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Pensions and Benefits Graphic
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PLAN
&
TELEPHONE #
TRADITIONAL1
(800) 414-7427
#001 -NJ PLUS #19
AETNA—US HEALTHCARE
(800) 309-2386 Retirees on Medicare (800) 345-4432
#20
CIGNA HEALTHCARE
(800) 244-6224
#28
OXFORD
(800)
760-4566
#33
AMERIHEALTH
(800) 877-9829
#34
HEALTH NET2
(800)
441-5741
PLAN
&
TELEPHONE #
NJ PLUS
In-network
(800)
414-7427
NJ PLUS
Out-of-network1
(800)
414-7427
SERVICE AREA Unrestricted All of NJ, DE, VA AND FL; parts of NY and PA Unrestricted All of NJ, CTand DE; parts of AZ, FL, IL, IN, MD, NY, NC, OH, PA, TX, and VA All of NJ, CT, DE, PA, AZ, SC and Washington DC; Parts of CA, FL, GA, MD, NY, VA, AND WV, All of NJ; parts of NY All of NJ and DE; parts of PA All of NJ and CT; Parts of NY (Parts of PA pending approval) SERVICE AREA
ALCOHOL ABUSE (INPATIENT) Same as any other illness Same as any other illness Same as any other illness 100% detox; 28-day rehab at 100% per occurrence 100% detox; 30-day rehab at 100% per occurrence 100% detox and rehab 100% detox; 28-day rehab at 100% per occurrence 100% detox; 28-day rehab at 100% per occurrence ALCOHOL ABUSE (INPATIENT)
DRUG ABUSE (INPATIENT) Same as any other illness Same as any other illness Same as any other illness 100% detox; 28-day rehab at 100% per occurrence 100% detox; 30 day rehab at 100% per occurrence 100% detox; 30-day rehab at 100% per occurrence 100% detox; 28-day rehab at 100% per occurrence 100% detox; 28-day rehab at 100% per occurrence DRUG ABUSE (INPATIENT)
ALCOHOL ABUSE (OUTPATIENT) Same as any other illness 100% no visit limit 70% after deductible 100% up to 60 visits per calendar year 100% up to 60 visits per calendar year 100% up to 60 visits per calendar year 100% up to 60 visits per calendar year 100% up to 60 visits per calendar year ALCOHOL ABUSE (OUTPATIENT)
DRUG ABUSE (OUTPATIENT) Same as any other illness 100%, no visit limit 70% after deductible 100% up to 60 days per calendar year 100% up to 60 days per calendar year 100% up to 60 visits per calendar year 100% up to 60 visits per calendar year 100% up to 60 visits per calendar year DRUG ABUSE (OUTPATIENT)
MENTAL HEALTH (INPATIENT)3 100% for 20 days per calendar year; balance at 80% after deductible up to annual/lifetime maximums 100% up to 25 days per calendar year; balance at 90% up to annual/ lifetime maximums 50 days per calendar year at 50% after deductible up to annual lifetime maximums 100% up to 35 days per calendar year 100% up to 30 days per calendar year 100% up to 30 days per calendar year 100% up to 30 days per calendar year 100% up to 30 days per calendar year MENTAL HEALTH (INPATIENT)
MENTAL HEALTH (OUTPATIENT)3 80% after deductible up to $10,000 annual/$20,000 lifetime maximum 90% up to $15,000 annual /$50,000 lifetime maximum 70% after deductible up to $15,000 annual /$50,000 lifetime maximum 100% after $10 copayment per visit for up to 30 visits per calendar year 100% after $5 copayment per visit for up to 30 visits per year 100% after $10 copayment per visit for up to 30 visits per calendar year 100% after $10 copayment per visit for up to 30 visits per calendar year 100% after $5 copayment per visit for up to 30 visits per calendar year MENTAL HEALTH (OUTPATIENT)
1Benefits, excluding hospital expenses, are based on the PACE allowance or the "reasonable and customary" fee schedule at the 90% percentile.

2Most plans require notice ot the PCP within 48 hours of the incident. Copayment waived if admitted.

3Biologically-based mental health conditions are treated like any other illness and not subject to annual or lifetime mental health dollar maximums or separate mental health visit limits.
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Copyright © State of New Jersey, 1996-2003
Division of Pensions and Benefits
PO Box 295
Trenton, NJ 08625-0295

All Technical issues regarding this Web site should be sent to the Division of Pensions and Benefits Webmaster.

Last Updated: May 18, 2004

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