Horizon BCBS Customers Getting $48.2M Back; Health Costs Lower Than Expected

Horizon Blue Cross Blue Shield of New Jersey is providing rebates totaling $48.2 million to customers who bought individual policies for 2019, company officials said Monday.

The checks, averaging $367 a person, reflect the pre-COVID era. But executives said the refunds were a sign that their strategy to lower health care costs was paying dividends.

Newark-based Horizon is the state's biggest health insurance company, with 3.4 million members. The rebates, put in the mail this month, are for 131,520 members who had individual plans.

The checks are arriving as the health care industry grapples with the financial impact of COVID-19 — a pandemic that is hurting hospitals' bottom lines, but could put more money in consumers' pockets at least in the short run.

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Horizon sets its premiums based on actuarial estimates of what it expects to pay the upcoming year. If the total claims payouts are less than 80% of the premium dollars collected from everyone in the individual market, it is required to pay rebates, said Michael Considine, a Horizon vice president.

Considine said the rebate from 2019 policies reflected the impact of Omnia, a plan formed in 2015 in which it partners with health providers to try to lower the cost of care.

The average rebates for 2019 were about three times higher than they were for 2018.

"I think that due to COVID, the (amount of premiums spent on services) for 2020 will be even lower because people avoided care," said Linda Schwimmer, president and chief executive officer of the New Jersey Health Care Quality Institute, an advocacy group.

"Despite this, the premiums went up for 2021 because the plans are projecting a surge in utilization based on delayed care," she said.

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With the pandemic continuing, consumers can purchase individual policies through Get Covered New Jersey, the state-operated health insurance marketplace that is commonly known as Obamacare, until May 15.

The Murphy administration said consumers have access to more subsidies this year, which could offset price increases. The average monthly net premium for people who qualify for financial aid is $121 a month, down from $164 a month last year.

The lower health care costs for consumers creates uncertainty for providers.

New Jersey hospitals saw many patients nervous about COVID-19 avoid emergency room, outpatient and inpatient visits, causing revenue to fall 2.6% during the first nine months of 2020, according to a recent report by the New Jersey Hospital Association, a trade group.

The result: 41% of the state's hospitals recorded net losses through the third quarter of 2020, compared with 22% the same time in 2019, the hospital association said.

Michael L. Diamond is a business reporter who has been writing about the New Jersey economy and health care industry for more than 20 years. He can be reached at [email protected].

This article originally appeared on Asbury Park Press: Horizon BCBS customers getting $48.2M back after health costs are lower than expected

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