benefits at a glance - 2016benefits at a glance - 2016 small group plans choose the best plan for...

Benefits at a Glance - 2016Small Group Plans

Choose the best plan for you and your business.Use this brochure to compare plans and cost-sharing.

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.

What’s included?We want to help you stay well, prevent illness, and benefit from healthy lifestyle choices. That’s why no matter what health plan you choose, the following benefits are always included.

Ten Essential Health Benefits 1. 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

10. Rehabilitation and habilitation services

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PLATINUM BENEFITS

EPO$15/$30

HMO$15/$30

POS PLUS$10/$25

POS PLUS$15/$30

CHOOSE YOUR NETWORK

LOCAL VALUE10

LOCAL VALUE10 4 LOCAL VALUE10 LOCAL VALUE10

REGIONAL PREFERRED REGIONAL PREFERRED REGIONAL PREFERRED

REGIONAL PREFERRED NATIONAL ACCESS NATIONAL ACCESS 4 NATIONAL ACCESS

In Network In Network In Network Out of Network In Network Out of Network

DEDUCTIBLE INDIVIDUAL / FAMILY

$0 / $0 $0 / $0 $0 / $0 $3,000 / $6,000 $0 / $0 $3,000 / $6,000

AFTER DEDUCTIBLE MEMBER PAYS

n/a n/a n/a 30% n/a 30%

MAXIMUM OUT OF POCKET

INDIVIDUAL / FAMILY$3,500 / $7,000 $3,000 / $6,000 $2,500 / $5,000 $5,000 / $10,000 $3,000 / $6,000 $6,000 / $12,000

Primary Care Visits $15 copay $15 copay $10 copay30% coinsurance,after deductible

$15 copay30% coinsurance,after deductible

Specialist Visits $30 copay $30 copay $25 copay $30 copay

Urgent Care Services $75 copay $50 copay $50 copay $75 copay

Emergency Room $100 copay1 $75 copay1 $100 copay1 $100 copay1

Outpatient Surgery Ambulatory Surgical

no charge

$225 copay $250 copay30% coinsurance,after deductible


Inpatient Hospital Services$300 copay,

up to 5 days12

$300 copay,up to 5 days12


X-rays & Diagnostic Imaging $30 copay $30 copay $25 copay30% coinsurance,after deductible

$30 copay30% coinsurance,after deductibleImaging

CT/PT Scans, MRIs $60 copay $60 copay $50 copay $60 copay

Laboratory no charge no charge no charge30% coinsurance,after deductible

no charge30% coinsurance,after deductible

Inpatient Treatment Mental Behavioral Health,

Substance Abuse Disorderno charge



30% coinsurance,after deductible


30% coinsurance,after deductibleOutpatient Treatment

Mental Behavioral Health, Substance Abuse Disorder

$30 copay $30 copay $25 copay $30 copay

Physical & Occupational Therapy

30 visits calendar year3

$30 copay $30 copay $25 copay30% coinsurance,after deductible


Speech & Cognitive Therapy 30 visits calendar year3

Chiropractic Care 30 visits calendar year2

Generic Rx 30 Day Supply4 $10 copay $10 copay $10 copay

not covered

$10 copay

not coveredBrand Rx

30 Day Supply4 $40 copay $40 copay $40 copay $40 copay

Non-Preferred Brand Rx 30 Day Supply4 $60 copay $60 copay $60 copay $60 copay

MED

ICAL

BEN

EFIT

SPR

ESCR

IPTI

ON B

ENEF

ITS

4 Denotes ON EXCHANGE

3

EPO$20/$40

POS PLUS$30/$40

POS PLUS$20/$40

POS PLUS$20/$4090% COINS

LOCAL VALUE10 LOCAL VALUE10 LOCAL VALUE10 LOCAL VALUE10

REGIONAL PREFERRED 4 REGIONAL PREFERRED 4 REGIONAL PREFERRED REGIONAL PREFERRED

NATIONAL ACCESS 4 NATIONAL ACCESS NATIONAL ACCESS NATIONAL ACCESS

In Network In Network Out of Network In Network Out of Network In Network Out of Network

$0 / $0 $0 / $0 $3,000 / $6,000 $0 / $0 $3,000 / $6,000 $0 / $0 $1,500 / $3,000

n/a n/a 30% n/a 30% n/a 30%

$4,000 / $8,000 $3,000 / $6,000 $6,000 / $12,000 $3,000 / $6,000 $6,000 / $12,000 $1,500 / $3,000 $3,000 / $6,000






