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
HOME HEALTH CARE
Services and supplies covered with
pre-approval; 60 visits in 61 days at 100% per ocurence
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
(Voluntary Program)
Not applicable
Asthma, chronic kidney disease, chronic pulmonary disease, coronary artery disease, diabetes, heart failure
Asthma, chronic kidney disease, chronic pulmonary disease, coronary artery disease, diabetes, heart failure
Asthma, chronic heart failure, coronary artery disease, diabetes, low back pain
Well Aware Program monitored by PCP for chronic conditions like asthma, diabetes and low back pain
Asthma, cardiac, congestive heart failure, depression, diabetes, healthy mother/baby program, rare chronic care program
Asthma, chronic pulmonary disease, congestive heart failure, coronary artery disease, diabetes,
end-stage renal disease
Asthma, chronic obstructive pulmonary disease, congestive heart failure, coronary arterty disease, depression, diabetes, end-stage renal disease, hypertension, neonatal intesive care
DISEASE MANAGEMENT5
(Voluntary
Programs)
PRIVATE DUTY NURSING
(Must be Medically Necessary)
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
Inpatient hospital care excluded; outpatient care must be authorized by PCP and services rendered by or supervised by a RN
Inpatient hospital care excluded; outpatient care must be authorized by PCP and services rendered by or supervised by a RN
Inpatient hospital care excluded; outpatient care must be authorized by PCP and services rendered by or supervised by a RN
Inpatient hospital care excluded; outpatient care must be authorized by PCP and services rendered by or supervised by a RN
PRIVATE DUTY NURSING
(Must be Medically Necessary)
INFERTILITY SERVICES
(Must be
Pre-Authorized)
Diagnosis covered; treatment covered with limitations; subject to a coinsurance and deductible.
Diagnosis covered; treatment covered with limitations
Diagnosis covered; treatment covered with limitations; subject to out-of-network insurance and deductible.
Diagnosis covered; treatment covered with limitations
Diagnosis covered; treatment covered with limitations
Diagnosis covered; treatment covered with limitations
Diagnosis covered; treatment covered with limitations
Diagnosis covered; treatment covered with limitations
INFERTILITY SERVICES
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.

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.