Benefits at a Glance

Transcription

1 209 Benefits at a Glance SMALL GROUP PLANS Choose the best health plan for you and your business. Use this brochure to compare health plans and cost-sharing.

2 Choose the best health plan Choosing a health plan is a big decision. But the good news is, you don t have to make it alone. We re here to help you whether it s to explain the different types of health plans or to help you figure out which one makes the most sense for your business. Everything you need to get started is here. With this booklet, you ll be able to look at health plans side by side, so you can see how much your employees pay when they receive covered services. You ll also find an overview of our networks. When you re ready to purchase or have questions, contact your broker. Coverage options All health plans are categorized by metallic tiers Bronze, Silver, Gold, or Platinum. You choose a health plan based on the cost of the plan and services it covers. For most health plans, there is a fixed amount each month, known as a premium or monthly rate. In addition to the premium you pay, members may also pay each time they receive care from a doctor or hospital, have a prescription filled, or get some type of medical care. These payments are often called costsharing or out-of-pocket costs, and come in the following types: deductible, copay, and coinsurance. BRONZE SILVER GOLD PLATINUM Your broker is ready to help you choose the best health plan for your business. May be a good fit if you only get annual check-ups. MONTHLY COST $ OUT-OF-POCKET COST $$$$ May be a good fit if you get annual check-ups and additional care more often. MONTHLY COST $$ OUT-OF-POCKET COST $$$ May be a good fit if, in addition to annual check-ups, you see doctors and/or specialists more often. MONTHLY COST $$$ OUT-OF-POCKET COST $$ May be a good fit if you have serious chronic conditions that require frequent doctor visits and/or extended hospitalization. MONTHLY COST $$$$ OUT-OF-POCKET COST $ Common health care terms Here are simple definitions of some of the health insurance terms in this guide. Coinsurance The percentage you pay for some covered services. If your coinsurance is 20%, your health insurance company will pay 80% of the cost of covered services, and you will pay the remaining 20%. Copay The amount you pay when you see a doctor or get other services. Cost-sharing The amount you pay for your health care costs beyond your premium. This includes your deductible, copayments, and coinsurance fees. Deductible The amount you pay each year before you start to receive insurance benefits. Out-of-network If you receive health care services from providers or facilities not included in your health plan, you may be subject to additional costs. Out-of-pocket costs The amount you pay for your health care services. The health care law sets a limit on your out-of-pocket costs, called an out-of-pocket maximum. Once you pay this amount, your health plan will pay 00% of the additional covered services you receive. Premium The amount you pay to your insurance company each month to pay your share of your health plan s costs. This is separate from the deductible, copayments, and coinsurance amounts you pay when you use your benefits to receive covered services. Referral If you have an HMO plan, your family doctor (or primary care provider) will need to write you a referral before you see other network providers, such as a heart doctor (cardiologist). As you can see, Bronze health plans generally have the lowest monthly fixed costs but likely have higher out-of-pocket costs when members get care. Platinum health plans generally cost the most each month, but will probably cost members less each time they need care. The Gold and Silver plans fall somewhere in the middle. Health plan options There are five types of health plans that you can choose from. The type of plan you choose for your members will affect the process your members follow to get care. Whether your members have to select a primary care provider and whether