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Population: New or Prospective Non-Represented

Benefit Details

Your Coverage Options

All the medical options generally cover the same basic services. The difference is how you receive care and how you pay your health care expenses.The following options are available:

No Coverage

If you choose No Coverage, you're confirming that you have coverage elsewhere. You’ll receive a credit as taxable cash back in your paycheck.

Traditional Deductible Option

  • You have the freedom to choose any health care provider.
  • Annual Deductible: $2,000 per person, not more than $4,000 per family
  • Coinsurance: 80% of eligible charges after the deductible if you receive care from a PPO provider*; 60% of eligible charges after the deductible if you receive care from a non-PPO provider.
  • Annual Out-of-Pocket Limit: $4,000 per person, not more than $8,000 per family (including deductible).

*You can save money by using a provider that participates in the Horizon Preferred Provider Organization (PPO). A PPO is a network of health care providers (physicians, hospitals, laboratories, etc.) that has agreed to provide services at a discount. You don't have to use a provider that participates in the PPO network, but if you do, you’ll reduce your out-of-pocket costs.

Quick Reference

Selectline offers a Traditional Deductible option:

$2,000/$4,000 Deductible

  • Annual Deductible: $2,000 per person, not more than $4,000 per family.
  • Coinsurance: 80% of fees if you go to a PPO provider, after the deductible; 60% of fees if you go to a non-PPO provider, after the deductible.
  • Annual Out-of-Pocket Limit: $4,000 per person, not more than $8,000 per family (including deductible).

Remember, when you use a provider that participates in the Horizon PPO network, your provider files the claim and your coinsurance is based on the discounted amount for service.

Is this option for me?
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Point-of-Service (POS) Option for New Jersey Residents

With the Horizon POS option, you choose how you receive care. Your level of coverage depends on whether you receive care in-network or out-of-network.

Each POS option offers a network of physicians, hospitals, and other providers, called "in-network'' providers. When you enroll, you'll need to select a Primary Care Physician (PCP) for yourself and each covered dependent. Your PCP is your source for preventive and general medical care. Your PCP also can refer you to specialists and other providers to make sure you still receive care in-network. Generally, you’ll pay a copayment for visits to your PCP and for other in-network office visits. There is an in-network deductible for inpatient hospital services, along with an out-of-pocket maximum.

Quick Reference

For in-network care:

  • PCP Copayment: $25 for PCP, chiropractor, and occupational, physical, respiratory, speech therapist and cognitive office visits.
  • Specialist Copayment: $35 for specialist visit.
  • Copayment for Emergency Room Care: $100 per visit (waived if admitted).
  • $250/$500 deductible applied to hospital inpatient services only.
  • Plan pays 90% for inpatient hospital expenses only up to a maximum out-of-pocket of $2,000 per person, not more than $4,000 per family (including deductible).

For out-of-network care:

  • Annual Deductible: $500 per person, not more than $1,000 per family.
  • Coinsurance: Eligible expenses are covered at 70% after you satisfy the deductible.
  • Annual Out-of-Pocket Limit: $4,000 per person, not more than $8,000 per family (including deductible).

Is this option for me?
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Point-of-Service (POS) Option for Residents Outside of New Jersey

If you reside outside of New Jersey and choose the POS option, your coverage is delivered through the national BlueCard Preferred Provider Organization (PPO) program. The BlueCard PPO links participating doctors and hospitals throughout the United States.

  • You do not need to select a Primary Care Physician (PCP) or obtain referrals to receive the in-network level of benefits;
  • You have low out-of-pocket costs when you receive care from a BlueCard PPO provider;
  • You receive full coverage for in-network preventive care services, such as well-child care and routine physicals, after a copayment;
  • There is an in-network deductible for inpatient hospital services, along with an out-of-pocket maximum; and
  • You have the option to go outside the network for care and still receive coverage, but you’ll have higher out-of-pocket costs.

Quick Reference

For in-network care:

  • PCP Copayment: $25 for PCP, chiropractor, and occupational, physical, respiratory, speech therapist and cognitive office visits.
  • Specialist Copayment: $35 for specialist visit.
  • Copayment for Emergency Room Care: $100 per visit (waived if admitted).
  • $250/$500 deductible applied to hospital inpatient services only.
  • Plan pays 90% for inpatient hospital expenses only up to a maximum out-of-pocket of $2,000 per person, not more than $4,000 per family (including deductible).

For out-of-network care:

  • Annual Deductible: $500 per person, not more than $1,000 per family.
  • Coinsurance: Eligible expenses are covered at 70% after you satisfy the deductible.
  • Annual Out-of-Pocket Limit: $4,000 per person, not more than $8,000 per family (including deductible).

Is this option for me?
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Health Maintenance Organization (HMO) Options

If you enroll in coverage under one of the HMOs (Aetna or Horizon), you’ll receive medical care through a network of physicians, hospitals, and other providers, called "in-network" providers. Your care is coordinated by a Primary Care Physician (PCP), who is your source for preventive and general medical care. When necessary, the PCP refers you to specialists and other providers to make sure you still receive care in-network. Generally, you’ll pay a copayment for PCP and other in-network office visits. There is an in-network deductible for inpatient hospital services, along with an out-of-pocket maximum. If you receive care out-of-network, however, your expenses are not covered.

Quick Reference

  • PCP Copayment: $20 for PCP, chiropractor, and occupational, physical, respiratory, speech therapist and cognitive office visits.
  • Specialist Copayment: $30 for specialist visit.
  • Copayment for Emergency Room Care: $75 per visit (waived if admitted).
  • $100/$200 deductible applied to hospital inpatient services only.

Is this option for me?
Compare your options!

Exclusive Provider Organization (EPO)—Albany Area

The EPO offers a network of physicians, hospitals, and other providers called "in-network" providers. To receive benefits under the Horizon EPO, you must use a provider that participates in the network. However, you don't need to choose a Primary Care Physician (PCP) to coordinate your care, and you can visit any network provider without a referral. Generally, you'll pay a copayment for office visits. There is an in-network deductible for inpatient hospital services, along with an out-of-pocket maximum. If you receive care out-of-network, however, your expenses are not covered.

Quick Reference

  • PCP Copayment: $20 for PCP, chiropractor, and occupational, physical, respiratory, speech therapist and cognitive office visits.
  • Specialist Copayment: $30 for specialist visit.
  • Copayment for Emergency Room Care: $75 per visit (waived if admitted within 24 hours).
  • $100/$200 deductible applied to hospital inpatient services only.

Is this option for me?
Compare your options!

Before choosing a coverage option, consider the cost of each option.

Exclusive Provider Organization (EPO)—CT

The EPO offers a network of physicians, hospitals, and other providers called "in-network" providers. To receive benefits under the Horizon EPO, you must use a provider that participates in the network. However, you don't need to choose a Primary Care Physician (PCP) to coordinate your care, and you can visit any network provider without a referral. Generally, you'll pay a copayment for office visits. There is an in-network deductible for inpatient hospital services, along with an out-of-pocket maximum. If you receive care out-of-network, however, your expenses are not covered.

Quick Reference

  • PCP Copayment: $20 for PCP, chiropractor, and occupational, physical, respiratory, speech therapist and cognitive office visits.
  • Specialist Copayment: $30 for specialist visit.
  • Copayment for Emergency Room Care: $75 per visit (waived if admitted within 24 hours).
  • $100/$200 deductible applied to hospital inpatient services only.

Is this option for me?
Compare your options!

Before choosing a coverage option, consider the cost of each option.