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New Jersey News

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6/8/11 - Effective January 1, 2011, groups with Massachusetts residents are required to cover state mandated core services and a broad range of medical benefits for all Massachusetts residents to
meet the Minimum Creditable Coverage (MCC) Certification in Massachusetts. Included are maternity benefits for female dependent children. The standard 51 to 99 plan designs sold by Horizon Blue Cross Blue Shield of New Jersey exclude dependent maternity services. As a result, Massachusetts employees will be penalized on their state income taxes for not having creditable coverage, if they remain in the group plan. There is no requirement for the health plan to cover the dependent maternity benefits, and the group has the option to not comply with the MCC requirements; however, Horizon BCBSNJ provides an alternative for those groups that want their Massachusetts employees to have creditable coverage.

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7/27/11 - Get more for your Health Care Dollars with the ExtraCare Health Card -  Effective July 1, 2011, Horizon Blue Cross Blue Shield of New Jersey subscribers who have pharmacy benefits through Horizon BCBSNJ will receive a CVS ExtraCare┬«┬┤┬┤Health Card. The ExtraCare Health Card is an exclusive program that provides a 20 percent savings on eligible CVS/pharmacy brand health-related items.


8/1/11 -Horizon Brief Notes MLR - Average Employee Counts for Medical Loss Ratio (MLR) reporting due August 19, 2011. The Affordable Care Act (ACA) established new rules related to medical loss ratios (MLRs) effective January 1, 2011. The ACA requires health insurance companies to provide premium rebates to enrollees when they do not meet certain MLRs for fully insured business in the individual and small and large group markets. To determine MLRs and potential rebates due, the law requires health insurance companies to obtain the average number of employees during the preceding calendar year for each employer group. To comply with federal requirements, Horizon Blue Cross Blue Shield of New Jersey is collecting from fully insured group customers with 200 and fewer enrollees, their average number of employees in calendar year 2010. The information is due by August 19, 2011.

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8/10/11 - Notice to Tri-State Brokers: Pharmacy Benefit Mail Order Cost Correction. It was recently discovered that certain members were undercharged for their pharmacy mail-order benefit.
Please note that the error has been corrected and several documents have been sent out to the members. The three documents are as follows:  The official communication from UnitedHealthcare/Oxford, the member letter and the letter to the employers. Affected members will not be required to pay retroactive payments but they will be charged the correct amount the next time they use their pharmacy mail-order benefit.


7/29/11 - AmeriHealth New Jersey launched its newest lower-cost SEH drug option: AmeriHealth New Jersey Custom Rx. This pharmacy product line is now available for all benefits plans in the following lines of business: PPO, POS, POS Plus, HMO, and HMO Plus. Save up to 27% compared to our $0 deductible plans with these lower-cost drug options. Each plan will include an up-front deductible that is applicable to brand drugs only, regardless of formulary. Generic drugs are not applied to the deductible.