AtlantiCare 2025 Benefits Booklet

MEDICAL

Welcome.................................... 2 What’s New?............................. 3 How to Enroll........................... 4 Medical....................................... 6 Prescription Drug.................14 FQHC.........................................16 Additional Medical Plan Resources................................17 AtlantiCare Longevity Lifestyle Program................18 Dental.......................................20 Vision.........................................22 Life Insurance........................25 Disability..................................26 Voluntary Offerings.............27 Educational Support & Career Development..........27 Financial Well-being...........28 Health &Wellness................29 Savings.....................................31 Voluntary Benefits...............32 Spending Accounts.............35 Retirement Benefits............36 Contacts...................................38 Legal Notices.........................40 Wellness Checklist...............42

You have two choices in Medical Plan Coverage: • Horizon OMNIA Plan • Horizon Preferred Provider (PPO) Plan

Both medical plan options are administered by Horizon Blue Cross Blue Shield and utilize the Horizon Blue Cross Blue Shield network alongside the national BlueCard network (when care is rendered outside of New Jersey). Via the Horizon networks, AtlantiCare’s employees and their dependents have access to one of the largest networks in the country. Included within both plan options is AtlantiCare’s Inner Circle network of providers and facilities which offers you the highest level of plan benefits and the least out-of-pocket costs for you.

Horizon OMNIA Plan The Horizon OMNIA Plan offers a lower biweekly contribution; and with this Plan, you are also eligible for an AtlantiCare-funded Health Reimbursement Account (HRA) to help you to offset some of your out-of-pocket costs. The HRA will be available to you based on your wellness credits earned in 2024. This plan allows for more affordable out-of-pocket costs when you receive care from Inner Circle or OMNIA Tier 1 providers. Features of the OMNIA Plan: • Three-levels of providers and benefits. The OMNIA Plan covers the same services across all three tiers noted above; however, the amount of your cost sharing will vary based on the tier designation of the provider from whom you receive care: 1) Inner Circle (AtlantiCare and its affiliates): when you receive care from an Inner Circle provider, you will have the least amount of cost-sharing and you will not be required to meet a deductible.

2) After the Inner Circle, the remaining participating doctors and hospitals are grouped into two tiers – OMNIA Tier 1 and Tier 2 . Your out-of-pocket costs depend on which tier the doctor or hospital is in. For example: a. OMNIA Tier 1 : With this tier, there is more member cost-sharing required than the Inner Circle as reimbursement for covered services will be subject to a deductible of $250 for individual coverage and $500 for family coverage. The out-of-pocket costs can be as high as a $1,000 copay. b. Tier 2 : This tier includes all other Horizon In-Network providers that are neither Inner Circle nor OMNIA Tier 1 providers. Tier 2 also includes all BlueCard providers that participate in the national BlueCard network. When you use Tier 2 providers, you will have the highest amount of cost sharing. There is a deductible of $350 for individual coverage and $700 for family coverage; and the copays for covered services are the highest amongst all tiers, reaching up to $1,500 for some services.

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