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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 #
PLAN & TELEPHONE #	#002 TRADITIONAL¹ 1-800-414-7427 www.horizonblue.com	In-network 1-800- 414-7427	Out-of-network¹ 1-800- 414-7427	#019 AETNA HMO 1-800-309-2386 www.aetna.com		#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 #
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.