Health Plan
Eligible employees may elect health insurance through our group plan, which is underwritten by Horizon Blue Cross-Blue Shield (prescription coverage included through ExpressScripts).
There are two health plans that you may select from, the base Horizon Direct Access Plan and the Horizon Managed Care POS Plan, which provides a less expensive alternative.
The Direct Access Plan (linked) gives participants the ability to see any in-network physician or specialist within the Direct Access network without having to receive a referral. A $20 co-pay applies for in-network physician office visits.
The Managed Care POS (linked) requires that participants elect a Primary Care Physician (PCP). Participants will need referrals to visit any in-network physicians. A $30 co-pay applies for in-network physician office visits. However, the monthly premium is less than the Direct Access premium.
Out-of-network coverage is also provided as follows:
Direct Access: Deductible ($300 single/$600 family) and coinsurance (30%) apply to out-of-network services. The maximum out of pocket, subject to UCR charge limitations, is $3,000 for single coverage and $6,000 for family coverage.
Managed Care POS: Deductible ($1,000 single/$2,000/family) and coinsurance (40%) apply to out-of-network services. The maximum out of pocket, subject to UCR charge limitations, is $5,000 for single coverage and $10,000 for family coverage.
Employees contribute towards a portion of their health care costs as follows:
| Direct Access Coverage Election | Employer Cost per month (12-month basis) |
Employee Cost per month (12-month basis) |
Employee |
$587.00 | $25.00 |
Employee & Child |
$613.00 | $265.00 |
Employee & Spouse |
$623.00 | $375.00 |
Employee & Family |
$633.00 | $550.00 |
| Managed Care POS Coverage Election | Employer Cost per month (12-month basis) |
Employee Cost per month (12-month basis) |
Employee |
$554.00 | $10.00 |
Employee & Child |
$613.00 | $195.00 |
Employee & Spouse |
$623.00 | $303.00 |
Employee & Family |
$633.00 | $430.00 |
Prescription (Rx) coverage through ExpressScripts is included as part of the health plan, and is structured as follows:
- Pharmacy Copay: $7 generic / $20 formulary / $40 non-formulary
- Mail Order/On-line Copay: $14 generic / $40 formulary / $80 non-formulary