Page 13 - Amerihealth New Jersey - Small Group - 2021 Benefits at a Glance

NEW PLAN
50% coinsurance after deductible 50% coinsurance after deductible $500 copay per admission after deductible7
NEW PLAN
SELECT SELECT EPO EPO HSA SELECT SELECT EPO EPO 50% 50% / / 50% 50% $50 / / $75
EPO $50 / $75
Local Local Value5
Value5
Local Local Value5
Value5
Regional Regional Preferred Preferred with with NY NY NEW Regional Regional Preferred Preferred with with NY NY National Access with NY IN-NETWORK IN-NETWORK IN-NETWORK IN-NETWORK IN-NETWORK $6 $6 000 000 000 000 / / $12 000 000 000 000 $3 000 000 000 000 / / $6 $6 000 000 000 000 $3 000 000 / $6 000 000 50% 50% 50% 50% 50% $7 000 000 / / $14 000 000 $8 550 / / $17 100
$8 550 / $17 100
50% coinsurance after after deductible10
deductible10
$50 copay after after deductible10
deductible10
$50 copay after deductible 50% coinsurance after after deductible deductible $75
copay after after deductible deductible $75
copay after deductible 50% 50% coinsurance coinsurance after after deductible deductible 50% 50% coinsurance coinsurance after after deductible deductible 50% coinsurance after deductible 50% coinsurance after deductible $500 copay per admission after deductible7
50% 50% coinsurance coinsurance after after deductible deductible 50% 50% coinsurance coinsurance after after deductible deductible 50% coinsurance after deductible 50% 50% coinsurance coinsurance after after deductible deductible 50% 50% coinsurance coinsurance after after deductible deductible 50% coinsurance after deductible $500 copay per admission after deductible7
50% coinsurance after after deductible deductible $500 copay per admission after after deductible7
50% coinsurance after after deductible deductible $75
copay after after deductible deductible $75
copay after deductible 50% coinsurance after after deductible deductible $75
copay after after deductible deductible $75
copay after deductible 50% 50% coinsurance coinsurance after after deductible deductible 50% 50% coinsurance coinsurance after after deductible deductible 50% coinsurance after deductible 30 30 DAY DAY SUPPLY4 SUPPLY4 30 30 DAY DAY SUPPLY4 SUPPLY4 30 DAY SUPPLY4 $25 copay 50% coinsurance up to $125 max after deductible 50% coinsurance up to $250 max after deductible17
$25 copay 50% coinsurance up to $250 max after deductible17
AmeriHealth New Jersey | 2021 Small Group health plans 11