Page 15 - Amerihealth New Jersey - Individuals and Families - 2021 Benefits at a Glance

$6,000/$12,000
$3,000/$6,000
$$$
NEW PLAN NEW PLAN
CATASTROPHIC
Simple Saver9
Local Value8
IN-NETWORK
EPO HSA
50%/50%
Local Value8
EPO
$50/$75
Local Value8
IN-NETWORK
IN-NETWORK
50% $7,000/$14,000
50% coinsurance, after deductible 50% coinsurance, after deductible
50% coinsurance, after deductible
50% coinsurance, after deductible
50% coinsurance, after deductible 50% coinsurance, after deductible 50% coinsurance, after deductible
50% coinsurance, after deductible
50% coinsurance, after deductible
50% coinsurance, up to $250 max, after deductible
All plans are available on-and off-exchange unless otherwise noted.
$8,550/$17,100 N/A $8,550/$17,100 $30 copay7
No charge, after deductible
50%
$8,550/$17,100
$50 copay, after deductible
$75 copay, after deductible
No charge, after deductible
No charge, after deductible
$85 copay, after deductible
50% coinsurance, after deductible
50% coinsurance, after deductible
$500 copay per admission, after deductible
50% coinsurance, after deductible
50% coinsurance, after deductible
$500 copay per admission, after deductible
|
No charge, after deductible No charge, after deductible
No charge, after deductible No charge, after deductible
30-day supply3
No charge, after deductible
$ are a guide for plan costs within each metallic tier. Network variations may impact cost.
$75 copay, after deductible
No charge, after deductible
$75 copay, after deductible
50% coinsurance, after deductible
50% coinsurance, after deductible
30-day supply3
30-day supply3
$25 copay
50% coinsurance, up to $250 max, after deductible15
Please see footnotes on page 24–25
AmeriHealth New Jersey | 2021 Individual and family health plans 13