You will now be able to join a Direct Primary Care practice (R-Health and Paladina) and never pay anything for primary care,.You will have an out-of-network option you do not have now,.The Horizon HMO is geographically limited to New Jersey and surrounding Pennsylvania and New York counties,.It is likely that your Aetna Primary Care Provider (PCP) will not be a Horizon PCP,.Members in the Aetna HMO should seriously consider switching to the CWA Unity PPO plan for the following reasons: To find out whether your regular provider is in the Horizon network check the Horizon website and contact your provider to confirm as insurance company lists of participating providers are often out of date. However, there are some medical practices and specialty providers (mental health, physical therapy, chiropractic, etc) that are not in the Horizon network. For instance, all acute care hospitals in New Jersey, NYC, and Philly are in-network with Horizon. Since the Horizon and Aetna PPO (Freedom, Freedom 10, 15, 15/25, etc) plans have a huge overlap of providers, most Aetna PPO members will see little change in switching to the Horizon equivalent plan. However, there can be significant differences in networks particularly in certain geographic areas and for Tier One of the Tiered network plans (Aetna Liberty Horizon Omnia.)Ĭurrent Aetna members living out-of-state should understand that while Horizon directly contracts with a limited number of out-of-state providers they will have access to the robust networks of local Blue Cross affiliates like Independence Blue Cross in Southeastern Pennsylvania and Empire Blue Cross in New York through the Blue Card program. The plan design (coverage, copays, deductibles) for the Aetna options is identical to the plan design for the Horizon equivalent. This means that anyone in an Aetna PPO (Freedom), HMO, tiered network (Liberty), or high deductible plan will need to switch to a Horizon plan during the October open enrollment. Aetna will continue to provide the Medicare Advantage and Dental Expense plans. SHBP recently rebid the medical contract for active members and early retirees Horizon’s price and presentation were deemed superior - they will be the sole carrier for SHBP active employees and early retirees. Starting in January 2020, Aetna will NO longer provide plans through the NJ State Health Benefit Plan (SHBP) medical plan for active employees and early retirees. State Health Aetna Members Must Switch but CWA Negotiated Strong Options
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