Pub. 14 2015-2016 Issue 4

N E W J E R S E Y C O A L I T I O N O F A U T O M O T I V E R E T A I L E R S 17 new jersey auto retailer W W W . N J C A R . O R G network. In 2016, we see their products shifting to EPO/PPO networks. These products provide seamless access to Aetna’s national network. Aetna also has the availability of their Com- munity network in certain markets and business segments, limited in size and scope but offered more affordably than their standard network products. Qualcare, recently purchased by Cigna, is a Multiple Employer Welfare Arrangement (MEWA) that has grown significantly over the past few years. Originally developed as a solution to medical provider’s health insurance needs, it is now available to most employers regardless of industry. In Qualcare’s cur- rent product portfolio, they offer several products that offer tiered networks and benefits. When using a preferred facility, employees’ costs are reduced. However, employees also have access to the full Qualcare network, if care is desired outside of the preferred facility. Perhaps the greatest change in network strategy lies with Horizon BCBS. There has been significant market coverage of Horizon’s new Omnia network, a different approach to provider contracting. Omnia-based products layer the smaller Omnia network alongside their traditional Managed Care network, with benefits varying based on the place of care chosen. Employees in an Omnia product will have reduced out-of-pocket expenses when they utilize an Omnia facility or provider. The Omnia network is focused on cost efficiency and quality, concepts that go hand-in-hand when determining overall costs. This is true, for example, when thinking of the added cost for re-admissions or duplicate testing. Additionally, Omnia providers may participate in the financial rewards of delivering quality care more affordably. Pricing for Horizon’s Omnia products, when comparing benefits in the Omnia network versus benefits in their traditional network, can be discounted by as much as 15%. In a changing environment, health insurance companies are forced to become more creative as they try to develop cost effective solutions for a marketplace that has become frus- trated by double-digit increases. Dealerships (and frankly, most employers regardless of industry) have typically responded to such increases by changing carriers, reducing benefits, increas- ing employee contributions, or just as likely, some combination of all three. Network strategies should be seen as a new way to address health insurance costs. With broader network options, it is hoped that more premium stability, and carrier stability, will be seen - and the insanity can be stopped! Bruce Mazzarelli is a Vice President with Fotek Insurance Solutions, a Division of HUB International Northeast, LLC. He can be reached at (732) 556-0446 or at bmazzarelli@fotek.net. Recently, Oxford has taken their original concept of “smaller is more cost effective” and extended it to what they call their Garden State network. As the name implies, it is a New Jersey-specific network that offers premium discounts below even their Liberty network.