The Direct Access Point-of-Service (POS) plan is administered by Horizon Blue Cross Blue Shield of New Jersey. Although the new Horizon Plan does not require referrals, the Plan still requires you to select a Primary Care Physician [PCP]. This plan puts a great emphasis on consultation with your PCP for all care. The PCP will determine whether specialty care is appropriate and in conjunction with Managed Care Protocols so that your claim can be processed properly. This includes the ability to see an in-network specialist outside New Jersey after consultation and approval by your PCP. Co-payments are $10 for a doctor’s office visit and $25 for an Emergency Room (fee waived if admitted).
Horizon members will have access to a toll free 24 hour Nurse Line, 1-888-624-3096, staffed by Registered Nurses to discuss medical concerns.
Under this plan, members may also obtain out of network services from a non-participating provider. However, these services are subject to a deductible of $400 per individual, and a maximum of $800 for all eligible dependents. Maximum out of pocket $2,500/$5,000. Claims will then be paid at 70% of Reasonable and Customary fees as determined by Horizon Blue Cross Blue Shield of New Jersey.
The Health Maintenance Organization (HMO) plan is administered by QualCare. The HMO plan uses an extensive network of participating service providers (doctors, hospitals, labs, x-ray groups etc.). Members must select a Primary Care Physician (PCP). ALL medically necessary care is obtained through your chosen PCP. There are no referrals required for a specialist. Co-payments are $10 for a doctor’s office visit and $25 for an Emergency Room (fee waived if admitted).
The employee will be responsible for any fees provided by non-participating providers.
(Not an enrollment option if hired after July 1, 1994) This health plan is the County’s Self Funded Employee Health Benefit Program, which was available to active employees, and eligible retired employees of the County of Monmouth hired prior to July 1, 1994. Insurance Administrator of America [IAA] administers this Plan. Covered employees are subject to bi-weekly payroll deductions, the amount of which is determined annually. All basic and major medical benefits are subject to the exclusions and limitations described more fully on the IAA website.
Monmouth County’s prescription drug plan is administered by Express Scripts. If employees choose to enroll in the prescription plan and they are not enrolled in a health plan there will be a minimal payroll deduction. Medications are dispensed at the pharmacy upon presentation of a doctor’s prescription and a nominal co-payment ($5 for generic and $20 for brand name drugs up to a maximum of 30 - day supply at the pharmacy).
This plan also provides a Mail order service for medication taken on an ongoing basis. The co-payment under the mail order service is $0 for generic and $15 for brand name, for a maximum 90 - day supply. Most medications are sent via standard shipping by the U.S. Postal Service at no cost to you.