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POS Charter Plan HMO's Aetna U.S. Healthcare Health Insurance Plan (HIP) Kaiser Permanente Oxford Health Plan Physician Health Services
Aetna U.S. Healthcare |
Plan Type: IPA Model HMO
| HOSPITAL: | Covered in full for semi-private accommodations. |
| PRIMARY OFFICE VISIT: | $5 co-payment |
| SPECIALIST: | $5 co-payment |
| EMERGENCY ROOM: | $35 co-payment |
| MENTAL HEALTH CARE: | Outpatient-$25copayment/20visits per year |
| ROUTINE EYE EXAM: | $5 co-payment/Lens replacement $100 for 24 months |
| ROUTINE GYN EXAM: | $5 co-payment/ 1 visit per year |
| CHIROPRACTIC: | $5 co-payment/20 visits per year |
| PEDIATRIC PREVENTIVE DENTAL: | $5 co-payment |
FOR FURTHER INFORMATION: 1-800-323-9930 or ((((--->>> Confirm---->>contact them via e-mail at solutions@ushc.com./// You can also reach U.S. Healthcare via the Internet www.aetnaushc.com/
COUNTIES COVERED:
| New York | Bronx, Brooklyn, Manhattan, Nassau, Orange, Putnam, Queens. Rockland, Staten Island, Suffolk, Westchester, Dutchess, Ulster and Sullivan. |
| New Jersey: | Bergen, Essex, Hudson, Hunterdon, Mercer, Middlesex, Monmouth, Morris Ocean, Passaic, Somerset, Sussex, Union and Warren. |
| Connecticut: | All. |
Health Insurance Plan (HIP) |
Plan Type: Staff Model HMO
| HOSPITAL: | Covered in full for semi-private room; covered in full for private room only if medically necessary |
| SURGICAL: | $5 co-payment per visit |
| HOME HEALTH CARE VISITS AND SERVICE: | $5 co-payment/visit |
| SKILLED NURSING FACILITIES: | 100 days/calendar year covered in full for semi-private room, board, nursing and physician care for non-custodial conditions |
| EMERGENCY CARE: | $25 co-payment for Emergency Room |
| AMBULANCE: | $5 co-payment |
| PHYSICIAN VISITS: | $5 co-payment/visit |
| X-RAY AND LABORATORY: | (outpatient) Covered in full |
| PRESCRIPTIONS: | Generic - $5 co-payment Brand name - $ 10 co-payment |
| PREVENTIVE CARE: | $5 co-payment, includes periodic exams, gynecological exams, pediatric check ups and immunizations |
| VISION SCREENING: | $5 co-payment |
| HEARING SCREENING: | $5 co-payment |
| ALLERGY CARE: | $5 co-payment, treatment |
| MENTAL HEALTH CARE: | Inpatient - up to 30 days per calendar year for psychiatric crisis intervention Covered in full Outpatient - $5 co-payment for one or two evaluation visits and up to 20 visits/year for short-term condition and/or crisis intervention |
| ALCOHOLISM/DRUG DEPENDENCY: | Inpatient - up to 7 days per incident for detoxification,
up to 30 days per calendar year for rehabilitation. Outpatient - $5 co-payment for six-week outpatient intensive rehabilitation program |
| MATERNITY: | $5 co-payment/visit, hospital care for both mother and infant if on family coverage. |
| PHYSICAL THERAPY: | $5 co-payment/visit; up to two months per incident |
| MAXIMUM BENEFITS: | No Maximum Benefits unless stated |
| DOMESTIC PARTNERSHIP ENROLLMENT: | Yes, no restrictions |
FOR FURTHER INFORMATION: 1-800-906-9010
Health Insurance Plan of New Jersey
COUNTIES COVERED:
New Jersey: Atlantic, Bergen Burlington, Camden, Essex, Gloucester, Hudson, Hunterdon, Mercer, Middlesex, Monmouth, Morris, Ocean, Passaic, Salem, Somerset and Union counties.
Kaiser Permanente |
Plan Type: Staff Model HMO
| HOSPITAL: | Covered in full |
| SURGICAL: | Covered in full |
| HOME HEALTH CARE VISITS AND SERVICE: | Covered in full when medically necessary |
| SKILLED NURSING FACILITIES: | 100 days/calendar year when medically necessary covered in full |
| EMERGENCY CARE: | Covered in full when in a Kaiser facility ; $25 copayment when visit is not in a Kaiser facility. |
| AMBULANCE: | Covered in full when approved or ordered by Kaiser physician. |
| PHYSICIAN VISITS: | $5 co-payment, covered in full |
| X-RAY AND LABORATORY: | (outpatient) Covered in full |
| PRESCRIPTIONS: | $5 co-payment |
| PREVENTIVE CARE: | $5 co-payment, covered in full; includes periodic physical exams; gynecological exams, pediatric check-ups |
| VISION SCREENING: | Covered in full |
| HEARING SCREENING: | Covered in full |
| ALLERGY CARE: | Covered in full |
| MENTAL HEALTH CARE: | Inpatient - 30 days/year covered in full. Outpatient - Visits 1-10 covered in full; visits 11-20 - 25% co-payment; visit 21-30 50% co-payment; visits 31+ member pays full fee for service |
| ALCOHOLISM/DRUG DEPENDENCY: | Inpatient - Limited to removal of toxic substance(s) in the
system. Outpatient - First 60 visits each calendar year covered in full if prescribed by a physician and provided at a facility designated by Kaiser. |
| MATERNITY: | Includes prenatal, delivery and post-natal care along with in-hospital, well-baby care, after initial prenatal visit. |
| PHYSICAL THERAPY: | Outpatient - $5 copayment per visit, limited to two months condition. |
| MAXIMUM BENEFITS: | No Maximum Benefits |
| DOMESTIC PARTNERSHIP ENROLLMENT: | Yes, no restrictions |
FOR FURTHER INFORMATION: New York - (800)305-1998
Connecticut - (800)305-199
Kaiser Permanente
COUNTIES COVERED:
New York: Westchester.
