Page 23 - Amerihealth New Jersey - 59-99 - 2021 Benefits at a Glance

$30/$50 $2,500/20%/$100 ER
IN-NETWORK
$2,500/$5,000
$6,000/$12,000
$20/$50 $2,000 30%
IN-NETWORK
$2,000/$4,000
$4,000/$8,000
$30 copay
$20 copay
$50 copay
$50 copay
$100 copay2
$100 copay2
$75 copay
$75 copay
20% coinsurance, after deductible
30% coinsurance, after deductible
$50 copay
$50 copay
20% coinsurance, after deductible
$50 copay
$75 copay
no charge, no deductible
no charge, no deductible
50% coinsurance, after deductible
20% coinsurance, after deductible
$50 copay
50% coinsurance, after deductible
30% coinsurance, after deductible
$50 copay
Please see footnotes on page 43
2021 Large Group Plans 21