oxford usa enrolling a new jersey small group SM

oxford usaSM enrolling a new jersey small group
If a group is located in New Jersey but has employees who live or work outside of Oxford’s New York, New Jersey
Connecticut, and Pennsylvania service areas*, we offer a sensible solution- Oxford USA, utilizing the UnitedHealthcare
Choice Plus Network.
How to Enroll New Groups
1. Enter one census to run rates for your in-area and outof-area employees.
2. If using external rating models (e.g., ChannelPoint), brokers
must select a non-gated Freedom® Plan PPOSM or Freedom Plan
Direct® product for their Oxford USA coverage.
3. Complete the Oxford NJ Small Employer Application
(Form #1087) for the in-area plan.
4. Complete the Oxford USA NJSG Addendum
(Form # 4787) for the Oxford USA plan.
6b. Complete the NJ Small Waiver of Coverage form (Form
#1086) for all eligible employees who are not electing
coverage.
7. For Oxford MyPlanSM, submit the HRA Application
(Form # 6740). For the Oxford HSA plan, submit the
Bank Notification (Form #7423).
8. Submit all other materials required, including the rates
generated for both plans, as stated on the Oxford
New Case Checklist:
5. Complete the New Jersey Small Group Member
Enrollment/Change Request Form (Form #6856) for all
enrollees. To ensure proper enrollment for these Members,
please include “Oxford USA” in the CSP field.
6. Complete the NJ Small Employer Certification
(Form# 1089) for all employees.
Oxford Health Plans
Attention: Group Enrollment
14 Central Park Drive
Hooksett, NH 03106
How to Enroll Existing Groups
If you have an in-force Oxford group with out-of-area membership and wish to enroll that membership into an Oxford
USA plan, you may do so at renewal. Please call Oxford Group Services for details about enrollment procedures.
important guidelines
1. Out-of-area enrollment is limited to 50% of the
eligible employees.
2. The Oxford USA plans are non-gated and utilize the
UnitedHealthcare Choice Plus Network. Enrollees do
not need to select a primary care physician.
3. Groups in a POS or PPO plan may enroll in the in-area
design Members residing in New York, Rhode Island,
Delaware, Eastern Pennsylvania: Monroe, Pike and
Wayne Counties (plus all counties listed in 3a) and the
following Massachusetts counties: Worcester, Hampden,
Franklin, Hampshire, and Berkshire. All other out-ofarea Members must enroll in an Oxford USA plan.
3a. Groups in an HMO or EPO may enroll in the in-area
design Members residing in Delaware or the following
Pennsylvania counties: Berks, Bucks, Chester, Delaware,
Philadelphia, Montgomery, Carbon, Columbia,
Dauphin, Lackawanna, Lehigh, Luzerne, Northampton
and Schuylkill. All other out-of-area Members must
enroll in an Oxford USA plan.
4. You must elect an Oxford USA plan design for your
out-of-area Members to have access to the Choice Plus
physicians on an in-network basis. Only the Freedom
Plan PPO or Freedom Plan Direct plan options will be
available as Oxford USA plans for New Jersey small
groups.
5. If a small group does not elect to set up an Oxford USA
plan for its out-of-area enrollees, those Members must
access care on an out-of-network basis only.
6. If a group plans to cover all employees under a Freedom
Plan PPO or Freedom Plan Direct, a single census for
both in-area and out-of-area should be used. In this case,
an Oxford USA NJSG Addendum is still required, and
Member Enrollment Forms for enrollees joining the
Oxford USA plan must have “Oxford USA” noted in
the CSP field.
7. All administrative rules will default to current
in-area selections.
8. Oxford’s dental riders are not available with Oxford
USA plans. Please be sure to rate the out-of-area
enrollees accordingly.
9. All Oxford USA Members will be covered under one plan
design per group. Class carve-out options are not available.
10. All forms forwarded to enroll an Oxford USA group are
available through Group Services, or on our web site:
www.oxfordhealth.com.
* A geographic area We define by county.
©2005 Oxford Health Plans, LLC. Insurance products are underwritten by Oxford Health Insurance, Inc.
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