Page 39 - Amerihealth New Jersey - 59-99 - 2021 Benefits at a Glance
P. 39
LOW OPTION
CUSTOM PLAN (FOR GROUPS 100+)
100% 0-100%
100%
PREVENTIVE OPTION
IN/OUT-OF-NETWORK6 IN/OUT-OF-NETWORK6
IN/OUT-OF-NETWORK6
100% 0-100%
100%
100% 0-100%
100%
100% 0-100%
100%
80% 0-100%
80% 0-100%
Not covered
100% 0-100%
100%
Not covered
80% 0-100%
Not covered
80% 0-100%
Not covered
80% 0-100%
Not covered
80% 0-100%
Not covered
80% 0-100%
80% 0-100%
Not covered 0-100%
Not covered
Not covered
Not covered
Not covered 0-100%
Not covered
Not coverd 0-100%
Not covered
$50/$150 excludes class 17 Flexible
$0
$1,000 excludes class 17 Flexible
$1,000
N/A Flexible
N/A
Please see footnotes on page 44
2021 Large Group Plans 37