they ll need a referral from that primary care provider are the biggest differences between the plans. Health maintenance organization (HMO) Best if members have or want a primary care provider to coordinate their care and refer them to specialists who are within the network you choose. HMO plans offer coverage for network doctors only and requires a referral. There is no out-of-network coverage. Health maintenance organization (HMO) Plus Best if members have or want a primary care provider to coordinate their care and want the ability to self refer to specialists who are within the network. There is no out-of-network coverage and no referral is required. Point-of-service (POS) Plus Best if members have or want a primary care provider to coordinate their care but still want the freedom to choose a doctor or hospital in- or out-of-network. POS Plus plans offer the highest level of benefits when members visit providers that participate within the network, but the plans also provide the option of seeking care outside of the network. No referral is required. Exclusive provider organization () Best if members want the freedom to see any doctor or specialist they want with no referral, as long as they re within the network you choose. There is no out-of-network coverage. Exclusive provider organization with a health savings account ( with HSA) Adding an HSA can save members money if you choose a plan with a high deductible. Members can put money into an HSA, and they won t get taxed for that part of their income. Then they can use that money to pay for approved health costs. 2 3

3 Network options AmeriHealth New Jersey has a variety of networks making health insurance more affordable for you, your family, or your business. Networks differ based on geography as well as participating doctors, hospitals, and other health care providers. To determine what network is best for you, visit /providerfinder. National Access Available through the Multiplan PHCS National network for services obtained outside of the Regional Preferred service area.,3 Lancaster Northampton Lehigh Bucks Berks Montgomery SOUTHEASTERN Chester Philadelphia Delaware PA Regional Preferred One of the largest network of doctors, hospitals, and labs in the state of New Jersey. 2 Members have access to participating physicians and providers in New Jersey, Delaware, and Southeastern Pennsylvania. 3 New Castle Kent Gloucester Salem Sussex DE Warren NJ Sussex Hunterdon 4 Cumberland Local Value The Local Value network offers small employers a more affordable rate by providing access to a subset of the Regional Preferred network in New Jersey. 4 Essex Union Somerset Middlesex Monmouth Mercer Camden The following Advantage networks are a subset of the Local Value network and are designed to offer more options focused on affordable, high quality health care coverage. AmeriHealth Advantage AmeriHealth Advantage allows members to pay lower out-of-pocket costs for select hospitals, and physician services if they use a participating facility. Tier 2 is available through the AmeriHealth New Jersey Local Value network. These plans were designed to meet the needs of small employers based in select counties. 5 Offered in collaboration with the following health systems: AtlantiCare, Cape Regional Medical Center, Cooper University Healthcare, Deborah Heart and Lung Center, Hackensack Meridian Health, and RWJBarnabas Health. 6 AmeriHealth Hospital Advantage AmeriHealth Hospital Advantage plans allow members to pay lower out-ofpocket costs for hospital and facility services if they use a participating AmeriHealth Hospital Advantage provider. Tier 2 providers are available through the AmeriHealth New Jersey Local Value network. 7,8 Coverage provided by Multiplan PHCS National Network. AmeriHealth New Jersey members accessing care in the AmeriHealth New Jersey service area must use the Regional Preferred network. 2 Data derived from analysis of information provided by a third party vendor and is subject to change. 