Page 23 - Amerihealth New Jersey - 59-99 - 2021 Benefits at a Glance
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TIER 1
$50/$75 $2 500/30% TIER 2 $2 500 /$5 0006
$6 850/$13 7007
$50 copay $75 copay 30% coinsurance after deductible
$100 copay after deductible
50% coinsurance 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 2021 Large Group Plans 21 21 Please see footnotes on page 45
