NJ Life Improvement Plan

• Medicare Prescription Drug Coverage (Part D)
• $0 co-payments for primary care visits
• 20% coinsurance for specialist visits
• No referrals needed
• 20% coinsurance for Medicare-covered eye exam
• $0 for ALL covered dental services
• Up to $400 per year ($100 per quarter) for non-prescription drugs or health
  related items using a health spending card at a local Rite Aid pharmacy
• FREE car service to and from your doctor up to 8 times per year(2 per quarter)
• Up to $1000 US for routine healthcare while traveling abroad, excluding US
  Territories
• Up to $10,000 a year for Medicare-covered services received from a Medicare provider in Puerto Rico.

Healthfirst participating hospitals in New Jersey>

Your Summary of Benefits will give you important information concerning all your
benefits coverage 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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