Page 27 - Amerihealth New Jersey - 59-99 - 2021 Benefits at a Glance

$30/$50 $250 $500/DAY
IN-NETWORK
$30/$50 $500/DAY
IN-NETWORK
$20/$40 $250/DAY
IN-NETWORK
$250/$500
$0/$0
$0/$0
$3 500/$7 000
$3 000/$6 000
000
$2 500/$5 000
$30 copay
$30 copay
$20 copay
$50 copay
$50 copay
$40 copay
$100 copay2
$100 copay2
$100 copay2
$75 copay
$75 copay
$75 copay
$500 copay/day after deductible
(max of 5 5 days $2 500)9
$500 copay/day (max of 5 5 5 days $2 500)9
$250 copay/day (max of 5 5 5 days $1 250)9
$300 copay
after deductible
$50 copay
$300 copay
$200 copay
$50 copay
$40 copay
10% coinsurance after deductible
no charge
no charge
no no charge
no no deductible
no charge
no charge
50% coinsurance after deductible
50% coinsurance 50% coinsurance $500 copay/day after deductible
(max of 5 5 days $2 500)9
$500 copay/day (max of 5 5 5 days $2 500)9
$250 copay/day (max of 5 5 5 days $1 250)9
$50 copay
$50 copay
$40 copay
2021 Large Group Plans 25 Please see footnotes on page 45