818 Route 202-206, Bridgewater, NJ 08807
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I) NJ Traditional Plans (Deductible and Coinsurance) Jump to Rates
This information is for illustrative purposes only - See individual contract for details and exclusions.
| Annual Deductible | Individual | Family (Aggregate) |
| $2500 | $5000 | |
| $1,000 | $1,000 | |
| $1,000 | $2,000 | |
| Coinsurance | ||
| CARRIER/INDIVIDUAL | 70/30% or 80/20% | |
| Maximum Annual Coinsurance Limit | Individual | Family |
| 80/20% | $2,000 | $4,000 |
| 70/30% | $2,500 | $5,000 |
| Lifetime Maximum | Unlimited | |
| FACILITY BENEFITS | ||
| Inpatient Hospital: | Semi-Private - Inpatient Services and Supplies | |
| (Subject to pre-approval) - 365 days per year; | ||
| Subject to annual deductible and coinsurance | ||
| Rehabilitation Center Services not immediately preceded by an inpatient hospital stay (Subject to pre-approval) |
Subject to annual deductible and coinsurance | |
| Emergency Room | Separate $100 copay | |
| (if admitted, credited toward inpatient admission); Subject to annual deductible and coinsurance | ||
| Home Health Care (Subject to pre-approval) | Subject to annual deductible and coinsurance | |
| Skilled Nursing (Subject to pre-approval) | Subject to annual deductible and coinsurance; Limited to 120 days per year in skilled nursing facility | |
| Hospice Charges(Subject to pre-approval) | Subject to annual deductible and coinsurance | |
| Mental/Nervous Health and Substance Abuse | Carrier pays: | |
| Outpatient/Inpatient (Subject to pre-approval) | $5,000 combined Annual Maximum; | |
| $25,000 combined Lifetime Maximum; | ||
| Subject to annual deductible and coinsurance | ||
| Alcoholism | ||
| Outpatient (Subject to pre-approval) | Subject to annual deductible and coinsurance | |
| Inpatient (Subject to pre-approval) | Subject to annual deductible and coinsurance | |
| PROVIDER BENEFITS | ||
| Primary (Preventive) Care | Carrier pays: | |
| well baby, routine physical exam, mammography, pap smears, vaccinations and screenings | $500 per individual per year | No deductible or coinsurance |
| $500 per year maximum benefit up to age 1 for newborns | No deductible or coinsurance | |
| Maternity Office Visits | Subject to annual deductible and coinsurance | |
| Surgical | Subject to annual deductible and coinsurance | |
| Outpatient and Inpatient | Subject to annual deductible and coinsurance | |
| Therapy Services | 30 visits per benefit period | |
| (Subject to pre-approval) | Radiation therapy and chemotherapy covered as any other illness | |
| Infusion therapy | ||
| OTHER SERVICES | ||
| Prescription | Subject to annual deductible and coinsurance | |
| Durable Medical Equipment | Subject to annual deductible and coinsurance | |
| (Subject to pre-approval) | ||
| Blood/Blood Products/Processing | Subject to annual deductible and coinsurance | |
| Pricing (Monthly Premium) | Husband/ | Parent/ | ||||||||
| Blue Cross/Blue Shield | Deductible | Single | Wife | Child | Family | |||||
| Coinsurance 70/30 | $2500 | $1,008 | $ 2,404 | $1,788 | $2,524 | |||||
| *2300/4600 | na | na | na | na | ||||||
| *1550/3050 | na | na | na | na | ||||||
| 1000 | 1,626 | 3,877 | 2,885 | 4,071 | ||||||
| Oxford | $2500 | $781 | $1,561 | $1,444 | $2,224 | |||||
| 1000 | 1,046 | 2,092 | 1,935 | 2,981 | ||||||
| Blue Cross/Blue Shield | Deductible | Single | Wife | Child | Family | |||||
| Coinsurance 80/20 | *$2300/4600 | na | na | na | na | |||||
| *1550/3050 | na | na | na | na | ||||||
| $2500 | 1,514 | 3,047 | 2,267 | 3,199 | ||||||
| 1,000 | 2,274 | 5,422 | 4,035 | 5,693 | ||||||
| Oxford | $2500 | $ 904 | $1,808 | $1,673 | $2,577 | |||||
| 1000 | 1,231 | 2,463 | 2,278 | 3,509 |