$100 copay1 $100 copay1 $100 copay1 $100 copay1

no charge



10% coinsurance30% coinsurance,after deductible$300 copay,

up to 5 days12






no charge no charge30% coinsurance,after deductible



no charge$300 copay,

up to 5 days12




10% coinsurance30% coinsurance,after deductible





$7 copay $7 copay

not covered

$7 copay

not covered

$7 copay

not covered$35 copay $35 copay $35 copay $35 copay


PLATINUM BENEFITS

CHOOSE YOUR NETWORK




INDIVIDUAL / FAMILY

Primary Care Visits

Specialist Visits

Urgent Care Services

Emergency Room


Inpatient Hospital Services

X-rays & Diagnostic Imaging

Imaging CT/PT Scans, MRIs

Laboratory


Substance Abuse Disorder

Outpatient Treatment Mental Behavioral Health,






Generic Rx 30 Day Supply4

Brand Rx 30 Day Supply4

Non-Preferred Brand Rx 30 Day Supply4

MED

ICAL

BEN

EFIT

SPR

ESCR

IPTI

ON B

ENEF

ITS


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GOLD BENEFITS

EPO$30/$5080% COINS

HMO $25/$50

RX 50%/$125 MAX

HMO$25/$50

RX 50%

HMO $30/$60

HMO $15/$30

CHOOSE YOUR NETWORK

LOCAL VALUE10

LOCAL VALUE10 LOCAL VALUE10 LOCAL VALUE10 LOCAL VALUE10 4REGIONAL PREFERRED 4

REGIONAL PREFERRED REGIONAL PREFERRED REGIONAL PREFERRED REGIONAL PREFERRED NATIONAL ACCESS

In Network In Network In Network In Network In Network


$1,000 / $2,000 $0 / $0 $0 / $0 $0 / $0 $2,000 / $4,000


20% n/a n/a n/a 40%


INDIVIDUAL / FAMILY$5,000 / $10,000 $5,500 / $11,000 $6,600 / $13,200 $6,600 / $13,200 $4,650 / $9,300

Primary Care Visits $30 copay $25 copay $25 copay $30 copay $15 copay

Specialist Visits $50 copay $50 copay $50 copay $60 copay $30 copay

Urgent Care Services $75 copay $85 copay $85 copay $85 copay $85 copay

Emergency Room $100 copay1 $100 copay1 $100 copay1 $100 copay1 $100 copay1



$250 copay $250 copay $250 copay



up to 5 days12

$500 copay,

up to 5 days12

$500 copay,

up to 5 days12

X-rays & Diagnostic Imaging $50 copay $50 copay $50 copay $50 copay $50 copay

Imaging CT/PT Scans, MRIs $100 copay $100 copay $100 copay $100 copay $100 copay

Laboratory no charge no charge no charge no charge no charge




$500 copay,

up to 5 days12

$500 copay,

up to 5 days12

$500 copay,

up to 5 days12



Substance Abuse Disorder$50 copay $50 copay $50 copay $60 copay $30 copay



$50 copay $50 copay $50 copay $50 copay $30 copaySpeech & Cognitive Therapy 30 visits calendar year3


Generic Rx 30 Day Supply4 $10 copay

50% coinsurance,

no deductible,

up to $125 maximum

50% coinsurance,

no deductible

$7 copay $10 copay

Brand Rx 30 Day Supply4 $40 copay 50% coinsurance,

no deductible,

up to $125 maximum

$40 copay

Non-Preferred Brand Rx 30 Day Supply4 $60 copay $60 copay

PRES

CRIP

TION

BEN

EFIT

SM

EDIC

AL B

ENEF

ITS


5

GOLD BENEFITS

POS $30/$60

POS PLUS $30/$60

HMO PLUS $30/$50

HMO PLUS $25/$50

CHOOSE YOUR NETWORK

LOCAL VALUE10 LOCAL VALUE10


REGIONAL PREFERRED

REGIONAL PREFERRED REGIONAL PREFERRED REGIONAL PREFERRED NATIONAL ACCESS

In Network Out of Network In Network Out of Network In Network In Network


$0 / $0 $3,000 / $6,000 $1,500 / $3,000 $3,000 / $6,000 $1,500 / $3,000 $0 / $0


n/a 30% n/a 30% 30% n/a


INDIVIDUAL / FAMILY$6,600 / $13,200 $13,200 / $26,400 $6,350 / $12,700 $12,700 / $25,400 $2,500 / $5,000 $5,500 / $11,000