3 The AmeriHealth New Jersey service area includes all New Jersey and Delaware counties, and nine Pennsylvania counties in the Philadelphia area including: Northampton, Lehigh, Bucks, Berks, Montgomery, Philadelphia, Delaware, Chester, and Lancaster counties. 4 The Local Value Network is not available in Hunterdon County. Morris Passaic Burlington Atlantic Cape May Bergen Ocean Hudson Salem Salem Warren Gloucester Sussex Camden Cumberland Morris Passaic Burlington Atlantic Cape May Essex Union Bergen Hudson Hunterdon 4 Somerset Middlesex Mercer Monmouth Warren Gloucester Sussex Camden Cumberland Morris Passaic Burlington Atlantic Cape May Essex Union Ocean Bergen Hudson Hunterdon 4 Somerset Middlesex Mercer Monmouth 5 AmeriHealth Advantage plans are only available to employers based in the following counties: Atlantic, Burlington, Camden, Cape May, Essex, Gloucester, Hudson, Mercer, Middlesex, Monmouth, Ocean, Somerset, and Union. Members can obtain services within the listed counties at the tier level. AmeriHealth Advantage members can also access tier 2 providers within the AmeriHealth New Jersey Local Value network. AmeriHealth Advantage tier hospitals are subject to change. 6 The following hospitals are included in the AmeriHealth Advantage health systems: Atlanticare Regional Medical Center Atlantic City Campus, Atlanticare Regional Medical Center Mainland Campus, Bayshore Medical Center, Cape Regional Medical Center, Clara Maass Medical Center, Community Medical Center, Cooper Hospital/University Medical Center, Deborah Heart and Lung Center, Hackensack University Medical Center (UMC) Hackensack UMC Mountainside, Hackensack UMC Palisades, Hackensack UMC at Pascack Valley, Holy Name Medical Center, Jersey City Medical Center, Jersey Shore University Medical Center, Monmouth Medical Center, Monmouth Medical Center Southern Campus, Newark Beth Israel Medical Center, Ocean Medical Center, Raritan Bay Medical Center Old Bridge Raritan Bay Medical Center Perth Amboy, Riverview Medical Center, Robert Wood Johnson University Hospital, Robert Wood Johnson University Hospital Hamilton, Robert Wood Johnson University Hospital Rahway, Robert Wood Johnson University Hospital Somerset, Saint Barnabas Medical Center, and Southern Ocean Medical Center. 7 AmeriHealth Hospital Advantage providers are an enhancement to your benefits. Tier 2 providers are AmeriHealth New Jersey Local Value network providers. 8 Pin drops are for illustrative purposes only. For a complete listing of AmeriHealth Hospital Advantage providers and facilities, visit /hospitaladvantage. Ocean PRESCRIPTION BENEFITS MEDICAL BENEFITS 30 DAY SUPPLY 4 BRONZE BENEFITS CHOOSE YOUR NETWORK DEDUCTIBLE AFTER DEDUCTIBLE MEMBER PAYS MAXIMUM OUT-OF-POCKET Primary Care Visits Specialist Visits Urgent Care Services Emergency Room Outpatient Surgery Ambulatory Surgical Inpatient Hospital Services Including Maternity X-rays & Diagnostic Imaging Imaging CT/PT Scans, MRIs Inpatient Treatment Outpatient Treatment AMERIHEALTH ADVANTAGE $25/$50 AMERIHEALTH HOSPITAL ADVANTAGE $50/$75 $50/$75 AMERIHEALTH ADVANTAGE 5 AMERIHEALTH HOSPITAL ADVANTAGE 9 LOCAL VALUE 8 REGIONAL PREFERRED Tier Tier 2 Tier Tier 2 In-network $25 copay, $50 copay, $3,000 2 / $6,000 6 $3,000 2 / $6,000 6 $3,000 2 / $6,000 $6,750 / $3,500 7 $6,750 / $3,500 7 $6,750 / $3,500 $50 copay, $75 copay, $200 copay per day, 0 0 $50 copay, $50 copay, $75 copay, $75 copay, per admission, per admission, Laboratory $200 copay per day, 0 0 per admission, 20% per admission, $50 copay, $70 copay, $70 copay, Rehabilitation Therapy Services 3 $50 copay, $65 copay, $65 copay, Chiropractic Care 2 Durable Medical Equipment Generic Rx Brand Rx Non-Preferred Brand Rx up to $25 max, up to $25 max, up to $25 max, 4 Plan year and calendar year options available. All Rx plans are creditable. 5

