er0105.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 #
		In-network 1-800-414-7427	Out-of-network¹ 1-800- 414-7427
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
HOSPITAL EMERGENCY ROOM ACCIDENT/NON-ACCIDENT CHARGES	100% for accidental injury; 80% for all others after deductible All physician fees are paid at 80% after deductible	100% after $50² copayment	100% after $50² copayment;subject to deductible and coinsurance	100% after $50²copayment	100% after $50² copayment	100% after $50² copayment	100% after $50² copayment	100% after $50² copayment	HOSPITAL EMERGENCY ROOM ACCIDENT/NON-ACCIDENT CHARGES
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. ²All plans require notice to the PCP or the Plan within 48 hours of the incident. Copayment waived if admitted. ⁶ Referral is not required from a PCP to a participating specialist.