Connecticut: Fairfield.
Oxford Health Plan |
Plan Type: IPA Model HMO
| HOSPITAL: | Covered in full |
| SURGICAL: | Covered in full |
| HOME HEALTH CARE VISITS AND SERVICE: | $5 co-payment, 60 visits/year covered in full when approved by Oxford's Medical Review Program |
| SKILLED NURSING FACILITIES: | Covered in full for 30 days/year |
| EMERGENCY CARE: | $50 co-payment (charge waived if admitted); outside of service area benefits payable for emergency care only |
| AMBULANCE: | Covered in full when medically necessary |
| PHYSICIAN VISITS: | $5 co-payment to physician's office $ 10 co-payment for housecalls |
| X-RAY AND LABORATORY: | (outpatient) Covered in full when at a participating laboratory |
| PRESCRIPTIONS: | Generic - $5 co-payment Brand - $10 co-payment |
| PREVENTIVE CARE: | Covered in full |
| VISION SCREENING: | One eye exam per 12-month period, $50 reimbursement One set of appliances per 24-month period, $70 reimbursement |
| HEARING SCREENING: | Covered as part of periodic health exam |
| ALLERGY CARE: | $5 co-payment; up to maximum of 14 visits/year |
| MENTAL HEALTH CARE: | Inpatient - Covered for 30 days/year at
approved facility Outpatient - 30 visits annually; 50% copayment |
| ALCOHOLISM/DRUG DEPENDENCY: | *Inpatient - 7 days/year covered in full for
detoxification. Up to 30 days/year covered for inpatient rehabilitation *Outpatient - Covered in full for 60 visits/year for rehabilitation |
| MATERNITY: | Covered in full for mother and child |
| PHYSICAL THERAPY: | Covered in full for short-term physical therapy for up to 60 days per 12 month period |
| MAXIMUM BENEFITS: | No Maximum Benefits |
| DOMESTIC PARTNERSHIP ENROLLMENT: | Restricted to same sex partners only |
FOR FURTHER INFORMATION: 1-800-444-6222
Oxford Health Plan
COUNTIES COVERED:
New York: Bronx, Brooklyn, Nassau, Manhattan, Queens,
Rockland, Staten Island, Suffolk and Westchester.
New Jersey: Bergen, Burlington, Essex, Hudson, Hunterdon, Mercer, Middlesex, Monmouth,
Morris, Ocean Passaic, Somerset, Sussex, Union and Warren.
Connecticut: Fairfield.
*at approved facilities only
Physicians Health Services |
Plan Type: IPA Model HMO
| HOSPITAL: | Covered in full for semi-private room |
| SURGICAL: | Covered in full |
| HOME HEALTH CARE VISITS AND SERVICE | Covered in full when medically necessary |
| SKILLED NURSING FACILITIES: | Provided for rehabilitation only-NY: 60 days/year |
| EMERGENCY CARE: | At physician's office - covered in full |
| EMERGENCY ROOM: | At hospital - $50 copayment |
| AMBULANCE: | Covered in full when medically necessary |
| PHYSICIAN VISITS: | $10 copayment, covered in full |
| X-RAY AND LABORATORY: | (outpatient) Covered in full |
| PRESCRIPTIONS: | $10 copayment, unlimited maximum. |
| PREVENTIVE CARE: | $10 copayment, covered in full, $0 copayment for children under 18 |
| VISION SCREENING: | Routine exams - not covered Medical Care for illness/injury covered in full after $ 1 0 copayment |
| HEARING SCREENING: | Routine exams not covered (except for children under 18): |
| CHIROPRACTIC CARE: | $10 copayment 15 visits per calendar year |
| MENTAL HEALTH CARE: | Inpatient - 30 days/year covered in full Outpatient - 20 visits/year; $20 copayment. |
| ALCOHOLISM/DRUG DEPENDENCY: | Inpatient - Detoxification covered in full *Outpatient - 60 visits/year covered in full for rehabilitation |
| MATERNITY: | Covered in full |
| PHYSICAL THERAPY: | Up to 30 visits per medical condition, $10 copayment |
| MAXIMUM BENEFITS: | No Maximum Benefits |
| DOMESTIC PARTNERSHIP ENROLLMENT: | Yes, no restrictions |
FOR FURTHER INFORMATION: 1-800-441-5741
Physician Health Services
COUNTIES COVERED:
New York: Westchester, Putnam, Rockland, Orange, Dutchess,
Richmond, Nassau, Suffolk, Bronx, Brooklyn, Queens and New York.
Connecticut: Fairfield, Hartford, Litchfield, Middlesex, New Haven, New London, Tolland
and Windham.
New Jersey: all
*At PHS approved facility
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