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Pensions and Benefits Graphic
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PLAN
&
TELEPHONE #
TRADITIONAL1
(800) 414-7427
#001 - NJ PLUS #19
AETNA
Active - (800)
309-2386 Retiree on Medicare (800)
345-4432
#20
CIGNA HEALTHCARE
(800) 244-6224
#28
OXFORD
(800)
760-4566
#33
AMERIHEALTH
(800) 877-9829
#34
HEALTH NET6
(800)
441-5741
PLAN
&
TELEPHONE #
NJ PLUS
In-network
(800)
414-7427
NJ PLUS
Out-of-network1
(800)
414-7427
SERVICE AREA Unrestricted All of NJ, DE, VA AND FL; parts of NY and PA Unrestricted All of NJ, CTand DE; parts of AZ, FL, IL, IN, MD, NY, NC, OH, PA, TX, and VA All of NJ, CT, DE, PA, AZ, SC and Washington DC; Parts of CA, FL, GA, MD, NY, 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 (Parts of PA pending approval) SERVICE AREA
HOME HEALTH CARE Services and supplies covered with pre-approval; 60 visits in 61 days at 80% Services and supplies covered with pre-approval; prior inpatient hospital stay not required; nursing home care or custodial care not covered Services and supplies covered with pre-approval; prior inpatient hospital stay not required; nursing home care or custodial care not covered; subject to out-of-network insurance and deductible Services and supplies covered with pre-approval; prior inpatient hospital stay not required; nursing home care or custodial care not covered Services and supplies covered with pre-approval; prior inpatient hospital stay not required; nursing home care or custodial care not covered Services and supplies covered with pre-approval; prior inpatient hospital stay not required; nursing home care or custodial care not covered: 120 visit per calendar year maximum Services and supplies covered with pre-approval; prior inpatient hospital stay not required; nursing home care or custodial care not covered Services and supplies covered with pre-approval; prior inpatient hospital stay not required; nursing home care or custodial care not covered HOME HEALTH CARE
DISEASE MANAGEMENT5 Not applicable Diabetes only Diabetes only Heat disease, asthma, diabetes, low back pain; Healthy Outlook Program available through you PCP -voluntary Well Aware Program monitored by PCP for chronic conditions like low back pain, asthma, and diabetes Voluntary program available for: Living with Diabetes; Better Breathing Asthma, Newborn Critical Care, Heart Smart Program, High Risk Maternity Connections Program voluntary for asthma, diabetes, heart failure, joint replacements; talk to PCP for details Voluntary program for diabetes, asthma, coronary artery disease, emphysema, rare diseases, kidney disease and other chronic diseases; call (800) 573-2177 DISEASE MANAGEMENT5
PRIVATE DUTY NURSING Must be ordered by a doctor, provided by an RN or LPN; excludes care that can be provided by hosiptal staff or home health care aides; excludes assistance with daily activies Must be ordered by a doctor, provided by an RN or LPN; excludes care that can be provided by hosiptal staff or home health care aides; excludes assistance with daily activies Must be ordered by a doctor, provided by an RN or LPN; excludes care that can be provided by hosiptal staff or home health care aides; excludes assistance with daily activies Inpatient hospital care excluded; outpatient care must be authorized by PCP and services rendered by or supervised by a RN; not covered unless medially necessary Inpatient hospital care excluded; outpatient care must be authorized by PCP and services rendered by or supervised by a RN; not covered unless medially necessary Inpatient hospital care excluded; outpatient care must be authorized by PCP and services rendered by or supervised by a RN; not covered unless medially necessary Inpatient hospital care excluded; outpatient care must be authorized by PCP and services rendered by or supervised by a RN; not covered unless medially necessary Inpatient hospital care excluded; outpatient care must be authorized by PCP and services rendered by or supervised by a RN; not covered unless medially necessary PRIVATE DUTY NURSING
INFERTILITY SERVICES Diagnosis covered; treatment covered wiht limitations; subject to a coinsurance and deductible. Must be pre-authorized; diagnosis covered; treatment covred with limitations Call plan for pre-authorization; diagnosis covered; treatment covered with limitations; subject to out-of-network insurance and deductible Must be pre-authorized; diagnosis covered; treatment covered with limitations Must be pre-authorized; diagnosis covered; treatment covered with limitations Must be pre-authorized; diagnosis covered; treatment covered with limitations Must be pre-authorized; diagnosis covered; treatment covered with limitations Must be pre-authorized; diagnosis covered; treatment covered with limitations INFERTILITY SERVICES
1Benefits, excluding hospital expenses, are based on the PACE allowance or the "reasonable and customary" fee schedule at the 90% percentile.

5Most disease management programs provide educational materials, and in some cases, individualized case management for members with an emphasis on health education and behavior modification.

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

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Copyright State of New Jersey, 1996-2003
Division of Pensions and Benefits
PO Box 295
Trenton, NJ 08625-0295

All Technical issues regarding this Web site should be sent to the Division of Pensions and Benefits Webmaster.

Last Updated: May 18, 2004

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