4 SILVER BENEFITS AMERIHEALTH ADVANTAGE $30/$60 AMERIHEALTH HOSPITAL ADVANTAGE $50/$75 20%/20% NEW 0%/30% 0%/0% $30/$70 COINS HMO POS PLUS $50/$75 3 $50/$75 CHOOSE YOUR NETWORK DEDUCTIBLE AFTER DEDUCTIBLE MEMBER PAYS MAXIMUM OUT-OF-POCKET Primary Care Visits Specialist Visits AMERIHEALTH ADVANTAGE 5 AMERIHEALTH HOSPITAL ADVANTAGE 9 LOCAL VALUE 8 LOCAL VALUE 8 LOCAL VALUE 8 LOCAL VALUE 8 LOCAL VALUE 8 LOCAL VALUE 8 REGIONAL PREFERRED REGIONAL PREFERRED REGIONAL PREFERRED REGIONAL PREFERRED REGIONAL PREFERRED REGIONAL PREFERRED Tier Tier 2 Tier Tier 2 In-network In-network In-network In-network In-network In-network Out-of-network $2,500 / $5,000 6 $,500 2 / $3,000 6 $2,500 2 / $5,000 $2,500 2 / $5,000 $2,500 2 / $5,000 $2,500 / $5,000 $2,500 / $5,000 $2,500 / $5,000 $5,000 / $0,000 20% 20% 30% n/a 20% 40% $30 copay $60 copay $7,500 / $5,000 7 $6,000 / $2,000 7 $6,750 / $3,500 $6,750 / $3,500 $6,750 / $3,500 $7,500 / $5,000 $7,500 / $5,000 $7,500 / $5,000 $5,000 / $30,000 Urgent Care Services $85 copay, Emergency Room Outpatient Surgery Ambulatory Surgical Inpatient Hospital Services Including Maternity $50 copay, $30 copay $50 copay $50 copay $75 copay, $70 copay $75 copay $75 copay $00 copay, 0% $85 copay, $85 copay $85 copay $00 copay, 40% 40% covered at in-network level covered at in-network level 40% X-rays & Diagnostic Imaging Imaging CT/PT Scans, MRIs $50 copay $00 copay 40% PRESCRIPTION BENEFITS MEDICAL BENEFITS 30 DAY SUPPLY 4 Inpatient Treatment Outpatient Treatment Laboratory 0% $60 copay $70 copay, $60 copay $70 copay $70 copay Rehabilitation Therapy Services 3 $60 copay $65 copay, $60 copay $65 copay $65 copay Chiropractic Care 2 Durable Medical Equipment Generic Rx $0 copay $0 copay, $0 copay, $0 copay, $5 copay, Brand Rx Non-Preferred Brand Rx up to $25 max, up to $25 max, up to $25 max, up to $25 max, up to $25 max, up to $25 max, 20% $0 copay $0 copay up to $25 max, 40% 40% 40% 40% up to $25 max, not covered; reimbursement Plan year and calendar year options available. All Rx plans are creditable. NEW POPULAR PLAN POPULAR PLAN 6 Plan year and calendar year options available. All Rx plans are creditable. 7

5 GOLD BENEFITS AMERIHEALTH ADVANTAGE $0/$30 AMERIHEALTH HOSPITAL ADVANTAGE $30/$50 0%/0% NEW 0%/20% 0%/0% $30/$60 20% COINS HMO $30/$65 3 RX /$25 MAX POS PLUS $30/$70 CHOOSE YOUR NETWORK DEDUCTIBLE LOCAL VALUE 8 LOCAL VALUE 8 REGIONAL PREFERRED AMERIHEALTH ADVANTAGE 5 AMERIHEALTH HOSPITAL ADVANTAGE 9 NATIONAL ACCESS REGIONAL PREFERRED REGIONAL PREFERRED REGIONAL PREFERRED REGIONAL PREFERRED NATIONAL ACCESS NATIONAL ACCESS Tier Tier 2 Tier Tier 2 In-network In-network In-network In-network In-network In-network Out-of-network $,200 / $2,400 6 $,200 / $2,400 6 $,550 c / $3,00 $,350 2 / $2,700 $,550 2 / $3,00 $,000 / $2,000 $0 / $0 $,500 / $3,000 $3,000 / $6,000 AFTER DEDUCTIBLE MEMBER PAYS MAXIMUM OUT-OF-POCKET 20% 20% 0% 20% n/a 20% 0% 0% 30% $5,500 / $,000 7 $5,000 / $0,000 7 $5,000 / $0,000 $4,900 / $9,800 $5,000 / $0,000 $7,000 / $4,000 $7,000 / $4,000 $6,500 / $3,000 $3,000 / $26,000 Primary Care Visits $0 copay $50 copay $30 copay 0% $30 copay $30 copay $30 copay Specialist Visits $30 copay $75 copay $50 copay 0% $60 copay $65 copay $70 copay Urgent Care Services $75 copay $75 copay Emergency Room $00 copay $00 copay Outpatient Surgery Ambulatory Surgical 20% Inpatient Hospital Services Including Maternity 20% per day, 0% 0% $75 copay $85 copay $85 copay covered at in-network level $00 copay $00 copay $00 copay, 0% up to $250 max 0% up to $250 max, 0 covered at in-network level X-rays & Diagnostic Imaging $50 copay $50 copay $50 copay 0% Imaging CT/PT Scans, MRIs $00 copay $00 copay $00 copay PRESCRIPTION BENEFITS MEDICAL BENEFITS 30 DAY SUPPLY 4 Inpatient Treatment Outpatient Treatment Laboratory 20% per day, 0% $30 copay $50 copay 0% Rehabilitation Therapy Services 3 $60 copay $50 copay 0% Chiropractic Care 2 Durable Medical Equipment 8 Plan year and calendar year options available. All Rx plans are creditable. 9 no charge 0 $60 copay $65 copay $70 copay $60 copay $65 copay $65 copay Generic Rx $0 copay $0 copay $0 copay, $0 copay, $0 copay, $0 copay Brand Rx $40 copay $40 copay, $40 copay, $40 copay up to $25 max, $40 copay up to $25 max, up to $25 max, Non-Preferred Brand Rx $75 copay $75 copay, $75 copay, $75 copay $75 copay Plan year and calendar year options available. All Rx plans are creditable. POPULAR PLAN POPULAR PLAN $0 copay not covered, reimbursement