Primary Care Visits $30 copay30%,

after deductible $30 copay

30%,after deductible

$30 copay $25 copay

Specialist Visits $60 copay30%,

after deductible$60 copay


$50 copay $50 copay

Urgent Care Services $75 copay $75 copay $75 copay $75 copay

Emergency Room $100 copay1 $100 copay,after deductible1 $100 copay1 $100 copay1

Outpatient Surgery Ambulatory Surgical $250 copay


$250 copay



$250 copay


up to 5 days12

$500 copay, up to 5 days12

$500 copay,

up to 5 days12

X-rays & Diagnostic Imaging $50 copay30% coinsurance,after deductible


$50 copay $50 copay

Imaging CT/PT Scans, MRIs $100 copay $100 copay $100 copay $100 copay

Laboratory no charge30% coinsurance,after deductible


no charge no charge



$500 copay,

up to 5 days12


$500 copay, up to 5 days12



$500 copay,

up to 5 days12


Substance Abuse Disorder$60 copay



$50 copay $50 copay





$50 copay $50 copaySpeech & Cognitive Therapy 30 visits calendar year3



not covered

$10 copay

not covered50% coinsurance,

no deductible,up to $125 maximum

50% coinsurance, no deductible,

up to $125 maximum


50% coinsurance,no deductible,

up to $125 maximum

$40 copay

Non-Preferred Brand Rx 30 Day Supply4 $60 copayPR

ESCR

IPTI

ON B

ENEF

ITS

MED

ICAL

BEN

EFIT

S


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GOLD BENEFITS

POS PLUS $30/$50

POS PLUS $20/$40

POS $30/$5070% COINS

EPO H.S.A100%/100%

CHOOSE YOUR NETWORK


LOCAL VALUE10LOCAL VALUE10

REGIONAL PREFERRED REGIONAL PREFERRED 4 REGIONAL PREFERRED 4

NATIONAL ACCESS 4 NATIONAL ACCESS REGIONAL PREFERRED NATIONAL ACCESS

In Network Out of Network In Network Out of Network In Network Out of Network In Network


$1,000 / $2,000 $2,000 / $4,000 $1,500 / $3,000 $3,000 / $6,000 $2,000 / $4,000 $4,000 / $8,000 $1,400 / $2,800


20% 40% 20% 30% 30% 40% n/a


INDIVIDUAL / FAMILY$2,750 / $5,500 $5,500 / $11,000 $4,000 / $8,000 $8,000 / $16,000 $3,500 / $7,000 $7,000 / $14,000 $5,000 / $10,000

Primary Care Visits $30 copay40%,



$30 copay40%,

after deductible no charge, after deductible

Specialist Visits $50 copay40%,



$50 copay40%,

after deductible

Urgent Care Services $75 copay $65 copay $75 copay

no charge, after deductible

Emergency Room $100 copay1 $100 copay1 $100 copay1

Outpatient Surgery Ambulatory Surgical 20%

coinsurance,after deductible




30% coinsurance,

after deductible




X-rays & Diagnostic Imaging $50 copay40%,

after deductible



no charge, after deductibleImaging

CT/PT Scans, MRIs $100 copay $80 copay $100 copay

Laboratory no charge40%,

after deductibleno charge














Substance Abuse Disorder$50 copay $40 copay




$50 copay40%,









not covered

$7 copay

not covered not covered not covered

$10 copay,after deductible



up to $125maximum

$35 copay$40 copay,

after deductible

Non-Preferred Brand Rx 30 Day Supply4 $50 copay

$60 copay,after deductiblePR

ESCR

IPTI

ON B

ENEF

ITS

MED

ICAL

BEN

EFIT

S


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GOLD BENEFITS

EPO H.S.A $20/$40

EPO H.S.A 70% COINSRX $10/$40/$60

EPO H.S.A 70% COINS

RX $7/50%/$125 MAX

EPO $30/$5070% COINS

EPO7

$10/$20

CHOOSE YOUR NETWORK

LOCAL VALUE10 LOCAL VALUE10 LOCAL VALUE10 LOCAL VALUE10COMMUNITY ADVANTAGE5 4

REGIONAL PREFERRED 4 REGIONAL PREFERRED REGIONAL PREFERRED REGIONAL PREFERRED AMERIHEALTH ADVANTAGE6 4NATIONAL ACCESS NATIONAL ACCESS NATIONAL ACCESS NATIONAL ACCESS

In Network In Network In Network In Network Tier 1 Tier 2


$1,500 / $3,000 $1,350 / $2,700 $1,350 / $2,700 $1,500 / $3,000 $1,000 / $2,0008


n/a 30% 30% 30% 10% 50%



Primary Care Visits$20 copay,

after deductible 30% coinsurance,after deductible



Specialist Visits$40 copay,

after deductible$50 copay $20 copay $75 copay

Urgent Care Services$65 copay,

after deductible30% coinsurance,after deductible



Emergency Room$100 copay,

after deductible1 $100 copay1 $50 copay1 $100 copay1






10% coinsurance,

after deductible

50% coinsurance,

after deductibleInpatient Hospital Services

$500 copay,after deductible, per admission16

X-rays & Diagnostic Imaging$40 copay,



$50 copay $50 copay

Imaging CT/PT Scans, MRIs

$80 copay, after deductible

$100 copay $100 copay

Laboratoryno charge,

after deductibleno charge,


after deductibleno charge no charge



$500 copay,after deductible, per admission16




10% coinsurance,

after deductible

50% coinsurance,

after deductible










$50 copay $20 copay $50 copaySpeech & Cognitive Therapy 30 visits calendar year3






$10 copay $10 copay


$40 copay,after deductible 50% coinsurance,

after deductible,up to $125 maximum

$40 copay $40 copay

Non-Preferred Brand Rx 30 Day Supply4


$60 copay $60 copay

PRES

CRIP

TION

BEN

EFIT

SM

EDIC

AL B

ENEF

ITS


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SILVER BENEFITS

POS PLUS $50/$75

HMO$50/$75

EPO H.S.A$50/$75

EPO7

$15/$35

CHOOSE YOUR NETWORK

LOCAL VALUE10LOCAL VALUE10 4

TIER 1 ADVANTAGE11 4

COMMUNITY ADVANTAGE54

REGIONAL PREFERREDREGIONAL PREFERRED AMERIHEALTH ADVANTAGE6 4NATIONAL ACCESS 4

In Network Out of Network In Network Tier 1 Tier 2 Tier 1 Tier 2


$2,000 / $4,000 $5,000 / $10,000 $2,000 / $4,000 $1,350 / $2,7008 $2,000 / $4,0008


