Recently we informed you that Horizon Blue Cross Blue Shield of New Jersey had issued notices of termination of its contracts with CHOP, which includes the hospital in Philadelphia and the specialty care centers in New Jersey, and the University of Pennsylvania Health System (UPHS), which includes Pennsylvania Hospital, Penn Presbyterian Medical Center and the Hospital of the University of Pennsylvania.

Please be advised that the terminations of CHOP and UPHS from the Horizon Hospital Network impact members differently, depending on their specific Horizon BCBSNJ health plan. The information included in this eAlert describes network access for their most popular plans. If your employees have specific questions they can contact their BenefitsVIP team for more information.

Effective March 11, 2009:
Horizon BCBSNJ Indemnity Members: Your employees can continue to access the Children’s Hospital of Philadelphia, which includes the hospital in Philadelphia and the specialty care centers in New Jersey, and the University of Pennsylvania Health System as they have in the past but may have higher out-of-pocket costs, depending on their plan’s benefits.

Horizon PPO Members: On an in-network basis, these members may access the Children’s Hospital of Philadelphia and the University of Pennsylvania Health System through the BlueCard PPO program. The front of the members’ ID cards should carry the PPO in a suitcase symbol, which indicates that they have BlueCard PPO coverage. On an out-of-network basis, these members may access the CHOP specialty care centers in New Jersey.

Horizon Direct Access Members with BlueCard PPO Coverage: On an in-network basis, these members may access the Children’s Hospital of Philadelphia and the University of Pennsylvania Health System through the BlueCard PPO program. The front of the members’ ID cards should carry the PPO in a suitcase symbol, which indicates that they have BlueCard PPO coverage. The CHOP specialty care centers in New Jersey are not accessible though the BlueCard PPO program, so members may access these centers on an out-of-network basis and will have to pay higher out-of-pocket costs than if they were to use in-network physicians and hospitals.

Horizon POS Members: On an in-network basis, these members may access the Children’s Hospital of Philadelphia, University of Pennsylvania Health System, and the CHOP specialty care centers in New Jersey only with a referral from their Primary Care Physician (PCP), except for emergency treatment. If they do not receive a referral from their PCP, these members may access Children’s Hospital of Philadelphia, University of Pennsylvania Health System, and the CHOP specialty care centers in New Jersey on an out-of-network basis (except for emergency treatment). These members will have to pay higher out-of-pocket costs than if they were to use in-network physicians and hospitals.

Horizon HMO, Horizon Medicare Blue Value and Medicare Blue Solutions Members: These members are covered for non-emergency care when they cannot use in-network physicians and hospitals, and have no out-of network benefits (except in the case of emergencies). However, Horizon BCBSNJ will transition these members to the appropriate facilities for their medical care, as you and your employees need it.

Horizon Medicare Blue Access Members: These members should not access the CHOP, the UPHS, and the CHOP specialty care centers in New Jersey since it is strictly out-of-network and will incur higher member liability.

Also, please not the important information about CHOP terminating its physicians from the Horizon BCBSNJ professional network. Horizon BCBSNJ received a letter form CHOP terminating its physicians form the Horizon BCBSNJ. This will be effective on September 17, 2009. At this time, it is not necessary for members to choose a new physician. Horizon BCBSNJ will facilitate a transition plan to a new PCP as they get close to the termination date of September 17, 2009.

WHAT DOES THIS MEAN TO YOU AS AN EMPLOYER?
In the next few days, you and your employees who are Horizon Blue Cross Blue Shield of New Jersey members will receive, at their house, an updated notice from Horizon Blue Cross Blue Shield of New Jersey explaining this change. In any event, Corporate Synergies will, as always, be reviewing before open enrollment every alternative out there for you and your employees. We are aware that your employees health insurance is an important benefit and that the convenience of having local hospitals in network is meaningful to you and your staff. We will continue to make sure that we explore every possibility to control your costs, check the in-network hospitals, and protect your employee’s family.

WHAT SHOULD I DO NEXT?
If you have questions regarding this eCommunication, please contact Corporate Synergies at 1.866.CSG.1719 or click here to contact us today.