Supplemental Benefit Descriptions                                                             

Doctor's Office Visit Indemnity Benefit                                                                 

Benefits are paid at a preselected fixed dollar amount per visit, up to a calendar year maximum. This benefit excludes routine exams and injections except under plan 3.
                                                             

Plan 3 Combination Doctor's Visit, Diagnostic X-Ray, Lab and Preventive Care Benefit       

This benefit includes all of the following and is paid at a preselected fixed dollar amount. Up to a maximum number of visits per year.

   -Visits to a doctor's office, urgent care facility or outpatient hospital                                                          

   -Diagnostic X-ray and lab tests ordered or performed by a doctor when hospital overnight stay is not required.           

   -Annual physical examinations and well child care for children up to age six.                                            

Outpatient Diagnostic X-Ray and Lab Benefit                                                                 

This benefit pays a preselected fixed dollar amount for one or more diagnostic X-ray or lab tests performed by a doctor during a single visit to a provider. A visit means one sitting for one or multiple diagnostic X-ray procedures or one sitting for one or multiple diagnostic laboratory procedures. Benefits are subject to a calendar year maximum and will be paid when overnight hospital confinement is not required.   

Outpatient Major Diagnostic Testing Benefit        

Benefits paid at a preselected fixed dollar amount up to a calendar year maximum number of tests for the following: magnetic resonance imaging (MRI), computed tomography (CT,CAT scan), mammography, stress test, electrocardiogram (ECG, EKG), ultrasound, bone density, amniocentesis and chromosome analysis.                                   

Hospital Inpatient Admission Benefit

This benefit pays for admission to a healthcare facility for a minimum of 24 hours when confinement is medically necessary and is the result of a non-occupational illness or injury. This benefit will be paid regardless of any other inpatient hospital benefit available to the insured.

Plan 3 Hospital Indemnity Benefit                                                                          

Benefits are paid on the first day of a covered stay. ICU, substance abuse, mental health and nursing facility stays are included with the hospital stay benefit. Each facility has a calendar year maximum number of days as selected, 500 days per lifetime unless otherwise noted in the policy. Please refer to your Plan Summary for details.

Surgical Benefit Schedule.pdf                                                                                 

This benefit pays a preselected fixed dollar for surgeries performed by a doctor. Benefits are paid according to the surgical schedule.

Outpatient Surgical Facility Benefit                                                                                   

Benefits will be paid at a preselected fixed dollar amount up to the maximum of surgeries per calendar year for an outpatient surgical facility that is used during surgical procedures not ordinarily performed in a private physician's office, but not requiring inpatient hospitalization. Outpatient Surgical Facility does not include the private office of a healthcare provider who engages in the lawful practice of surgery.                                                                                        

Surgical Anesthesia Benefit                                                                                     

This provides benefits for anesthesia administered by an anesthesiologist or anesthetist in connection with a covered surgical procedure. This benefit is 40% of the benefit payable for the surgical procedure.    

Generic Prescription Drug Benefit List of Participating Pharmacies.pdf                                  

This pays 100 percent of all generic out-of-hospital prescription costs after the co-payment is met. There is no calendar year maximum. Brand name drugs are not covered under this benefit; however, a discount is available through the Pharmacy Program.

Health Patient Advocacy Detailed.pdf                                                                      

Finding the right answers at the right time is at the heart of what Health Advocate NurseLine provides. Whether it is getting advice about a child's fever at midnight or to help correct a medical bill, members get the right answers. You will make smarter healthcare decisions, reduce unnecessary trips to the ER or doctor and get the healthcare help you really need.

Wallet Saver Detailed.pdf                                                                                         

Anytime a member has a medical bill over $40 not covered by their insurance, Health Advocate associates will work with all providers to get a discount. Successful negotiations can save members hundreds, sometimes thousands of dollars.

Survivor Benefit                                                                                                       

If an employee dies while insured, any covered dependents will be extended benefits (except Dependent Life) without premium payments for up to two years after the employee's death. This is as long as the plan remains in force and the covered dependent meets the coverage requirements in the policy.    

Discount Services      Click Here for Brochure.pdf                                                               

Total Costs Combining the NJ Horizon EPO with the Supplements Plans varies based on location, gender and age of the oldest adult. Rates for the supplemental plan typically do not change from year to year, however the Horizon Rates change quarterly, but are guaranteed not to change from your initial effective date for 12 consecutive months.