The Kirwan Companies, LTD

The following information depicts a sample MSA Plan Benefit Summary offered by Horizon of New Jersey. State variations will apply, including plans with Multiple Deductibles ranging up to $10,000.

Alternative HSA Plans having PPO or Direct Access Coverage are available.
Please ask for a Comparison of Benefits and Rates for Your State.

Horizon PPO High Deductible Plans
and Horizon MSA Companion Plans
Benefit Highlights

	In Network *	Out of Network *
Annual Deductible (Selections 1 and 2 are Horizon PPO High Deductible Plans. Selections 3 and 4 are Horizon MSA Companion Plans.)	Selection 1: $1,500 Single policy/$3,000 Family Unit policy. Selection 2: $2,250 Single policy/$4,500 Family Unit policy. Selection 3: $1,900 Single policy/$3,750 Family Unit policy. Selection 4: $2,850 Single policy/$5,650 Family Unit policy.
Coinsurance	100% for most services.	80%
Out-of-Pocket Maximum	Single Policy: $3,000; Family Unit Policy: $5,500 (Selections 1 and 2) Single Policy: $3,750; Family Unit Policy: $6,900 (Selections 3 and 4)

Lifetime Maximum

Unlimited

Practitioner Services Hospital Services Other Services

Select one of the services above to see the coverages for each.

Please Note:

	This is not a contract. This benefit highlights is only a summary of the standard Small Employer Health (SEH) Plan D in a Preferred Provider Organization format with a high deductible component that may be used in conjunction with a Medical Savings Account (MSA) offered by Horizon Blue Cross Blue Shield of New Jersey. Precertification may be required for certain services listed above.
	With respect to family unit coverage, no benefits are payable until one person or any combination of persons in the family has incurred total family deductible. Family unit coverage includes (1) family, (2) husband and wife, (3) adult and child(ren) coverage.
*	All Payments based on our allowable terms.

All payments based on medical necessity and appropriateness of services. For complete information and verification of all your benefits, refer to your benefits certificate. In the event a conflict exists between the information contained on this benefits highlights and the actual terms of a group policy, the terms of the policy will prevail. For further information on your policy, you may also call Customer Service at 1-800-355-BLUE.

Horizon of NJ Disclosure of information as required by Health Insurance Portability and Accountability Act

Our Supporting Medical Groups:
AIMS-Metropark, IPA, LLC Physicians of Edison and Muhlenberg Hospitals	www.bcmspa.org	Atlantic County Medical Society of NJ Middlesex-Somerset County Medical Societies of NJ www.mcmsnj.org