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Gusciora on Tiered Health Insurance Hearing: DOBI & Horizon Leave Underinsured & Urban Areas Out in the Cold

Assembly Regulatory Oversight Committee Chair Reed Gusciora held a joint hearing of his committee along with the Assembly Health and Senior Services Committee on Wednesday to examine the issue of tiered health insurance networks, which has raised concerns in recent months over certain parts of the state being shut out from access to premium health coverage.

Hospitals in Gusciora’s 15th legislative district have been left out of Horizon Blue Cross Blue Shield’s new Omnia Health Alliance plan, which will provide select coverage for its insured at only 22 state hospitals, leaving others with higher premiums and deductibles if they utilize hospitals not designated in either plan.

Gusciora previously joined with elected officials from his district to call on the NJ Department of Banking and Insurance (DOBI) to place a hold on Horizon’s plan because it excludes most urban hospitals, including both capital city hospitals in his district, from premiere insurance coverage designated as Tier 1. He has also met with both DOBI and Horizon officials on the issue.

“There are two main issues of concern here – the lack of oversight DOBI has shown on this issue and the lack of public transparency displayed by Horizon,” said Gusciora (D-Mercer/Hunterdon). “DOBI should have been asking the questions we’ve been asking before they approved a plan like this one. It’s their responsibility in this situation to prevent a faulty plan from being rolled out in the first place.

“Meanwhile, Horizon took unilateral action without any public airing or transparency. If they truly operate in the public interest they should go back to the drawing room and negotiate in good faith with all hospitals in the state, and not just a chosen few.

“Instead, urban working poor are going to be required to travel great distances to find adequate health care under the Omnia plan. This is nothing more than a ‘bait and switch’ to encourage people to sign up for affordable rates but with no hospital care at their reach.”

Gusciora noted that at a September 30 meeting with Horizon, they were told that Horizon would work out a “solution” for Mercer county, but then at a subsequent meeting on October 29 they were told that no other hospitals will be admitted at this time.