20% 40% 50% 50% 20% 50%



Primary Care Visits $50 copay 40% coinsurance,

after deductible

$50 copay$50 copay,

after deductible$15 copay $50 copay

Specialist Visits $75 copay $75 copay$75 copay,

after deductible$35 copay $75 copay

Urgent Care Services $85 copay $85$75 copay,

after deductible20%

coinsurance,after

deductible

50% coinsurance,

after deductibleEmergency Room $100 copay1 $100 copay,

after deductible1

$100 copay,after deductible1


Outpatient Surgery Ambulatory Surgical 20%


40% coinsurance,

after deductible




20% coinsurance,

after deductible

50% coinsurance,

after deductibleInpatient Hospital Services

X-rays & Diagnostic Imaging $50 copay 40% coinsurance,

after deductible

$5050% coinsurance, after deductible

50% coinsurance,after deductibleImaging

CT/PT Scans, MRIs $100 copay $100

Laboratory no charge40% coinsurance,after deductible

no chargeno charge,

after deductibleno charge



20% coinsurance,

after deductible 40% coinsurance,

after deductible




20% coinsurance,

after deductible

50% coinsurance,

after deductible




$35 copay $60 copay



$5040%


$50 copay$50 copay,

after deductible$35 copay $50 copaySpeech & Cognitive Therapy




not covered50% coinsurance,



$7 copay


50% coinsurance,no deductible,up to $125maximum


up to $125 maximum

50% coinsurance, after deductible,

up to $125 maximumNon-Preferred Brand Rx 30 Day Supply4

PRES

CRIP

TION

BEN

EFIT

SM

EDIC

AL B

ENEF

ITS


9

SILVER BENEFITS

EPO$30/$5080% COINS

EPO$30/$5050% COINS

EPO H.S.A$30/$50

EPO H.S.A90%/90%

EPO H.S.A100%/100%

CHOOSE YOUR NETWORK

LOCAL VALUE10 LOCAL VALUE10 LOCAL VALUE10 LOCAL VALUE10 LOCAL VALUE10 4

REGIONAL PREFERRED REGIONAL PREFERRED 4 REGIONAL PREFERRED REGIONAL PREFERRED 4 REGIONAL PREFERRED

NATIONAL ACCESS NATIONAL ACCESS NATIONAL ACCESS NATIONAL ACCESS NATIONAL ACCESS

In Network In Network In Network In Network In Network


$2,500 / $5,000 $2,500 / $5,000 $2,000 / $4,000 $2,200 / $4,400 $2,350 / $4,700


20% 50% 50% 10% n/a



Primary Care Visits $30 copay $30 copay$30 copay,



Specialist Visits $50 copay $50 copay$50 copay,

after deductible

Urgent Care Services $75 copay50% coinsurance,after deductible




Emergency Room $100 copay1

Outpatient Surgery Ambulatory Surgical 20% coinsurance,






X-rays & Diagnostic Imaging $50 copay $50 copay50% coinsurance,after deductible


no charge, after deductibleImaging

CT/PT Scans, MRIs $100 copay $100 copay

Laboratory no charge no chargeno charge,



after deductible













$50 copay $50 copay$50 copay,





Generic Rx 30 Day Supply4 $7 copay $7 copay




Brand Rx 30 Day Supply4 50% coinsurance,


50% coinsurance,no deductible,

up to $125 maximum

$40 copay,after deductible 50% coinsurance,

after deductible,up to $125 maximumNon-Preferred Brand Rx

30 Day Supply4

$60 copay,after deductiblePR

ESCR

IPTI

ON B

ENEF

ITS

MED

ICAL

BEN

EFIT

S


amerihealthnj.com10

BRONZE BENEFITS

EPO H.S.A$50/$75

EPO $50/$75

EPO $50/$75

EPO7 $25/$50

CHOOSE YOUR NETWORK

LOCAL VALUE10 4 LOCAL VALUE10

TIER 1 ADVANTAGE11 4

COMMUNITY ADVANTAGE5 4REGIONAL PREFERRED 4 REGIONAL PREFERRED

AMERIHEALTH ADVANTAGE6 4NATIONAL ACCESS 4 NATIONAL ACCESS

In Network In Network Tier 1 Tier 2 Tier 1 Tier 2


$3,000 / $6,000 $3,000 / $6,000 $3,000 / $6,0008 $3,000 / $6,0008


50% 50% 50% 50%


INDIVIDUAL / FAMILY$6,450 / $12,900 $6,850 / $13,700 $6,850 / $13,7009 $6,850 / $13,7009

Primary Care Visits$50 copay,

after deductible$50 copay,


after deductible

$25 copay,after

deductible

$50 copay,after

deductible

Specialist Visits$75 copay,



after deductible

$50 copay,after

deductible

$75 copay,after

deductible

Urgent Care Services50% coinsurance, after deductible

50% coinsurance, after deductible


30%coinsurance,

after deductible

50%coinsurance,

after deductibleEmergency Room

30%coinsurance,

after deductible

50%coinsurance,

after deductible



50% coinsurance, after deductible 20%,

after deductible

50%,after

deductibleInpatient Hospital Services$500 copay,

after deductible, up to 5 days12

$500 copay, after deductible, up to 5 days12

X-rays & Diagnostic Imaging50% coinsurance, after deductible

$50 copay, after deductible 50% coinsurance,

after deductible50% coinsurance, after deductibleImaging

CT/PT Scans, MRIs$100 copay,

after deductible

Laboratory50% coinsurance, after deductible

no charge, no deductible







20% coinsurance,

after deductible

50% coinsurance,

after deductible

30%coinsurance,

after deductible

