For Plan Year 2020, the State Health Benefits Program (SHBP) will continue to offer an Incentive Program for the Horizon OMNIA Tiered-Network plan. This program encourages employees to subscribe to the Tiered-Network Plan by offering a financial incentive. New employees enrolling during the remainder of 2019 as well as Plan Year 2020 are eligible for this incentive.
The Incentive Program is available to first-time enrollees who must remain enrolled for one year, from January 1, 2020, through December 31, 2020. This program does not extend to over age children or COBRA members. The program offers a financial incentive to first-time enrollees at all coverage levels (i.e., Single, Member and Spouse, Parent and Child, or Family coverage) who remain enrolled for one year.
IMPORTANT – The incentive shall be forfeited and returned to the SHBP if you fail to remain enrolled in the Tiered Plan for one plan year, except if you become ineligible for healthcare due to: layoff, involuntary separation, reduction to part-time status, or classification into an ineligible position. If you voluntarily retire or change health plans due to catastrophic or emergency health needs as determined by the NJDPB after a full year, then the incentive shall be forfeited on a pro-rata basis.
State employees are automatically eligible to participate in the program. For local employees, the incentive program is voluntary and at the option of the employer; therefore, eligibility for the incentive is based on whether the employer participates. Local employers must complete a Resolution for the Incentive Program for the Tiered-Network plans .
The Horizon OMNIA Health Plan gives members the flexibility to visit practitioners in the carrier’s managed care network as well as significant premium share reductions, with no referrals required. The plan offers members lower cost sharing, with copays as low as $5.00 for an office visit, when utilizing Tier 1 providers. Tier 1 refers to specific doctors, hospitals and other health care professionals who offer cost-effective care. OMNIA plan members also have the flexibility to see any Tier 2 provider included in the managed care network, but with slightly higher cost sharing. There is no out-of-network coverage with either plan.
Note: This incentive is for active members enrolled in the SHBP only.
For more information about the tiered-network plan:
Horizon’s OMNIA Health Plan -- Members can identify Tier 1 and Tier 2 providers on the Horizon online Doctor & Hospital finder
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