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Health Republic Insurance of New Jersey (HRINJ) One of 23 non-profit, member-governed health insurance companies in America. Part of the Affordable Care Act: –goal of bringing down health care costs and making health insurance accessible to millions of people –HRINJ received start up and “reserve” loans from the U.S. Department of Health and Human Services to get started A Progressive Champion: –Our mission is to provide innovative health plan choices and put the interests of our members first. ensure benefits are provided in an affordable way that works for all members be the persistent advocate and change-agent working for the health and wellness of the communities we serve Who we are. 2
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New Jersey’s only CO-OP. Consumer Operated and Oriented Plan 5 501(c)29 non-profit organization, a signature program o of the Affordable Care Act In 2015, 51% of our Board of Directors will be members of the Plan Monitored and audited by state and federal government Use our surplus revenues wisely as a CO-OP to benefit enrollees – keep premiums affordable and improve benefits Provide a new choice for consumers Serve as a health care organization that is inclusive, trustworthy, active, and communicates clearly 3 Our focus is where it should be — on our members.
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What we offer. 4 AFFORDABLE PLANS Health insurance options for individuals and small businesses All surplus revenues will be used to reduce premiums and improve benefits GREAT BENEFITS/FEATURES All products meet or exceed requirements for Essential Health Benefits under the Affordable Care Act and New Jersey State insurance requirements Vast provider network in partnership with QualCare. More than 25,000 providers and 68 hospital facilities available with all plan designs. REAL CONTROL Choice of many plans to meet employer needs and budget Members’ voices count. 51% of our Board of Directors will be comprised of health plan members.
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5 Four questions. Here are four questions consumers should ask when enrolling in an insurance plan: 1. What are my choices for health insurance? 2. How do I get it? 3. How much will it cost me? 4. How will I use it?
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Why HRINJ? 6
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Our products. 7 CORE A health plan that helps your employees control costs on their day-to-day healthcare. In keeping with our core principle of supporting our members, the Core plan options allow: Members to use co-pays to cover regular costs, such as visits to primary care doctors and specialists and for prescription drugs. PRIME A plan that encourages your employees to get to know their doctor. Some plan features include: Prime Silver option: First 4 visits to your Primary Care Physician with no out- of-pocket expenses $0 copay for Generic Drugs SOLID A simple pay-as-you go plan with the added benefit of co- insurance. Instead of paying a higher monthly premium, you will pay a percentage of the cost for health services that you use; allowing you to be totally in control of health expenses. Solid plan options are all non- gated (referrals to specialists are not required). All plans have access to one of New Jersey’s largest provider networks and integrated wellness and alternative care programs
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8 Our service area. We serve: The entire State of New Jersey
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Comprehensive network. 9 Statewide QualCare Regional HMO Network More than 25,000 providers at 33,000 locations 100 Acute, Specialty and Rehabilitation Hospitals ONE Network for all plan designs
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10 Our partners. QualCare More than 1 00 acute, specialty and rehabilitation hospitals; 25,000 physicians and ancillary providers at 33,000 locations. Pharmacy Benefits Manager US Script (URAC Accredited). www.usscript.com Billing and Enrollment Morneau-Shepell Vision Davis Vision
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11 Our niche. We can meet the needs of individuals and small companies that are looking for more choice. 9 plans statewide serving NJ small groups and individuals Consumer Operated and Oriented (CO-OP) Plan – Board of Directors comprised of 51% plan members Benefit plans that are straightforward. All plans have access to one network statewide. Establishing a long lasting relationship with your Primary Care Physician is our focus. Members represent members.
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Target members. Small Employer Market (2-50 lives) – On and off “The Marketplace” Individual products on and off “The Marketplace” for Sole-proprietors, independent contractors and entrepreneurs Working uninsured 12 Image FPO
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Benefit Design Highlights 13
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Sample Plan Designs *Core Platinum Solid (NG) Gold Prime** Silver Prime Bronze Deductible (Individual/Family)$750/ $1500$1750/ $3500$2000/4000$2500/$5000 Max Out of Pocket Limit (Individual/Family) $1250/$2500$2000/$4000 $6350/ $12700 Cost Sharing (Co-Insurance) 20% 30%**50% Cost Sharing-Medical Services PlatinumGoldSilverBronze Inpatient/SNF/Hospice-Facility (per admission) Ded/CoinsCoinsurance after Deductible is Met Outpatient- FacilityDed/CoinsCoinsurance after Deductible is Met Surgeon (Inpatient)Ded/CoinsCoinsurance after Deductible is Met Surgeon (Outpatient)Ded/CoinsCoinsurance after Deductible is Met PREVENTIVE CARENo Charge Other Primary Care$10Coinsurance after Deductible is Met Specialist$25Coinsurance after Deductible is Met PT/OT/STDed/CoinsCoinsurance after Deductible is Met ER (Co-Pay after Deductible is Met)Ded/CoinsCoinsurance after Deductible is Met Diagnostic imaging/ X-Ray Lab Services $100 copay Imaging, $25 xray/lab Coinsurance after Deductible is Met Urgent Care$50 CopayCoinsurance after Deductible is Met **Prime Silver Plan – 1 st 4 PCP visits, NO CHARGE. 0 copay Generic drugs All Solid Plan designs are Non Gated *Core plans have co-pay options of $10/$25 and $20/$35.
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15 Contact Info: MAIL Health Republic Insurance of New Jersey 1 Gateway Center, Suite 2600 Newark, NJ 07102 ONLINE www.newjersey.healthrepublic.us Roy Frank Manager of Member Engagement Office Direct line: 201.308.8582 Cellular: 973-986-2620 rfrank@newjersey.healthrepublic.us
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