ABEL BUSINESS SERVICES, INC.
Health Plan: Rates and Services Chart
FOR NEW JERSEY
(Employee's primary doctor is in New Jersey)HIP EPO Health Plan of New Jersey
(Visit any doctor in PHCS network.)
| H.I.P. EPO - LG Plan
Feb. 1, 2008 - Jan. 31, 2009 |
|
| Coverage Details | Single $420.00
Family $1,023.00 |
| Primary Doctor Office Visit | $25 copay |
| Specialist Office Visit | $40 copay |
| Hospitalization (per admission) | $500 copay |
| Ambulatory Surgery (Outpatient) | $75 copay |
| Emergency Room | $50 copay |
| Prescription: generic/formulary*/
non-formulary* |
$20 / $30 / $50 copays. $100 Deductible each person. |
| Refractive Eye Exam | $15 copay |
| Diabetic Supplies | $25 copay |
| Fertility | Infertility base benefits only |
| Optical (once every 2 years) | $45 for eyeglasses every 24 months |
| Dental | Not covered |
| Preventive Dental included | Preventive Dental included |
| Dependent Coverage | Covered
until end of the month in which they turn 19
Full-time Students until end of the year they turn 23 |
| Durable Medical Equipment (DME) | Not covered |
| Private Duty Nursing (PDN) | Not covered |
| Skilled Nursing Facility (SNF) | Unlimited |
| Home Health Care (HHC) | 200 HHC visits |
| In Patient Therapies (IP Therapies) | 90 Days limit |
| Out Patient Therapies (OP Therapies) | 90 Visits |
| In Patient Mental Health Care (MH) | 30 Days |
| In Patient Alcohol/Substance Abuse Detox (ALC/SA) | 7 Days |
| In Patient Alcohol/Substance
Abuse
Rehab (ALC/SA) |
Not covered |
| Out Patient Alcohol/Substance Abuse Rehab (ALC/SA) | $25 copay. 60 Visits |
| Out Patient Mental Health Care (MH) | $40 copay, 20 visits limit |
| Dialysis | $25 copay |
* formulary = list of prescription drugs approved for preferred rates.
See the website:
http://www.hipusa.com
<< >>
Guardian Dental Not available everywhere.
| Plan Prices (Feb. 1, 2006 - Jan. 31, 2007) | Individual
$23.00
Employee + Spouse $40.00 Employee + Child(ren) $43.00 Employee + Family $58.00 |
| Dental Visit Copay | $5 |
|
Website: www.glic.com Search for a dentist at the above site. Choose "Group Services" > "Dental" > Managed Dental Guard FL/NY" |
Questions: 1-888-278-4542 |