abuse0105.htm

PLAN & TELEPHONE #	#002 TRADITIONAL¹ 1-800-414-7427 www.horizonblue.com	In-Network 1-800- 414-7427	Out-of-Network¹ 1-800-414-7427	#019 AETNA HMO 1-800-309-2386 www.aetna.com		#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 #
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 #
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.