50%coinsurance,

after deductible






$50 copay,after

deductible

$60 copay,after

deductible











up to $125 maximum



up to $125 maximum


up to $125 maximum

Brand Rx 30 Day Supply4 50% coinsurance,

after deductible,up to $125 maximumNon-Preferred Brand Rx

30 Day Supply4

MED

ICAL

BEN

EFIT

SPR

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ON B

ENEF

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NETWORK OPTIONS AmeriHealth New Jersey has a variety of networks – making health insurance more affordable for you, your family and 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 amerihealthnj.com/provider_finder.

National Access Available through the Multiplan PHCS National network for services obtained outside of the Regional Preferred service area.14,15

Regional Preferred One of the largest network of doctors, hospitals, and labs in the state of New Jersey. Members have access to participating physicians and providers in New Jersey, Delaware and Southeastern Pennsylvania.14

Local Value The Local Value network currently represents 82% of the New Jersey-based Regional Preferred network, offering individuals and employers a more affordable rate.10,15

The following plans are a subset of the Local Value network and are designed to offer additional options focused on affordability and high-quality health care coverage.

• Tier 1 Advantage plans allow members to pay lower out-of-pocket costs for hospital and facility services if they use a participating Tier 1 Advantage provider. Tier 2 providers are available through the AmeriHealth New Jersey Local Value network.10,11

• Community Advantage plans are offered in collaboration with Cooper University Health Care, Shore Medical Center and Cape Regional Medical Center to meet the needs of individuals and employers based in Atlantic, Burlington, Camden, Cape May, and Gloucester counties.5,7

• AmeriHealth Advantage plans are offered in collaboration with Meridian Health to meet the needs of individuals and employers based in Monmouth and Ocean counties.6,7

259 Prospect Plains Road, Bldg. M, Cranbury, NJ 08512

amerihealthnj.com

All plans within this brochure reflect member cost-sharing.

Important plan informationThe benefits summaries in this brochure represent only a partial listing of benefits of the plans. Benefits and exclusions may be further defined 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.

For on-exchange members, abortions will be covered at the Federal Definition; abortions are covered in the case of rape or incest, or for a pregnancy which, as certified by a physician, places the woman in danger of death unless an abortion is performed.

For off-exchange members, elective abortions are covered.

Medical and Network Footnotes:

© 2016 AmeriHealth | 18440 | 2015 October AmeriHealth Insurance Company of New Jersey | AmeriHealth HMO, Inc.

1 Emergency room copay waived if admitted.2 Members can utilize 30 visits per calendar year. 3 Members can utilize 30 visits combined per calendar year.4 Prescription mail order benefit is available at 2x applicable cost-sharing for a 90 day supply.5 Community Advantage plans are only available to individuals and small employers based in Atlantic, Burlington, Camden, Cape May, and Gloucester Counties. 6 AmeriHealth Advantage plans are only available to individuals and small employers based in Monmouth and Ocean Counties. 7 Members with Community Advantage or AmeriHealth Advantage plans can obtain services at the Tier 1 level in Atlantic, Burlington, Camden, Cape May, Gloucester, Monmouth, and Ocean Counties. Tier 2 providers are AmeriHealth New Jersey Local Value network providers. 8 Deductible is combined for Tier 1 and Tier 2.9 Out-of-pocket maximum is combined for Tier 1 and Tier 2.

10 The Local Value network is not available in Hunterdon County.11 Tier 1 providers are an enhancement to your benefits. Tier 2 providers are AmeriHealth New Jersey Local Value network providers.12 Copay is required per day, up to a maximum of 5 days per admission. Copay waived if readmitted within 90 days.13 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.14 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.15 Data derived from analysis of information provided by a third party vendor and is subject to change.16 Copay waived if readmitted within 90 days.

© 2016 AmeriHealth | AmeriHealth New Jersey General Taglines | 2016 NovemberAmeriHealth Insurance Company of New Jersey | AmeriHealth HMO, Inc.

