Page 21 - Amerihealth New Jersey - 59-99 - 2021 Benefits at a Glance
P. 21

 $50/$75 $2,500/30%
TIER 1
 TIER 2
 $2,500 /$5,0006
  $6,850/$13,7007
  $50 copay
  $75 copay
 30% coinsurance, after deductible
  50% coinsurance, after deductible
 $100 copay, after deductible
   30% coinsurance, after deductible
 50% coinsurance, after deductible
 $50 copay, after deductible
  50% coinsurance, after deductible
  50% coinsurance, after deductible
  50% coinsurance, after deductible
  30% coinsurance, after deductible
  $60 copay
     Please see footnotes on page 43
2021 Large Group Plans 19
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