818 Route 202-206, Bridgewater, NJ 08807
Telephone 908-722-6868, Toll Free: 1-800-392-0980, Fax: 1-908-722-2827, E-Mail: info@forefin.com

New Jersey Small Employer Plans (2-49)

I) HMO with Rider Options

 

 

 

 

 

This information is for illustrative purposes only. See individual contract for details and exclusions.

  Copay Option w/ Rider
REFERRED
FINANCIAL
Deductible Single/Family
Coinsurance
Coinsurance Limit: Single/Family
Lifetime Maximum Benefit
N/A
N/A
N/A
N/A
PRIMARY CARE PHYSICIAN VISITS SPECIALTY CARE
Office Visits
Diagnostic Outpatient Testing
Outpatient Therapy
OUTPATIENT SURGERY
$10,$15,20,$25,$30,$40,50 copay
copay per visit
copay per visit
copay per visit
copay per visit
HOSPITALIZATION
Room & /Board (Semi-Private)
Surgery & Anesthesia
Medical & Surgical Specialist Care
Diagnostic Testing

copay per visit
SKILLED NURSING FACILITY
EMERGENCY ROOM
HOME CARE
MATERNITY
First OB Visit
No copay
$50 copay
No copay

$25 copay
MENTAL HEALTH & SUBSTANCE ABUSE
Inpatient

no copay
Maximum of 30
inpatient days
Outpatient copay/visit, 20 visits
PREVENTATIVE CARE
Routine Physicals
Routine GYN Exam
Immunizations
Mammography
CHIROPRACTIC CARE
PRESCRIPTIONS (generic/brand)

copay per visit
copay per visit
copay per visit
copay per visit
Not covered
$5/10/15/20/30 copay

II)Point-of-Service Plans

Open Access (Point-Of-Service Plan) : Visit In-Network physicians without a referral.  No primary physician required.

This information is for illustrative purposes only. See individual contract for details and exclusions.

  Copay Option
w/ Rider In-Network

Out-of-Network
FINANCIAL
Deductible: Single
Deductible: Family
Coinsurance
Maximum Out-of-Pocket

Lifetime Maximum Benefit

N/A
N/A
N/A
N/A
N/A
N/A

$500/$1,000
$1,000/$2,000
Plan C 70/30 Plan D 80/20
Plan C $3,000
Plan D $2,000
unlimited
PRIMARY CARE PHYSICIAN VISITS
Office Visits
Diagnostic Outpatient Testing
Outpatient Therapy*
OUTPATIENT SURGERY*
$5,$10,$15,$20,$30,$40,$50 copay
copay per visit
copay per visit
copay per visit
copay per visit
subject to deductible & coinsurance
subject to deductible & coinsurance
subject to deductible & coinsurance
subject to deductible & coinsurance
subject to deductible & coinsurance
HOSPITALIZATION*
Room & /Board (Semi-Private)
Surgery & Anesthesia
Medical & Surgical Specialist Care
Diagnostic Testing

no copay

subject to deductible & coinsurance
SKILLED NURSING FACILITY*
EMERGENCY ROOM
HOME CARE*
MATERNITY
First OB Visit
No copay
$50 copay
No copay

$25 copay
subject to deductible & coinsurance

subject to deductible & coinsurance

subject to deductible & coinsurance
MENTAL HEALTH & SUBSTANCE ABUSE
Inpatient

Outpatient*

no copay
Maximum of 30
inpatient days

copay/visit, 20
visits
 
PREVENTATIVE CARE
Routine Physicals
Routine GYN Exam
Immunizations
Mammography
CHIROPRACTIC CARE
PRESCRIPTIONS (generic/brand)

copay per visit
copay per visit
copay per visit
copay per visit
Not covered
$5/10/$15/$20/$30 copay

$500 to age 1
$300 per covered person


30 visits max. deductible & coins.
subject to deductible & coinsurance

* Member pre-certification required or benefits paid will be substantially reduced.

III)  Health Savings Accounts (HSA)

HSA Plans include two components: a lower cost, high deductible health insurance plan and a tax-favored savings account.  The money you save on premiums with your high deductible plan can be put into your tax-favored savings account (HSA).  You can withdraw the money to help pay your deductible or other qualified health care expenses.  Once your deductible is met, the insurance plan starts paying for covered expenses.  The best part of the HSA, is that your unspent savings roll over year after year.

An HSA Plan may be right for you if you want:

More control over how your health care dollars are spent
One annual deductible per family
To save money on monthly premiums and taxes
Tax Savings
Portability for any employee to take the HSA when leaving the job. Whether an employee changes jobs or retires, the funds and interest travel with him or her.
Long-term savings because the funds may be withdrawn for any reason after age 65. 

For additional information on your insurance needs or information about our Financial Services, call 1-800-392-0980, complete the inquiry request form, or simply E-Mail us at: info@forefin.com.

 

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