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
IMMUNIZATIONS Not covered 100% after $5 copayment per visit (except for travel and/or job related) 70% for children under 12 months, after deductible 100% after $5 copayment per visit (except for travel and/or job related) 100% after $5 copayment per visit (except for travel and/or job related) 100% after $5 copayment per visit (except for travel and/or job related) 100% after $5 copayment per visit (except for travel and/or job related) 100% after $5 copayment per visit (except for travel and/or job related) IMMUNIZATIONS
MATERNITY
CARE
Basic benefits at 100%; balance at 80% after deductible $5 copayment for first prenatal office visit then 100% covered 70% after deductible $5 copayment for first prenatal visit then 100% covered $5 copayment for first prenatal visit then 100% covered $5 copayment for first prenatal visit then 100% covered $5 copayment for first prenatal visit then 100% covered $5 copayment for first prenatal visit then 100% covered MATERNITY
PHYSICAL EXAMS Not covered 100% after $5 per visit copayment Not covered 100% after $5 copayment per visit 100% after $5 copayment per visit
(1 visit per calendar year)
100% 100% after $5 copayment per visit 100% after $5 copayment per visit PHYSICAL EXAMS
WELL BABY
CARE
Not covered 100% after $5 per visit copayment Not covered 100% after $5 copayment per visit 100% after $5 copayment per visit 100% 100% after $5 copayment per visit 100% after $5 copayment per visit WELL BABY
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.


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