child0105.htm

Note: SHBP Plans for State Employees Covered Under New Labor Agreements Effective July 2007

PLAN & TELEPHONE #	#102 TRADITIONAL¹ 1-800-414-7427 www.horizonblue.com/shbp	#004 - NJ PLUS www.horizonblue.com/shbp		#005 AETNA HMO 1-800-309-2386 www.aetna.com	#006 CIGNA HEALTHCARE HMO 1-800-244-6224 www.cigna.com/health	#007 OXFORD HMO 1-800-760-4566 www.oxfordhealth.com	#008 AMERIHEALTH HMO 1-800-877-9829 www.amerihealth.com	#009 HEALTH NET⁶ HMO 1-800-441-5741 www.healthnet.com	PLAN & TELEPHONE #
PLAN & TELEPHONE #	#102 TRADITIONAL¹ 1-800-414-7427 www.horizonblue.com/shbp	In-network 1-800-414-7427	Out-of-network¹ 1-800- 414-7427	#005 AETNA HMO 1-800-309-2386 www.aetna.com		#007 OXFORD HMO 1-800-760-4566 www.oxfordhealth.com	#008 AMERIHEALTH HMO 1-800-877-9829 www.amerihealth.com	#009 HEALTH NET⁶ HMO 1-800-441-5741 www.healthnet.com	PLAN & TELEPHONE #
SERVICE AREA	Unrestricted	All of NJ and FL; Parts of DE, NY, and PA	Unrestricted	All of NJ, CT, DE, ME, and Wash.DC; Parts of AZ, FL, GA, IL, IN, MA, MD, NC, NH, NV, NY, OH, PA, TN, TX, VA, and WA	All of NJ, AZ, CT, DE, MD, ME, NH, NM, RI, VT & Wash. DC; Parts of AL, AR, CA, CO, FL, GA, ID, IL, IN, KS, KY, LA, MA, MI, MO, MS, NV, NY, NC, OH, OK, OR, PA, SC, TN, TX, UT, VA, WA, WI & WV	All of NJ; Parts of NY	All of NJ and DE; Parts of PA	All of NJ and CT; Parts of NY	SERVICE AREA
IMMUNIZATIONS	Not covered	100% after $15 copayment per visit (except for travel and/or job related)	70% for children under 12 months, after deductible	100% after $15 copayment per visit (except for travel and/or job related)	100% after $15 copayment per visit (except for travel and/or job related)	100% after $15 copayment per visit (except for travel and/or job related)	100% after $15 copayment per visit (except for travel and/or job related)	100% after $15 copayment per visit (except for travel and/or job related)	IMMUNIZATIONS
MATERNITY	Basic benefits at 100%; balance at 80% after deductible	$15 copayment for first prenatal office visit then 100% covered Precious Additions - a voluntary prenatal education program	70% after deductible Precious Additions - a voluntary prenatal education program	$15 copayment for first prenatal visit then 100% covered Moms to Babies - a voluntary prenatal education program	$15 copayment for first prenatal visit then 100% covered Healthy Babies - a voluntary prenatal education program	$15 copayment for first prenatal visit then 100% covered Healthy Mother, Healthy Babies - a voluntary prenatal education program	$15 copayment for first prenatal visit then 100% covered Baby Foot Steps - a voluntary prenatal education program	$15 copayment for first prenatal visit then 100% covered Pregnancy Matters - a voluntary prenatal education program	MATERNITY
PHYSICAL EXAMS	Not covered	100% after $15 copayment per visit	Not covered	100% after $15 copayment per visit	100% after $15 copayment per visit (1 visit per calendar year)	100%	100% after $15 copayment per visit	100% after $15 copayment per visit	PHYSICAL EXAMS
WELL BABY	Not covered	100% after $15 per visit copayment	Not covered	100% after $15 copayment per visit	100% after $15 copayment per visit	100%	100% after $15 copayment per visit	100% after $15 copayment per visit	WELL BABY
¹Benefits, excluding hospital expenses, are based on the Horizon's discounted provider network allowance or the "reasonable and customary" fee schedule at the 90% percentile. Some State employees may not be eligible for enrollment in the Traditional Plan. ⁶Referral is not required from a PCP to a participating specialist.