6 PRESCRIPTION BENEFITS MEDICAL BENEFITS 30 DAY SUPPLY 4 PLATINUM BENEFITS CHOOSE YOUR NETWORK DEDUCTIBLE AFTER DEDUCTIBLE MEMBER PAYS MAXIMUM OUT-OF-POCKET HMO PLUS $5/$30 REGIONAL PREFERRED POS PLUS $5/$30 REGIONAL PREFERRED NATIONAL ACCESS In-network In-network Out-of-network $0 / $0 $0 / $0 $3,000 / $6,000 n/a n/a 30% $3,000 / $6,000 $3,000 / $6,000 $6,000 / $2,000 Primary Care Visits $5 copay $5 copay Specialist Visits $30 copay $30 copay Urgent Care Services $50 copay $75 copay covered at in network level Emergency Room $75 copay $00 copay covered at in network level Outpatient Surgery Ambulatory Surgical Inpatient Hospital Services Including Maternity 0% up to $225 max $300 copay per day, 0% up to $250 max per day, X-rays & Diagnostic Imaging $30 copay $30 copay Imaging CT/PT Scans, MRIs $60 copay $60 copay Inpatient Treatment Outpatient Treatment Laboratory no charge no charge $300 copay per day, per day, $30 copay $30 copay Rehabilitation Therapy Services 3 $30 copay $30 copay Chiropractic Care 2 Durable Medical Equipment Generic Rx $0 copay $0 copay Brand Rx $40 copay $40 copay Non-Preferred Brand Rx $75 copay $75 copay not covered, reimbursement Ten Essential Health Benefits No matter what health plan you choose, the following benefits are always included. Preventive, wellness, and disease management services 2 Emergency care 3 Ambulatory services 4 Hospitalization 5 Maternity and newborn services 6 Pediatric services, including dental and vision 7 Prescription drugs 8 Laboratory services 9 Mental health and substance abuse services, including behavioral health treatment 0 Rehabilitation and habilitation services Did you know... Your yearly checkup is free? Find a provider at /providerfinder. Technology and resources We know you don t always have the time or the resources to focus on your health. That s why we have online account management systems and personalized tools to help manage your health quickly and easily so you get the most out of your benefits. Health insurance that s mobile. Manage your health online at amerihealthexpress.com or download the free AHNJ On the Go app to help you make the most of your health plan. Streamlined navigation will make it easier than ever to find a participating provider, view your claims and benefit information, manage your spending account, download a temporary ID card, , or fax one directly to your doctor, and so much more! Get Connected It pays to stay in the know with AmeriHealth New Jersey Wire text messages. Sign up at /getwired. Search Provider Finder. Search for a participating doctor by name, location, or specialty. Find out where a doctor went to medical school, his or her board certification, and languages spoken. You can even view office hours and the hospitals to which a physician has admitting privileges. Start shopping. Start saving with the Insider Discount program. Find great deals on a wide range of attractions and events, some are even FREE! Learn how to get discounted movie tickets, and so much more at /discounts. Your health coverage can help pay for college. We can help families keep up with the cost of attending college through an arrangement with The College Tuition Benefit. Learn more at amerihealthnj.collegetuitionbenefit.com. Please have your member ID card ready when you text to sign up. Standard message and data rates may apply. Text STOP to stop and HELP for help. Terms and conditions available at myhelpsite.net/amerihealth. Notification messages within AmeriHealth New Jersey Wire are sent via automated SMS. Enrollment in AmeriHealth New Jersey Wire is not a requirement to purchase goods and services from AmeriHealth New Jersey. Wire is a trademark of Relay Network, LLC. Plan year and calendar year options available. All Rx plans are creditable. 0

