Page 4 - CPC Behavioral Healthcare 2022 - 2023 Benefits Guide

MEDICAL PLAN OPTIONS

YOUR MEDICAL COVERAGE

CPC Behavioral Healthcare employees are offered
medical insurance through Horizon Blue Cross/Blue
Shield of New Jersey. You have three plan options to
choose from, including:
Advantage EPO
POS Design 10
Direct Access Design 1

The Advantage EPO is the lowest premium cost option.
This plan only offers in-network benefits only, meaning
that you must use a physician within the Horizon
Managed Care/Blue Card PPO network.

The POS Design 10 and Direct Access Design 1 plans
feature in- and out-of-network coverage, no in-network
deductibles, set copays, coinsurance; and out-of-pocket
maximums as outlined on the medical plan options page
of this guide.

Keep in mind, that if you are in either the POS or Direct
Access plans, you can seek services with in- or out-of-
network providers. However; you will always pay less if you
are treated within the provider network because the plan
pays a higher percentage of your covered expenses.

For both the POS and Direct Access plans if you choose to go out
of network you must meet the annual deductible before the
medical plan begins to cover your health care expenses. Once
the deductible is met, the medical plan begins to pay for a
percentage of covered expenses (coinsurance), as outlined on
the medical plan options page of this guide. Remember, the
plan will reimburse you based on Medicare’s fee schedule. You
may contact Horizon directly if you would like to determine
Medicare’s fee schedule for a certain procedure. Any amounts
billed by your out of network provider (over and above
Medicare’s fee), may be billed to you.

Out-of-pocket maximums apply to all of the plans. This is the
maximum amount you will pay for health care costs in a calendar
year. Once you have paid the out-of-pocket maximum, the plan
will cover the remaining eligible medical expenses at 100% for
the rest of the year. If out of network providers are used, then
you are responsible for charges that are above what is allowed
by Medicare.

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