PLAN
&
TELEPHONE #
#002 TRADITIONAL1
1-800-414-7427
www.horizonblue.com
#001 - NJ PLUS
www.horizonblue.com
#019
AETNA HMO
1-800-309-2386
www.aetna.com
#020
CIGNA HEALTHCARE HMO
1-800-244-6224
www.cigna.com/health
#028
OXFORD HMO
1-800-760-4566
www.oxfordhealth.com
#033
AMERIHEALTH HMO
1-800-877-9829
www.amerihealth.com
#034
HEALTH NET6 HMO
1-800-441-5741
www.healthnet.com
PLAN
&
TELEPHONE #
In-Network 1-800-
414-7427
Out-of-Network1 1-800-414-7427
SERVICE AREA Unrestricted All of NJ and FL;
Parts of NY and PA
Unrestricted All of NJ, CT, DE, ME, and Wash.DC; Parts of AZ, FL, IL, IN, MA, MD, NC, NH, NV, NY, OH, PA, TX, and VA All of NJ, AZ, CT, DE, SC and Washington DC; Parts of CA, FL, GA, MD, NC, NY, PA, 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 SERVICE AREA
ALCOHOL ABUSE (INPATIENT)
Same as any other illness
Same as any other illness
Same as any other illness
100% detox; rehab-28 days at 100% per occurrence
100% detox; rehab-30 days at 100% per occurrence
100% detox and rehab
100% detox; rehab-28 days at 100% per occurrence
100% detox; rehab-28 days 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; rehab-28 days at 100% per occurrence
100% detox; rehab-30 days at 100% per occurrence
100% detox; rehab-30 days at 100% per occurrence
100% detox; rehab-28 days at 100% per occurrence
100% detox; rehab-28 days 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; no copayment
100% up to 60 visits per calendar year; no copayment
100% up to 60 visits per calendar year; no copayment
100% up to 60 visits per calendar year; no copayment
100% up to 60 visits per calendar year; no copayment
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 HEALTH3 (INPATIENT)
100% for 20 days per calendar year; balance at 80% after deductible up to annual and/or lifetime maximums
100% up to 25 days per calendar year; balance at 90% up to annual and/or lifetime maximums
50 days per calendar year at 50% after deductible up to annual and/or 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 HEALTH3 (INPATIENT)
MENTAL HEALTH3 (OUTPATIENT)
80% after deductible up to annual and/or lifetime maximums
90% up to annual and/or lifetime maximums
70% after deductible up to annual and/or lifetime maximums
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 HEALTH3 (OUTPATIENT)
1Benefits, excluding hospital expenses, are based on the Horizon's discounted provider network allowance or the "reasonable and customary" fee schedule at the 90% percentile. Some State employees may not be eligible for
enrollment in the Traditional Plan; see other side of chart for details.

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.

6 Referral is not required from a PCP to a participating specialist.