Language Taglines and Nondiscrimination Notice

AmeriHealth New Jersey – General Taglines 2016

Language Access Services If you, or someone you’re helping, has questions about AmeriHealth New Jersey, you have the right to get help and information in your language at no cost. To talk to an interpreter, call 1-888-968-7241 TTY 711. Si usted, o alguien a quien usted está ayudando, tiene preguntas acerca de AmeriHealth New Jersey, tiene derecho a obtener ayuda e información en su idioma sin costo alguno. Para hablar con un intérprete, llame al 1-888-968-7241 TTY 711. 如对 AmeriHealth New Jersey 有任何问题，请您或您所帮助的人联系我们提供的免费多语言信息服务。翻译服务请拨打 1-888-968-7241。 AmeriHealth New Jersey와 관련하여 궁금한 사항이 있으신 경우 귀하 또는 귀하의 지원을 받는 사람은 관련 정보

및 지원을 해당 언어로 무료로 받으실 수 있습니다. 통역사와 상담하시려면 1-888-968-7241 로 전화해 주십시오.

Se você, ou alguém a quem você está ajudando, tem perguntas sobre o AmeriHealth New Jersey, você tem o direito de obter ajuda e informação em seu idioma e sem custos. Para falar com um intérprete, ligue para 1-888-968-7241. જો તમને અથવા તમે કોઇને મદદ કરી રહ્યા તેમાાંથી કોઇને AmeriHealth New Jersey વવશે પ્રશ્નો હોય, તો તમને મદદ અને માહહતી તમારી ભાષામાાં કોઈપણ ખર્ચ વવના મેળવવાનો અવિકાર છે. દુભાવષયા સાથે વાત કરવા માટે, આ 1-888-968-7241 પર કોલ કરો. Jeśli Ty lub osoba, której pomagasz macie pytania odnośnie do programu AmeriHealth New Jersey, mogą Państwo uzyskać bezpłatną informację i pomoc w Waszym języku. Aby porozmawiać z tłumaczem, proszę zadzwonić pod numer 1-888-968-7241. Se tu o qualcuno che stai aiutando avete domande su AmeriHealth New Jersey, hai il diritto di ottenere gratuitamente aiuto e informazioni nella tua lingua. Per parlare con un interprete, puoi chiamare il numero 1-888-968-7241.

الضرورية ، فلديك الحق في الحصول على المعلوماتAmeriHealth New Jersey إذا كان لديك أو لدى شخص تساعده أسئلة بخصوص .7241-968-888-1 بلغتك دون أي تكلفة. للتحدث مع مترجم اتصل بـ

Kung ikaw, o ang taong iyong tinutulungan, ay may mga katanungan tungkol sa AmeriHealth New Jersey, may karapatan kang makakuha ng tulong at impormasyon sa iyong wika nang walang gastos. Upang makausap ang isang interpreter, tumawag sa 1-888-968-7241. Если у вас или лица, которому вы помогаете, имеются вопросы по поводу программы AmeriHealth New Jersey, то вы имеете право на бесплатное получение помощи и информации на вашем языке. Для разговора с переводчиком позвоните по телефону 1-888-968-7241. Si ou menm, oswa yon moun w ap ede, gen kesyon konsènan AmeriHealth New Jersey, ou gen dwa pou resevwa èd ak enfòmasyon nan lang ou gratis. Pou pale ak yon entèprèt, rele 1-888-968-7241. यदि आपके, या आप द्वारा सहायता दकए जा रह ेदकसी व्यक्ति के AmeriHealth New Jersey के बारे में प्रश्न ह,ै तो आपके पास अपनी भाषा में मुफ्त में सहायता और सचूना प्राप्त करने का अक्तिकार ह।ै दकसी िभुाक्तषए से बात करने के क्तिए, 1-888-968-7241 पर कॉि करें।. Nếu quý vị hoặc người mà quý vị đang trợ giúp có câu hỏi về AmeriHealth New Jersey, quý vị có quyền nhận được trợ giúp và thông tin bằng ngôn ngữ của quý vị hoàn toàn miễn phí. Để yêu cầu thông dịch viên, hãy gọi số 1-888-968-7241. Si vous, ou quelqu'un que vous aidez, a des questions à propos d’AmeriHealth New Jersey, vous avez le droit d'obtenir gratuitement de l'aide et l'information dans votre langue. Pour parler à un interprète, appelez 1-888-968-7241.

Language Access Services

(OVER)

© 2016 AmeriHealth | AmeriHealth New Jersey General Taglines | 2016 NovemberAmeriHealth Insurance Company of New Jersey | AmeriHealth HMO, Inc.

