Exclusive Provider Organization (EPO)
The EPO Plan is a consumer driven health plan with a Health Reimbursement Account offering members a different approach to how you pay for today’s health care with an opportunity to save for your future health care expenses. It is a lower-premium, high-deductible health insurance plan, which means you pay less out of your paycheck for premiums and more out of pocket at the point of service before the plan pays for services that are not considered preventive. Members who enroll in the EPO plan will be provided with an employer paid Health Reimbursement Account to help pay for some of these out-of-pocket medical expenses including deductibles, copays and other healthcare expenses.
In New Jersey, members have access to all doctors, specialists and hospitals that participate in Horizon’s Managed Care Network (“Advantage EPO”). Outside of New Jersey throughout the United States and worldwide, members have access to doctors and hospitals through the BlueCard® PPO program. There is no benefit coverage outside of the Managed Care Network.
In-network preventive care services as defined by the plan are covered at 100%, meaning you do not pay for these types of services. For all other in-network services, you are responsible for paying the full cost of care until you reach the plan’s deductible ($1,500 individual/$3,000 family). Once you meet the deductible, services are covered at 100% plus the applicable copay for the service and/or facility. Copays are $20 for primary care office visit, $40 for specialist office visit, and $100 for emergency room visit. Laboratory services must be performed at the in network lab facility, Quest. Prescription copays are $10 for preferred generic drugs, $25 for preferred name brand drugs, and $50 for non-preferred drugs. There is a mail-order option through Prime Therapeutics which can result in cost savings.
Refer to the Plan Design for additional information.
Health Reimbursement Arrangement (HRA)
The WEX (formerly Discovery Benefits) HRA is an employer funded account available to you when you enroll in the new EPO Plan. The HRA reimburses you for eligible out-of-pocket health care expenses, such as deductibles, copays and prescription expenses on a tax-free basis.
The HRA funding is $750 for individual coverage, and $1,500 for two person or family coverage. The HRA is funded January 1 of each year for employees enrolled in the EPO Plan (prorated for members who enroll later in the year, such as new hires or members who experience a life event that allows such late enrollment).
- Use It Today: Pay for your regular, eligible, out-of-pocket health care expenses you incur during the year.
- Save It For Tomorrow: The HRA Plan has a rollover feature where any unused portions of your HRA will rollover each year while you are active with no caps on rollover amounts, and your new funding will be added on January 1. Employees who resign or retire from the University with 5 years of eligible service will be vested in the HRA and may continue to draw on these funds for eligible expenses for up to 10 years.
- Use It For Eligible Health Care Expenses: Not only can you use your HRA for eligible out-of-pocket medical expenses such as your deductible, copay and prescriptions, but you can also use your funds for other eligible out-of-pocket health care expenses such as vision and dental.
- Access To Your Funds: You can access the funds in your HRA several ways:
- You can use your WEX Debit Card to pay for eligible expenses with providers that accept a major credit card.
- You can arrange to have your healthcare provider be paid directly from your HRA (Pay My Provider Option).
- You can also be reimbursed for eligible expenses you pay out of pocket (Pay Me Option).
- Save Your Receipts: In most cases, WEX Debit Card transactions for eligible expenses may automatically be approved. Please remember to always save your detailed receipts and Explanation of Benefits with your IRS returns in case you are ever audited.
If you decide to also enroll in the Healthcare Flexible Spending Account (FSA), which also reimburses you for eligible out-of-pocket health care expenses, your Healthcare FSA dollars will be loaded onto the same debit card. Healthcare FSA dollars will be used first, before your HRA funds are accessed.