Consumers have already begun enrolling in OMNIA health plans, which offer lower premiums than other Horizon plans and less cost-sharing if consumers agree to seek care from a list of preferred providers, according to the report.
Horizon is New Jersey’s largest health insurer, with about 3.8 million people enrolled in its health plans. It has projected 250,000 people will enroll in the new OMNIA plans, which take effect Jan. 1. The OMNIA plans divide providers into two tiers. Those included in “Tier 1,” the preferred group, agree to receive lower reimbursements from Horizon in exchange for seeing more patients. Patients that visit providers included in “Tier 2” will have higher deductibles, coinsurance and copayments.
OMNIA plans are currently being sold to small business, government employees on the State Health Benefits Program, and individuals, including those who receive subsidies through the federal marketplace under the Affordable Care Act, according to the report. One of Horizon’s OMNIA plans has been used as a basis to calculate the subsidies for all New Jersey customers on HealthCare.gov who receive subsidies. If the plan were to be removed, subsidies for everyone purchasing health plans on the federal marketplace would need to be recalculated.
On Nov. 20, 17 hospitals that have been relegated to Horizon’s “Tier 2” status filed an appeal against the state’s approval of the OMNIA plans, claiming the state “abdicated its responsibility” to act in the public’s best interest. The hospitals worry their non-preferred status would dissuade patients from choosing them for their healthcare services.
The 17 hospitals that requested the state rescind its approval of the OMNIA plans will now take their case to the Appellate Division of the State Superior Court and ask the court to reverse the state’s action, according to the report.
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