Language Access Services


Language Access Services If you, or someone you’re helping, has questions about AmeriHealth New Jersey, you have the right to get help and information in your language at no cost. To talk to an interpreter, call 1-888-968-7241 TTY 711. Si usted, o alguien a quien usted está ayudando, tiene preguntas acerca de AmeriHealth New Jersey, tiene derecho a obtener ayuda e información en su idioma sin costo alguno. Para hablar con un intérprete, llame al 1-888-968-7241 TTY 711. 如对 AmeriHealth New Jersey 有任何问题，请您或您所帮助的人联系我们提供的免费多语言信息服务。翻译服务请拨打 1-888-968-7241。 AmeriHealth New Jersey와 관련하여 궁금한 사항이 있으신 경우 귀하 또는 귀하의 지원을 받는 사람은 관련 정보

및 지원을 해당 언어로 무료로 받으실 수 있습니다. 통역사와 상담하시려면 1-888-968-7241 로 전화해 주십시오.

Se você, ou alguém a quem você está ajudando, tem perguntas sobre o AmeriHealth New Jersey, você tem o direito de obter ajuda e informação em seu idioma e sem custos. Para falar com um intérprete, ligue para 1-888-968-7241. જો તમને અથવા તમે કોઇને મદદ કરી રહ્યા તેમાાંથી કોઇને AmeriHealth New Jersey વવશે પ્રશ્નો હોય, તો તમને મદદ અને માહહતી તમારી ભાષામાાં કોઈપણ ખર્ચ વવના મેળવવાનો અવિકાર છે. દુભાવષયા સાથે વાત કરવા માટે, આ 1-888-968-7241 પર કોલ કરો. Jeśli Ty lub osoba, której pomagasz macie pytania odnośnie do programu AmeriHealth New Jersey, mogą Państwo uzyskać bezpłatną informację i pomoc w Waszym języku. Aby porozmawiać z tłumaczem, proszę zadzwonić pod numer 1-888-968-7241. Se tu o qualcuno che stai aiutando avete domande su AmeriHealth New Jersey, hai il diritto di ottenere gratuitamente aiuto e informazioni nella tua lingua. Per parlare con un interprete, puoi chiamare il numero 1-888-968-7241.

الضرورية ، فلديك الحق في الحصول على المعلوماتAmeriHealth New Jersey إذا كان لديك أو لدى شخص تساعده أسئلة بخصوص .7241-968-888-1 بلغتك دون أي تكلفة. للتحدث مع مترجم اتصل بـ

Kung ikaw, o ang taong iyong tinutulungan, ay may mga katanungan tungkol sa AmeriHealth New Jersey, may karapatan kang makakuha ng tulong at impormasyon sa iyong wika nang walang gastos. Upang makausap ang isang interpreter, tumawag sa 1-888-968-7241. Если у вас или лица, которому вы помогаете, имеются вопросы по поводу программы AmeriHealth New Jersey, то вы имеете право на бесплатное получение помощи и информации на вашем языке. Для разговора с переводчиком позвоните по телефону 1-888-968-7241. Si ou menm, oswa yon moun w ap ede, gen kesyon konsènan AmeriHealth New Jersey, ou gen dwa pou resevwa èd ak enfòmasyon nan lang ou gratis. Pou pale ak yon entèprèt, rele 1-888-968-7241. यदि आपके, या आप द्वारा सहायता दकए जा रह ेदकसी व्यक्ति के AmeriHealth New Jersey के बारे में प्रश्न ह,ै तो आपके पास अपनी भाषा में मुफ्त में सहायता और सचूना प्राप्त करने का अक्तिकार ह।ै दकसी िभुाक्तषए से बात करने के क्तिए, 1-888-968-7241 पर कॉि करें।. Nếu quý vị hoặc người mà quý vị đang trợ giúp có câu hỏi về AmeriHealth New Jersey, quý vị có quyền nhận được trợ giúp và thông tin bằng ngôn ngữ của quý vị hoàn toàn miễn phí. Để yêu cầu thông dịch viên, hãy gọi số 1-888-968-7241. Si vous, ou quelqu'un que vous aidez, a des questions à propos d’AmeriHealth New Jersey, vous avez le droit d'obtenir gratuitement de l'aide et l'information dans votre langue. Pour parler à un interprète, appelez 1-888-968-7241.


کے بارے ميں سواالت کرنے AmeriHealth New Jerseyاگر آپ، يا کوئی شخص جس کی آپ مدد کر رہے ہيں، کو ہيں تو آپ کو بال معاوضہ اپنی زبان ميں مدد اور معلومات حاصل کرنے کا حق حاصل ہے۔ کسی مترجم سے بات کرنے

پر کال کريں۔ 7241-968-888-1کے لئے، D77 kwe’4 atah n7l7n7g77 AmeriHealth New Jersey haada yit’4ego b7na 7d7[kidgo 4i doodago h1ida b7k1 anilyeed7g77 t’1adoo le’4 y7na’7d7[kidgo bee n1 ah00t’i’d77 t’11 hazaadk’ehj7 h1k1 a’doowo[go bee haz’3 doo b33h 7l7n7g00. Ata’ halne’7g77 koj8’ bich’8’ hod77lnih 1-888-968-7241. ご本人やお客様の周りの人が、 AmeriHealth New Jersey についてご質問などがある場合、無料でご希望の言語でのサポートや情報を入手することができます。インタプリタをご利用する方は、1-888-968-7241 までお電話ください。 Wenn Sie selbst oder eine Person, der Sie helfen, Fragen über AmeriHealth New Jersey haben, so haben Sie das Recht, kostenlos Hilfe und Informationen in Ihrer Sprache anzufordern. Um mit einem Dolmetscher zu sprechen, rufen Sie bitte die Nummer 1-888-968-7241 an.

