A check in the mail from Horizon? Not a scam

Nov. 18--Horizon Blue Cross Blue Shield of New Jersey has sent rebate checks on average of $423 to thousands of customers, the insurer said Thursday, in a sign that it needed to pay health care providers less than it expected.

The checks will be sent to nearly 155,000 customers who bought individual policies in 2015 either through the company or through the Obamacare marketplace.

"When we succeed at controlling costs, our members benefit not just through lower out-of-pocket costs, but through reduced premiums and rebates like this," said Michael J. Considine, a Horizon vice president.

Newark-based Horizon is the state's biggest health insurer. It has about 60 percent of the individual market, which includes consumers who aren't covered by Medicare, Medicaid or their employer.

MORE: What can save Obamacare in New Jersey?

Horizon has said it is collaborating more closely with doctors and hospitals by sharing data, trying to encourage consumers to live healthier lives and lower health care costs. There are signs it is paying off. The company in September said the strategy prevented 3,500 emergency room visits and 400 in-patient hospital stays, saving a combined $6.6 million.

Meanwhile, it introduced Omnia, a health insurance plan that offers consumers lower out-of-pocket costs if they visit doctors and hospitals in their preferred network. As part of the plan, the insurer is working more closely with RWJ Barnabas, whose hospitals include Monmouth Medical Center in Long Branch, Monmouth Medical Center's Southern Campus in Lakewood and Community Medical Center in Toms River.

The Patient Protection and Affordable Care Act's open enrollment for 2017 is underway, even though President-elect Donald J. Trump and Republican members of Congress have pledged to repeal the law. Open enrollment lasts until Jan. 31, but consumers who wish to be covered beginning in January need to buy plans by Dec. 15.

MORE: NJ Obamacare enrollment starts: 4 things to know

MORE: Docs feel Obamacare financial pinch

The rebates are the result of state law that requires health insurance companies to spend at least 80 percent of premium dollars on claims.

In addition to individuals, Horizon said it is sending another $2.4 million in rebates to customers who have small group plans. For HMO members, the average check will be $4,103. For non-HMO members, it will be $77.

Horizon's average rebate last year for consumers with individual policies was $90. Small group customers didn't receive a rebate, the company said.

Michael L. Diamond; 732-643-4038; [email protected]

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