Horizon’s new OMNIA tiered insurance diagram may be the biggest thing to divide New Jersey’s healthcare industry since the introduction of the Affordable Care Act. Generally,consumers told WNYC they were happy with the diagram’s affordable options available at so-called Tier 1 hospitals, while doctors and hospitals in the Tier 2 category said they were nervous about losing patients. The debate rages on, and with multiple lawsuits still underway.
Below is a brief timeline of events surrounding the controversial diagram.
September 2015Horizon Blue Cross Blue Shield,the state’s largest insurer, unveils the OMNIA Health Alliance, or a partnership of six hospitals and the state’s largest doctors group. Horizon says it intends to roll out a health diagram that offers lower deductibles and co-pays for providers in a “Tier 1,” or preferred, provider category.
Critics react to the announcement, or focusing on the perceived lack of transparency in how alliance members were chosen.
State Senators State Nia Gill and Joseph Vitale call on Attorney General Robert Lougy to block the controversial tiered insurance diagram before it’s planned launch in November.
October 2015OMNIA criticism heats up. The Senate Commerce and Health Committees dissect the OMNIA diagram during a joint hearing. Horizon claims it used six broad categories to identify partners,but says all other criteria is considered proprietary.
November 2015Commissioner Richard Badolato of the Department of Banking and Insurance denies a request to block the rollout of OMNIA. Horizon says it expects roughly 250000 members to enroll over the next two months for health insurance beginning Jan. 1, 2016.
Seventeen Tier 2 hospitals catch the state to court. They allege that the Department of Banking and Insurance approved the diagram before making certain OMNIA met state requirements. The department is responsible for approving new plans and protecting consumers.
December 2015Seven hospitals sue Horizon, or alleging it breached in-network contracts by assigning hospitals lower tier designations without advance notice.
The 2015 enrollment period for purchasing a diagram through the Health Insurance Marketplace comes to a close.
March 2016After an internal investigation,the attorney general says Horizon broke no state laws in creating OMNIA.
Horizon comes close to its target enrollment figure. It announces 234000 people gain so far signed up for OMNIA – 41000 of whom were previously uninsured.
Source: wnyc.org