سوالی داريد، اين حق برای شما محفوظ است AmeriHealth New Jerseyاگر شما يا شخصی که به وی کمک می کنيد، در رابطه با که بدون نياز به پرداخت هر نوع هزينه، اطالعات مربوطه را به زبان خود دريافت نماييد. جهت گفتگو با يک مترجم، با شماره

تماس حاصل فرماييد. 1-888-968-7241 Nondiscrimination Notice & Notice of Availability of Auxiliary Aids & Services AmeriHealth New Jersey complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. AmeriHealth New Jersey does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

AmeriHealth New Jersey: Provides free aids and services to people with disabilities to communicate effectively with us, such as: qualified sign

language interpreters; and written information in other formats (large print, audio, accessible electronic formats, other formats)

Provides free language services to people whose primary language is not English, such as: qualified interpreters, and information written in other languages

If you need these services, contact our Civil Rights Coordinator.

If you believe that AmeriHealth New Jersey has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with our Civil Rights Coordinator. You have five ways to file a grievance directly with AmeriHealth New Jersey: in person or by mail: AmeriHealth New Jersey, ATTN: Civil Rights Coordinator, 1901 Market Street, Philadelphia, PA 19103; by phone: 888-377-3933 (TTY 711), by fax: 215-761-0245, or by email: [email protected]. If you need help filing a grievance, our Civil Rights Coordinator is available to help you.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW, Room 509F, HHH Building, Washington, DC 20201, 1-800-368-1019, 800- 537-7697 (TDD). Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

Effective Date: July 18, 2016, Version 1.0


کے بارے ميں سواالت کرنے AmeriHealth New Jerseyاگر آپ، يا کوئی شخص جس کی آپ مدد کر رہے ہيں، کو ہيں تو آپ کو بال معاوضہ اپنی زبان ميں مدد اور معلومات حاصل کرنے کا حق حاصل ہے۔ کسی مترجم سے بات کرنے

پر کال کريں۔ 7241-968-888-1کے لئے، D77 kwe’4 atah n7l7n7g77 AmeriHealth New Jersey haada yit’4ego b7na 7d7[kidgo 4i doodago h1ida b7k1 anilyeed7g77 t’1adoo le’4 y7na’7d7[kidgo bee n1 ah00t’i’d77 t’11 hazaadk’ehj7 h1k1 a’doowo[go bee haz’3 doo b33h 7l7n7g00. Ata’ halne’7g77 koj8’ bich’8’ hod77lnih 1-888-968-7241. ご本人やお客様の周りの人が、 AmeriHealth New Jersey についてご質問などがある場合、無料でご希望の言語でのサポートや情報を入手することができます。インタプリタをご利用する方は、1-888-968-7241 までお電話ください。 Wenn Sie selbst oder eine Person, der Sie helfen, Fragen über AmeriHealth New Jersey haben, so haben Sie das Recht, kostenlos Hilfe und Informationen in Ihrer Sprache anzufordern. Um mit einem Dolmetscher zu sprechen, rufen Sie bitte die Nummer 1-888-968-7241 an.

سوالی داريد، اين حق برای شما محفوظ است AmeriHealth New Jerseyاگر شما يا شخصی که به وی کمک می کنيد، در رابطه با که بدون نياز به پرداخت هر نوع هزينه، اطالعات مربوطه را به زبان خود دريافت نماييد. جهت گفتگو با يک مترجم، با شماره

تماس حاصل فرماييد. 1-888-968-7241 Nondiscrimination Notice & Notice of Availability of Auxiliary Aids & Services AmeriHealth New Jersey complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. AmeriHealth New Jersey does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

AmeriHealth New Jersey: Provides free aids and services to people with disabilities to communicate effectively with us, such as: qualified sign

language interpreters; and written information in other formats (large print, audio, accessible electronic formats, other formats)

Provides free language services to people whose primary language is not English, such as: qualified interpreters, and information written in other languages

If you need these services, contact our Civil Rights Coordinator.

If you believe that AmeriHealth New Jersey has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with our Civil Rights Coordinator. You have five ways to file a grievance directly with AmeriHealth New Jersey: in person or by mail: AmeriHealth New Jersey, ATTN: Civil Rights Coordinator, 1901 Market Street, Philadelphia, PA 19103; by phone: 888-377-3933 (TTY 711), by fax: 215-761-0245, or by email: [email protected]. If you need help filing a grievance, our Civil Rights Coordinator is available to help you.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW, Room 509F, HHH Building, Washington, DC 20201, 1-800-368-1019, 800- 537-7697 (TDD). Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

Effective Date: July 18, 2016, Version 1.0

Nondiscrimination Notice & Notice of Availability of Auxiliary Aids & Services

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