7 Dental Plans Healthier mouth, healthier life. Good oral health can have a direct impact on your overall health and wellness. That s why AmeriHealth New Jersey offers several dental plan options for you to pair with your medical benefits. You have the freedom to see any dentist but can save on out-of-pocket costs by choosing a dentist in the Advantage Plus 2.0 network. Plus, you ll never need a referral to visit a provider. To find a dental provider, visit /dental. BENEFIT 2 Pediatric Pediatric with Adult Preventive Family Family Plus AGES All Family Members All Family Members All Family Members PEDIATRIC DEDUCTIBLE $75 $75 $75 $75 ADULT DEDUCTIBLE n/a $50 $50 $50 PEDIATRIC ANNUAL MAXIMUM unlimited for individuals up to age 9 in-network and $,000 out-of-network ADULT ANNUAL MAXIMUM n/a $,000 for adult in- and out-of-network PEDIATRIC OUT-OF-POCKET MAXIMUM (IN-NETWORK BENEFIT 4 ) ADULT OUT-OF-POCKET MAXIMUM (IN-NETWORK BENEFIT 4 ) PREVENTIVE SERVICES Exams/Evaluations Cleaning X-rays Emergency/Palliative Treatment Flouride Treatments, Sealants, Space Maintainers BASIC Fillings (Amalgam restorations-metal;resin-based composite restorations-white) Simple and surgical extractions Crown and denture repair Root canals (Endodontic therapy and services) Surgical and non-surgical periodontics and maintenance Oral surgery General anesthesia, nitrous oxide, and/or IV sedation MAJOR Crowns, inlays, onlays Complete or fixed partial dentures (prosthetics) ORTHODONTIA (Child only age 0-8) Medically necessary orthodontia $350 for child; $700 for 2 or more children n/a n/a n/a n/a not subject to deductible,, not subject to deductible covered only for children age 0-8, not sublect to deductible covered only for children age 0-8, covered only for children age 0-8, not subject to deductible covered only for children age 0-8, not sublect to deductible, 80%, covered only for children age 0-8,, Implants not covered not covered not covered not covered,,,, Cosmetic orthodontia not covered not covered not covered, 7 Vision Plans The clear solution to your vision care needs Choose AmeriHealth New Jersey Adult Vision Care to save on out of-pocket costs and get access to eye exams, eyeglasses, contacts, and value-added discounts. Routine eye exams help keep you seeing clearly and can help detect more serious medical conditions like diabetes, hypertension, and heart disease. That s why AmeriHealth New Jersey offers several vision plan options for you to pair with your medical benefits. To find a vision provider, visit /vision. RATES 3 (MONTHLY) BENEFIT Adult Vision Care 00 Adult Vision Care 50 Adult Vision Care 80 Eye Exam, once every calendar year Eyeglasses Contact lenses (instead of glasses) Additional Visionworks frame option No matter which plan you choose, you ll get: Choose from the Exclusive Davis Collection for low or no cost frames available at most participating providers. Service at more than 60,000 access points, including ophthalmologists, optometrists and retail stores, including Visionworks 2. Access to Visionworks, which offers over 2,000 frames, plus the convenience of on-site labs in most locations. Contact lenses available in lieu of glasses. (in-network) (in-network) (in-network) standard lenses: fully covered standard lenses: fully covered standard lenses: fully covered Davis Vision frames: fashion - $0 designer - $5 premier - $40 participating provider frame collection: up to $00 allowance, plus a 20% discount on any overage up to $00 allowance, plus a 5% discount on any overage One-year breakage warranty for glasses purchased at participating providers. Discounts on other services, such as laser vision correction. n/a Davis Vision frames: fashion - $0 designer - $0 premier - $0 participating provider frame collection: up to $50 allowance, plus a 20% discount on any overage up to $50 allowance, plus a 5% discount on any overage Davis Vision members also have access to a routine hearing test and brand-name hearing aid technology at reduced prices through EPIC Hearing, an industry leader. n/a Davis Vision frames: fashion - $0 designer - $0 premier - $25 participating provider frame collection: up to $30 allowance, plus a 20% discount on any overage up to $30 allowance, plus a 5% discount on any overage up to $80 allowance, plus a 20% discount on any overage at Visionworks locations nationwide Single $4.9 $7.78 $4.43 Husband/Wife $9.82 $5.56 $8.86 Parent w/child $9.82 $5.56 $8.86 Parent w/children $9.82 $5.56 $8.86 Family $4.73 $23.34 $3.29 RATES 5 Per member per month Age $9.00 All 9+ n/a $5.00 $29.00 $

