blue Cross Blue Shield of NJ to the general public in the state. Here are some of the details for the plans offered:

Horizon Basic and Essential EPO and EPO Plus
This plan provides policyholders with in-network-only access to basic healthcare services. Out-of-network doctors or hospitals can be used only in medical emergencies. The Horizon Managed Care Network provides all services. Examples of coverage include $30 office copay, $700 outpatient treatment, $500 copay for inpatient services, and $100 copay for emergency room services.

Horizon Individual Direct Access Plan A/50 70/50
This plan allows policyholders to receive healthcare from in-network sources or from physicians and hospitals outside the network without the need for referrals. An annual deductible must be chosen for either $2,500 or $5,000. Copayments of up to $30 for office visits apply and coinsurance is 50% to 70%. Out-of-pocket limits are $5,000/$10,000 for in-network and $15,000/$30,000 for out-of-network. Lifetime benefits are unlimited.

Horizon Individual Direct Access Plan C 80/70
This plan provides for higher coinsurance payments than the A/50 70/50 plan. Deductibles are still $2,500 or $5,000, but coinsurance goes to 80% or 70%. Maximum out-of-pocket limits are $5,000/$10,000 for in-network and $10,000/$20,000 for out-of-network.

Horizon Direct Access Plan C 100/70
This plan provides for the highest levels of coverage benefits of any of the Direct Access Plans. There are no deductibles and office copayments in network are $30 for your PCP and $50 for others. Inpatient copayment is $300 per day and outpatient surgery is $60 per visit.

Horizon HMO
The Horizon HMO plans offer comprehensive coverage with low out-of-pocket expenses. Claim forms are simple to fill out and monthly rates are low. PCPs can be chosen from a network of over 10,000 physicians. Available HMS plans include the following:

  • HMO $15
  • HMO $30
  • HMO $30/$50
  • HMO $50/$70
  • HMO Coinsurance

Horizon Centurion Dental
This dental plan is very affordable at only $60/year for individuals. There are no deductibles and no maximum limits. Claims never have to be submitted.

Horizon Individual Dental
This plan allows for preventative care, and acceptance is guaranteed. The cost is only $180/year for individual insurance.

NJ Protect
This plan is for individuals who are uninsurable due to pre-existing conditions. There are two separate plans, but to be eligible, you must be a U.S. citizen or legal alien, a NJ resident, have been uninsured for the past 6 months, have a pre-existing medical condition. The two plans are the NJ Protect 100/70 and the NJ Protect 80/70.

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