Hoboken Workers Face Insurance Change: Horizon, CarePoint To End Coverage

Hoboken, NJ – The health insurance coverage for Hoboken's municipal workers may be about to change for the first time in decades, but there is some confusion as to who is responsible.

According to city officials, Horizon Blue Cross Blue Shield - Hoboken’s employee healthcare insurance provider for the past 34 years - is set to drop two local hospitals from its in-network coverage for city workers.

The insurance provider will drop Hoboken University Medical Center on June 1, and Bayonne Medical Center on May 1, city officials announced in a Monday news release.

Both facilities are owned by CarePoint Health, city officials stated.

Due to the planned change, Hoboken officials have negotiated a deal with United Healthcare/UMR that would allegedly “provide the current level of benefits while retaining in-network access to all CarePoint Health facilities, [while] gaining access to 687 more in-network doctors and facilities.”

The deal will help the city avoid a $5 million potential cost increase to its municipal workers’ health coverage, while also ensuring in-network access to CarePoint Health facilities, officials stated.

“The city of Hoboken has been navigating a difficult situation involving Horizon,” Mayor Dawn Zimmer wrote in a letter to city employees on Friday. “If we were to remain with Horizon, the city’s medical claims could increase by an estimated $5 million, and employees would face higher payroll deductions and out of pocket expenses with all CarePoint Health facilities and physicians being out of network.”

“As a result, we are proposing that the council approve transitioning our healthcare coverage and third party administrator from Horizon to United Healthcare/UMR effective June 1.”

Zimmer’s full letter to city employees can be seen here.

HORIZON RESPONDS

In contrast to Zimmer's letter, Horizon is claiming that it was actually CarePoint that chose to terminate its contracts for the two hospitals.

Horizon provided Patch with the below statement on Tuesday:

"Two hospitals owned by the for-profit CarePoint Health company, Bayonne Hospital and Hoboken University Medical Center, will end their longstanding relationship with Horizon Blue Cross Blue Shield New Jersey (Horizon BCBSNJ) in the next 45 days. CarePoint Health terminated, without cause, both contracts and refused reimbursement increases offered by Horizon BCBSNJ, the state’s largest health insurer.

"CarePoint Health withdrew Christ Hospital in Jersey City from Horizon BCBSNJ’s network on June 1, 2015. CarePoint is terminating Bayonne’s in-network status effective May 1, 2016 and Hoboken University Medical Center effective June 1, 2016. As of that date, all of CarePoint Health’s facilities and providers will be out-of-network.

"In accordance with New Jersey state regulations, Horizon BCBSNJ has sent notices to members in the Hudson County area advising that the facilities will no longer be in Horizon BCBSNJ’s hospital network. Horizon BCBSNJ members will be subject to higher out-of pocket costs when using the CarePoint facilities as a result."

Kevin McArdle, Public Affairs Manager for Horizon BCBSNJ, offered further comment:

“There has been some confusion about who is responsible for the termination, but the facts are clear: CarePoint Health notified us last year that they were exercising their right to terminate the contract without cause... We have put forward a number of reasonable offers to CarePoint and continue to hope that they will return to the negotiating table."

PUBLIC MEETING

City officials will host a public meeting to discuss the potential change at 7 p.m. on Tuesday, April 26 at the Council Chambers at City Hall.

During the April 26 meeting, the council will also discuss a deal that would possibly bring a Trader Joe’s supermarket to Hoboken.

• See related article: Hoboken Trader Joe's Update: Developer Has Zoning Approval For 14th and Willow Store

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