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| How it Works |
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The following example illustrates how Horizon MyWay HRA can cover health care expenses.
Jane is a healthy, single woman who enjoys an active lifestyle. She typically uses her health plan benefits for preventive and routine care. Jane's employer has chosen to limit HRA funds to pay for deductibles, coinsurance, and other member cost sharing under the Horizon PPO health plan. Jane's beginning HRA balance is $750. Jane's annual Horizon PPO deductible is $1,500.
| Beginning HRA Balance |
N/A |
$750 |
| Annual Physical: (Covered by the Horizon PPO preventive care benefit at 100%. Preventive care is not subject to a deductible and does not count toward a deductible.) |
$150 |
$750 |
| Internist Visits: (Applied to deductible.) |
$200 |
$550 |
| Lab Tests: (Applied to deductible.) |
$80 |
$470 |
| Jane's Total Out-of-Pocket Expenses for Year One |
$0 |
N/A |
| Ending HRA Balance (This amount rolls over to Year Two.) |
N/A |
$470 |
The following year, Jane breaks her leg while skiing. The medical expenses for treatment of Jane's injury total $3,000. In addition to the $750 deposited in her HRA by her employer for Year Two, Jane rolled over $470 from Year One, for a total of $1,220 toward her $1,500 deductible.
| Beginning HRA Balance |
N/A |
$1,220 |
| Broken Leg: Includes emergency room visit, specialist, and physical therapy. ($1,500 applied to deductible.) |
$3,000 |
$0 |
| Jane's Total Out-of-Pocket Expenses for Year Two* |
$280 |
N/A |
| Ending HRA Balance (This amount rolls over to Year Three.) |
N/A |
$0 |
* Horizon PPO pays for the remaining $1,500 for services related to Jane's broken leg.
Thankfully, Jane has fully recovered from her broken leg and has returned to her healthy lifestyle. In Year Three, as in previous years, Jane's employer allocates $750 into an HRA. Jane uses her health plan funds for preventive and routine care.
| Beginning HRA Balance |
N/A |
$750 |
| Annual Gyn Physical: (Covered by Horizon PPO preventive care benefit at 100%. Preventive care is not subject to a deductible.) |
$150 |
$750 |
| Lab Tests: (Applied to deductible.) |
$80 |
$670 |
| Jane's Total Out-of-Pocket Expenses for Year Three |
$0 |
N/A |
| Ending HRA Balance (This amount rolls over to Year Four.) |
N/A |
$670 |
Jane, like all employees covered by Horizon MyWay HRA, can take advantage of Horizon Blue Cross Blue Shield of New Jersey's negotiated rates for services covered by the Horizon PPO health plan and reduce her out-of-pocket costs by using physicians, hospitals and facilities that participate in Horizon BCBSNJ's networks.
Furthermore, because Jane's plan includes a payment-card option, she can access her HRA quickly and easily at her doctor's office, her pharmacy, and the hospital. The payment-card option reduces the paperwork employees must typically submit to access their HRAs and can be used only to pay for eligible HRA expenses.
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