| 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 | |
| HOSPITAL
EMERGENCY ROOM ACCIDENT/NON-ACCIDENT CHARGES |
100%
for accidental injury; 80% for all others after deductible
All physician fees are paid at 80% after deductible |
100%
after $25 copayment if reported to PCP and/or NJ PLUS within 48 hours
|
100%
after $25 copayment if reported to PCP and/or NJ PLUS within 48 hours;
if not reported within 48 hours, subject to deductible and coinsurance
|
100%
after $352 copayment
|
100%
after $352 copayment
|
100%
after $252 copayment
|
100%
after $352 copayment
|
100%
after $352 copayment
|
HOSPITAL
EMERGENCY ROOM ACCIDENT/NON-ACCIDENT CHARGES |
|
| 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. 2Most plans require notice to the PCP within 48 hours of the incident. Copayment waived if admitted. 6 Health Net referral is not required from a PCP to a participating specialist. |
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