NJ Coordinated Benefits Plan
- $10 co-payments for primary care visits
- No referral needed
- $0 for annual dental cleaning and exam including enhanced benefits
- $0 annual routine eye exam
- Up to $125 in eyewear per year
- Up to $500 for hearing aids every three years
- Up to $200 per year ($100 every 6 months) for non-prescription drugs and health
related items using a health spending card at Rite Aid Pharmacy locations
- Up to 8 round trips per year (2 per quarter) of free car service to and from your doctor
- Up to $1000 US for routine healthcare while traveling abroad, excluding U.S.
Territories
- Up to $10,000 a year for Medicare-covered services received from a Medicare Provider in Puerto Rico
- No Medicare Part D Prescription Drug Coverage
Healthfirst participating hospitals in New Jersey>
Your Summary of Benefits will give you important information concerning all your
benefits such as applicable conditions and limitations, premiums, out-of-network
coverage, cost-sharing and any conditions associated with the receipt or use of these benefits.
You can also reference your Evidence of Coverage to find out more about grievances, exceptions, coverage determinations, appeals procedures and our quality assurance
policies and procedures.
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H7015 MKT08_08 11/07 |
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