Horizon Blue Cross Blue Shield of New Jersey this morning is announcing the launch of
a new self-funded health benefits option that it says will help small and mid-sized
employers lower their health costs by combining more customized plan design with
intensive, hands-on claims management.
The new offering, built around the recently acquired, Minnesota-based third-party
administrator HealthEZ, will begin being sold this summer for coverage that takes effect
Jan. 1, 2027.
It will target employers with 50 to 2,000 employees — giving Horizon access to an
estimated 400,000 people in self-funded arrangements who previously have not been
able to access Horizon’s network and products through a TPA platform.
The goal of reducing costs isn’t new. But how Horizon intends to help companies get
there is.
Horizon and HealthEZ officials say the plan is meant to save employers money in two
main ways:
- Customized self-funded plan design: Employers can build plans around the
specific needs and risks of their own workforce instead of buying one-size-fits-
most fully insured coverage. - Aggressive, hands-on claims and advocacy work: HealthEZ teams actively
manage individual claims, steer members to lower-cost settings and challenge
billing errors and misdirected claims, rather than leaving employers and workers
to navigate the system alone.
The launch comes at a time when New Jersey employers, especially small and mid-
sized firms, continue to grapple with rising health costs, premium volatility and limited
flexibility.
(Recent polling, for example, shows health care is among the top concerns for business
leaders in the state.)
Horizon’s Jared Ferguson, a VP of consumer, small group and mid markets, said the new TPA-based product should be seen as another tool for companies who are looking for more control over their health benefits.
“Our collaboration with HealthEZ is really about adding another arrow to a quiver of
weapons that plan sponsors can use to fight these escalating costs,” he said.
For Horizon, the early priority will be winning over employers that use third-party
administrators and have long wanted a self-funded solution plugged into its network.
Ferguson said Horizon knows there is a large population of New Jersey workers and
their families in that segment because he says he hears from them on a regular basis.
“Candidly, the TPA model that we’re engaging through HealthEZ is one that our
employer constituents in New Jersey have been asking about for some time,” Ferguson
said.
“There’s 400,000 members — employees and their dependent families — in the state of
New Jersey right now that are using a third-party administrator model. And, until now,
that hasn’t been a platform that we’ve been able to offer to those constituents.
“Our first and foremost priority is going to be to make this available to customers that
have really always wanted to do business with us in this manner.”
At the heart of the strategy is the argument that self-funding — with stop-loss protection
and active management — can give employers more control over both benefits and
costs than traditional fully insured products. Employers keep more of the risk on their
books but gain more room to tailor benefit designs.
“Putting our network together with the level of employee specification and level of
employee–employer attention that HealthEZ can give is really where the savings
develop from,” Ferguson said. “That level of customized individual attention to specific
employee needs at the employer level.”
HealthEZ, which Horizon acquired in 2025, brings a suite of cost-containment tools that
it applies case by case. Those include steering patients to more appropriate and less
expensive sites of care, reworking payment arrangements for particularly high-cost
services and running rigorous claim-integrity and subrogation processes to ensure other
insurers pay when they should.
HealthEZ CEO Jeff Bakke described the company’s approach as resting on
three pillars: customer service, cost containment and cost predictability.
And while customer service is key — and the company prides itself on its high scores
for customer satisfaction — Bakke knows the cost-containment part is the most
important differentiator.
“We’re really obsessed with this,” he said. “We’re super aggressive in the way we
manage the cost of care for the plan sponsor. And I’m not talking about just shifting
costs to the employee.”
Bakke pointed to employers that he says have seen meaningful savings after moving to
HealthEZ-administered self-funded plans, quoting an average of 20% to 23%.
Here’s the feature that employees will like.
Bakke said a key piece of the model is the company’s advocacy work on individual
cases.
He pointed to an example of a car accident and having a representative determine who
should be first on the claim, the auto insurer or the health insurer.
“Once we actually know that you got in a car accident, our subrogation team would be
working on collecting from your auto insurance,” he said. “An advocate would be
reaching out and telling you, ‘Don’t worry about this. We got it.’”
Bakke said this customer-service feature not only is great for the employee involved —
how great would it be to have someone else fight your insurance payment battles? —
but good for everyone in the plan.
Lowering the amount of insurance use ultimately lowers the cost of premiums for all
involved, Bakke said. Simply put, it’s a key feature in how the plan works.
The launch also illustrates how Horizon is using flexibility it gained from the corporate
restructuring approved in 2022.
That year, state regulators allowed Horizon to reorganize as a nonprofit mutual holding
company, a move that gave it more leeway to invest in subsidiaries outside its core
insurance business, including HealthEZ.
Horizon officials now point to the new TPA-based offering as one of the most significant
examples so far of that strategy in action for New Jersey employers.
