For Immediate Release: Position of the Union side of the State Health Benefits Plan Design Committee on Tiered Network Plans being developed by Horizon and AETNA

For Immediate Release: Monday, Oct 5th, 2015

Contact: Joshua Henne: 732-407-5938

Position of the Union side of the State Health Benefits Plan Design Committee on Tiered Network Plans being developed by Horizon and AETNA

 (Trenton, NJ)  – Every year, the State Health Benefits Plan (SHBP) Design Committee reviews the plans that are offered to the hundreds of thousands of participants.  This year, the Union side of the Plan Design Committee supported two major innovations:  a) a lower cost Tiered Network, and b) an “add on” Direct Primary Care Medical Home (DPCMH) program that we designed in concert with Senate President Steve Sweeney.

Below, please find a statement from Union leaders on the SHBP Design Committee on Tiered Network Plans being developed by Horizon and Aetna. It is signed by Hetty Rosenstein (CWA), Kevin Lyons (NJPBA), Dave Jones (NJSTA), Mary Meeker (AFSCME), Patrick Nowlan, (AAUP/AFT) and Abdur Yasin (NJFMBA):

“While there may be some continued issues with Horizon about which hospitals they designated as Tier 1, we believe the program they’ve laid out will provide some of our members with the option we were looking for with a Tiered Network plan.  We also note that some of the hospitals – not covered by Horizon – will be covered by the new AETNA tiered network, and we think that competition in this situation will benefit our members and the State. We never believed this was a Plan from which all of our members would benefit.  However, the Tiered Network option is an important part of the package of options that the Plan Design developed, and we are anxious to implement them.

“The pilot Direct Primary Care Medical Home program that we developed with Senator Steve Sweeney, as well as a Tiered Network program, are two innovative options to provide quality healthcare while substantially reducing costs for both the public and for our members.  Bidding is taking place on the DCPMH program and Horizon has rolled out its OMNIA Tiered Network and AETNA is also developing a Tiered Network.”

The Union side of the Plan Design Committee supported developing a Tiered Network program that would be an option for our members that would provide the following:

  1. A premium savings of 25% or more over the most popular Preferred Provider Organization (PPO) plans.
  2. An extensive choice of primary care physicians, including all of the physicians that will be in the pilot Direct Primary Care Medical Homes.
  3. A narrower network of hospitals – called Tier 1 hospitals – where there would be no co-pays and deductibles or balanced billing, as well as provide for a second tier of hospitals that would be the same as the hospitals covered in the current PPO plans, that would have some co-pays and deductibles, but would have an Out of Pocket Maximum.
  4. Provide for 100% coverage if a participant is out of state or someplace where they must receive emergency or urgent care.