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Horizon BCBSNJ | Amendment to Definition of "Allowance"

Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) has updated the definition of "Allowance" in its health insurance policy.

This change applies to out-of-network claims and is based on changes to federal law designed to protect members from certain excessive out-of-network surprise bills.

Overview of the Horizon BCBSNJ amendment:

  1. Horizon BCBSNJ has removed the phrase "as the least of the following amounts" from the definition.

  2. Horizon BCBSNJ has added a statement saying that sometimes, they may agree on a different payment amount with out-of-network providers (doctors who are not part of their insurance network).

  3. In line with federal laws, they added information about the "Surprise Billing Reimbursement Rate". This new rate is for specific situations when:

    1. Members receive emergency services from out-of-network providers.

    2. Members receive certain services from out-of-network providers at an in-network facility (a hospital or clinic that is part of their insurance network).

    3. Members use air ambulance services from out-of-network providers.

For your reference, please see an example of the letter Horizon BCBSNJ has sent to employers HERE.

To assist you with communicating this change to employees, please see our employee communication template.

If you have any questions, please your Ascela Account Manager.


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