| 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. |
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