8 All plans within this brochure reflect member cost-sharing. Important health plan information The benefi ts summaries in this brochure represent only a partial listing of benefi ts of the health plans. Benefi ts and exclusions may be further defi ned by medical policy. These managed care plans may not cover all your health care expenses. Read your contract carefully to determine which health care services are covered. If you need more information, please contact your broker.. Medical Footnotes: Emergency room copay waived if admitted. 2 Members can utilize 30 visits per benefit period. 3 Members can utilize 30 visits combined for physical and occupational therapy per benefit period, and 30 visits combined for speech and cognitive therapy per benefit period.. 4 Prescription mail order benefit is available at 2x applicable cost-sharing for a 90 day supply. 5 AmeriHealth Advantage plans are only available to employers based in the following counties: Atlantic, Burlington, Camden, Cape May, Essex, Gloucester, Hudson, Mercer, Middlesex, Monmouth, Ocean, Somerset, and Union. Members can obtain services within the listed counties at the tier level. AmeriHealth Advantage members can also access tier 2 providers within the AmeriHealth New Jersey Local Value network. AmeriHealth Advantage tier hospitals are subject to change. 6 Deductible is combined for tier and tier 2. 7 Out-of-pocket maximum is combined for tier and tier 2. 8 The Local Value network is not available in Hunterdon County. 9 AmeriHealth Hospital Advantage providers are an enhancement to your benefits. Tier 2 providers are AmeriHealth New Jersey Local Value network providers. 0 Copay is required per day, up to a maximum of 5 days per admission. Copay waived if readmitted within 90 days. Copay waived if readmitted within 90 days. 2 Individual deductible not applicable in policies covering 2 or more people. 3 Certain services may require a referral from your primary care physician. Dental Footnotes: AmeriHealth New Jersey dental plans are administered by United Concordia. 2 This summary is intended to highlight the benefits available to you. For a complete program description, including all benefits, limitations, and exclusions, please refer to the dental contract rate capped at 3 members<9. 4 If you choose to use a non-network dentist, you may pay the difference between the amount the plan pays and the amount charged by the non-network dentist. 5 Pediatric dental benefits only cover up to age 9. Be sure to purchase a dental care plan that provides benefits for anyone age 9 and older in your family who needs coverage. 6 Pediatric benefits through end of contract year in which member reaches age 9. 7 Cosmetic orthodontia covered up to a lifetime max of $,000 per child Vision Footnotes: Administered by Davis Vision. 2 An AmeriHealth New Jersey affiliate has a financial interest in Visionworks. 3 Adult Vision Care plans cover members 9 and older, as well as child dependents age 9 to 26. Vision benefits for members under 9 are included in the medical plans. Additional information Your broker, consultant, or account executive can provide information about the following upon request. Factors that may affect changes in premium rates Renewability of coverage Description of the geographic areas served by our HMO plans Benefi ts and premiums for all the health benefi t plans for which you qualify Minimum employer and group participation rules that apply AmeriHealth New Jersey reserves the right to change premium rates. 5

9 209 AmeriHealth October AmeriHealth Insurance Company of New Jersey AmeriHealth HMO, Inc.