md0105.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
PHYSICIAN (SURGERY)	Basic benefit at 100%; balance at 80% after deductible¹	100%	70% after deductible	100%	100%	100%	100%	100%	PHYSICIAN (SURGERY)
PHYSICIAN (OFFICE VISITS)	80% after deductible; No coverage for wellness care.	100% after $15 copayment per visit	70% after deductible; No coverage for wellness care	100% after $15 copayment per visit	100% after $15 copayment per visit	100% after $15 copayment per visit	100% after $15 copayment per visit	100% after $15 copayment per visit	PHYSICIAN (OFFICE VISITS)
CHIROPRACTIC	80% after deductible for up to 30 visits per calendar year.	100% after $15 per visit copayment; 30 visits per calendar year; no PCP referral required	70% after deductible for up to 30 visits per calendar year combined in-network and out-of-network	100% for up to 20 visits per year, after $15 per visit copayment; PCP referral required	100% up to 20 visits per year $15 per visit copayment per visit; PCP referral required	100% after $15 per visit copayment, no visit maximum; PCP referral required	100% up to 20 visits per year, no copayment; PCP referral required	100% up to 20 visits per year $15 per visit copayment; no referral needed	CHIROPRACTIC
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. ⁶ Referral is not required from a PCP to a participating specialist.