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
HOME HEALTH CARE
Services and supplies covered with pre-approval; 60 visits in 61 days at 100% per occurence
Services and supplies covered with pre-approval; prior inpatient hospital stay not required; nursing home care or custodial care not covered
Services and supplies covered with pre-approval; prior inpatient hospital stay not required; nursing home care or custodial care not covered; subject to out-of-network insurance and deductible
Services and supplies covered with pre-approval; prior inpatient hospital stay not required; nursing home care or custodial care not covered
Services and supplies covered with
pre-approval; prior inpatient hospital stay not required; nursing home care or custodial care not covered
Services and supplies covered with pre-approval; prior inpatient hospital stay not required; nursing home care or custodial care not covered: 120 visit per calendar year maximum;
$5 copayment
Services and supplies covered with pre-approval; prior inpatient hospital stay not required; nursing home care or custodial care not covered
Services and supplies covered with pre-approval; prior inpatient hospital stay not required; nursing home care or custodial care not covered
 HOME HEALTH CARE
DISEASE MANAGEMENT5
(Voluntary Programs)
Not applicable
Asthma, Chronic Kidney Disease,
Chronic Obstructive Pulmonary Disease, Coronary Artery Disease, Diabetes, Heart Failure, Obesity, Hepatitis C, Multiple Sclerosis
Asthma, Chronic Kidney Disease,
Chronic Obstructive Pulmonary Disease, Coronary Artery Disease, Diabetes, Heart Failure, Obesity, Hepatitis C, Multiple Sclerosis
Asthma, Chronic Heart Failure, Coronary Artery Disease, Diabetes, Low Back Pain
Well Aware Program monitored by PCP for chronic conditions like Low Back Pain, Asthma, and Diabetes
Asthma, Cardiac, Congestive Heart Failure, Depression, Diabetes, Healthy Mother/Healthy Baby Program, Rare Chronic Care Program
Asthma, Diabetes, Congestive Heart Failure, Chronic Obstructive Pulmonary Disease, Coronary Artery Disease, End-stage Renal Disease
Asthma, Chronic Obstructive Pulmonary Disease, Congestive Heart Failure, Coronary Artery Disease, Depression, Diabetes, End-stage Renal Disease, Hypertension, Neonatal Intesive Care
 DISEASE MANAGEMENT5
PRIVATE DUTY NURSING
(Must be Medically Necessary)
Must be ordered by a doctor, provided by an RN or LPN; excludes care that can be provided by hosiptal staff or home health care aides; excludes assistance with daily activies
Must be ordered by a doctor, provided by an RN or LPN; excludes care that can be provided by hosiptal staff or home health care aides; excludes assistance with daily activies
Must be ordered by a doctor, provided by an RN or LPN; excludes care that can be provided by hosiptal staff or home health care aides; excludes assistance with daily activies
Inpatient hospital care excluded; outpatient care must be authorized by PCP and services rendered by or supervised by a RN
Inpatient hospital care excluded; outpatient care must be authorized by PCP and services rendered by or supervised by a RN
Inpatient hospital care excluded; outpatient care must be authorized by PCP and services rendered by or supervised by a RN
Inpatient hospital care excluded; outpatient care must be authorized by PCP and services rendered by or supervised by a RN
Inpatient hospital care excluded; outpatient care must be authorized by PCP and services rendered by or supervised by a RN
 PRIVATE DUTY NURSING
INFERTILITY SERVICES
(Must be
Pre-Authorized)
Diagnosis covered; treatment covered with limitations; subject to a coinsurance and deductible.
Diagnosis covered; treatment covered with limitations
Treatment covered with limitations; subject to out-of-network insurance and deductible
Diagnosis covered; treatment covered with limitations
Diagnosis covered; treatment covered with limitations
Diagnosis covered; treatment covered with limitations
Diagnosis covered; treatment covered with limitations
Diagnosis covered; treatment covered with limitations
 INFERTILITY SERVICES
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.

5Most disease management programs provide educational materials, and in some cases, individualized case management for members with an emphasis on health education and behavior modification.

6Referral is not required from a PCP to a participating specialist.