| PLAN & TELEPHONE # |
#004
- NJ PLUS www.horizonblue.com/shbp |
PLAN & TELEPHONE # |
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| In-network 1-800-414-7427 |
Out-of-network1 1-800- 414-7427 |
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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; |
All
of NJ and CT; Parts of NY |
SERVICE
AREA |
|
| HOSPITAL INPATIENT |
100% for up to 365 days; day 366+ at 80% after deductible | 100% | 70% after $200 per hospital stay deductible | 100% | 100% | 100% | 100% | 100% | HOSPITAL INPATIENT |
|
| SKILLED NURSING FACILITY |
100% for up to 30 days per confinement | 100% for up to 120 days per calendar year | 70% for up to 60 days per calendar year | 100%; unlimited days | 100% for up to 120 days per calendar year | 100% for up to 120 days per calendar year | 100% for up to 180 days per calendar year | 100% for up to 120 days per confinement | SKILLED NURSING FACILITY |
|
| HOSPITAL PRE-ADMISSION TESTING |
100% | 100% | 70% after deductible | 100% | 100% | 100% | 100% | 100% | HOSPITAL PRE-ADMISSION TESTING |
|
|
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 |
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