misc0106.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
RADIATION/CHEMOTHERAPY OUTPATIENT	80% after deductible	100%	70% after deductible	100% after $15 copayment per office visit	100% after $15 copayment per office visit	100% after $15 copayment per office visit	100% after $15 copayment per office visit	100% after $15 copayment per office visit	RADIATION/CHEMOTHERAPY OUTPATIENT
HOSPICE	100%	100%	70% after deductible	100%	100%	100%	100%	100%	HOSPICE
PHYSICAL/SPEECH THERAPY⁴	80% after deductible	100% after $15 copayment per visit	70% after deductible	100% after $15 copayment per visit for up to 60 visits per condition per year	100% after $15 copayment per visit for up to 60 visits per condition per year	100% after $15 copayment per visit for up to 60 visits per condition per year	100% after $15 copayment per visit for up to 60 visits per condition per year	100% after $15 copayment per visit for up to 60 visits per condition per year	PHYSICAL/SPEECH THERAPY²
DENTAL COVERAGE	The SHBP Employee Dental Plans are offered to Active State Employees and to Active Local Government/Educational Employees (if the Local Employer adopts the Dental Plans) as a separate dental benefit. These plans fall under one of two basic types: the indemnity style Dental Expense Plan, and one of several Dental Plan Organizations (DPOs). For more information about the SHBP Employee Dental Plans, see the SHBP Employee Dental Plans Member Handbook.								DENTAL COVERAGE
LAB TESTS	80% after deductible; some charges paid at 100%	100%	70% after deductible	100%	100%	100%	100%	100%	LAB TESTS
PRESCRIPTION DRUGS^,	*State Employees are eligible for the SHBP Employee Prescription Drug Plan. Click here for more information.*								PRESCRIPTION DRUGS^,
ROUTINE VISION EXAM	None	100% after $15 copayment; one exam per calendar year, no referral needed	None	100% after $15 copayment; exam every 1 to 3 years based on age; no referral needed	100% after $15 copayment; one exam per calendar year; no referral required	$50 reimbursed toward routine exam per 12 month period	100% after $15 copayment; one exam every 24 month period; must use specified vendor, no referral needed	100% after $15 copayment; one exam per calendar year, no referral needed	ROUTINE VISION EXAM
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. ⁴Speech therapy limited to: restoration after a loss or impairment of a demonstrated previous ability to speak; develop or improve speech after surgical correction of a birth defect. ⁶Referral is not required from a PCP to a participating specialist.