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. MS-05-1128 8082