Page 41 - Amerihealth New Jersey - 59-99 - 2021 Benefits at a Glance

LOW OPTION CUSTOM PLAN (FOR GROUPS 100+)
PREVENTIVE OPTION IN/OUT-OF-NETWORK6 IN/OUT-OF-NETWORK6 IN/OUT-OF-NETWORK6 IN/OUT-OF-NETWORK6 IN/OUT-OF-NETWORK6 100% 100% 0-100%
100% 100% 100% 0-100%
100% 100% 100% 0-100%
100% 100% 100% 0-100%
100% 80% 0-100%
Not covered
100% 100% 0-100%
100% 80% 0-100%
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%
Not covered
80% 0-100%
Not covered
Not covered
0-100%
Not covered
Not covered
0-100%
Not covered
Not covered
0-100%
Not covered
$50/$150 excludes class 17 Flexible
$0
$1 000 excludes class 17 Flexible
$1 000 N/A
Flexible
N/A
2021 Large Group Plans 39
Please see footnotes on page 46