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HMO Choices

  Selecting an HMO
 

 

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Choosing an HMO

Select An HMO Plan
and Get Detailed Information On Services Provided

  AmeriChoice

Amerigroup

Horizon NJ Health

University
Health Plans

 

  

TO CHOOSE AN HMO, THINK ABOUT:

1. What doctor do you want for you and your family?

2.What you need to do to see a Pediatrician, Physician, Dentist, Eye Doctor and get a prescription filled.

3. Looking at other benefits that are important to your family.

4. Calling a FamilyCare worker at 201-368-4200 or TTY 201-368-4361.

WHEN YOU CHOOSE AN HMO, BE SURE TO:

1. Check off your choice on the Plan Selection Form. Make sure the HMO is in your county.

2. Write in the names of the doctors for the plan that you have chosen.

3. Sign the form.

4. Make a copy and keep it for your records.

5. Send the other copy in the return envelope.

Choosing an HMO

SERVICES PROVIDED

To visit the AmeriChoice website, click here

 
Where Medical Care is Provided:
(Where you go to get health care)
 
Private doctors offices, hospital based health centers, or Federally Qualified Health Centers.
Choosing a Doctor:
(What are the choices for a personal doctor)
 
Choose a doctor from the plan's network. If you have not talked to Member Services, call 1-800-941-4647 to choose the child's personal doctor right away.
Referral Process:
(What to do to see a specialist)
 
Your personal doctor will give you a referral to see a specialist when needed.
Obstetrician/Gynecologist Services:
(What to do to see an OB/GYN)
 
A plan OB/GYN may be used at any time without a referral.
Seeing a Dentist:
(What to do to see a dentist)
 
Choose a dentist from the AmeriChoice network and make an appointment; no referral is needed.
For Plan D, coverage is limited to preventive services for children under 12.
Eye Care and Glasses:
(What eye care services are provided)
 
One eye exam a year for members under 21 years. No referral is needed. $100 allowance for eyeglasses.
For Plan D, one pair of eyeglasses or contacts covered in a 24 month period or as medically necessary. Eye exams, including one routine eye exam per year.
Emergency Care:
(Who you should call first and where you should go in case of an emergency. When are emergency room visits covered)
 
If possible, contact your personal doctor when an emergency occurs. If life threatening, go to the nearest emergency room. Follow-up care must be provided by the child's personal doctor.
Other Benefits:
(Other things the HMO offers)
Special Preferred Member Club, special Community-based programs for pregnant Women and new moms, including Skilled Nursing Assessment, if desired. Specialized Case Management to treat HIV/AIDS, TB, Sickle Cell Disease, Asthma and other chronic conditions. Health Education Workshops. Nurse-On-Call 24 hours a Day to answer questions. Nutritional Program with SHARE NJ.
Pharmacy:
(What pharmacies can be used)
You can use any pharmacy showing the “PAID” symbol.

Member Services:
(Customer helpline number)
Multi-lingual Member Services Staff
1-800-941-4647 (English)
1-800-943-4647 (Espanol)
24 hours, every day
TDD 1-800-852-7897 24 hours, every day
 

SERVICES PROVIDED

To visit the AMERIGROUP website, click here
 
Where Medical Care is Provided:
(Where you go to get health care)
 
Private doctor's offices, health centers, hospital based centers, or Federally Qualified Health Centers.
Choosing a Doctor:
(What are the choices for a personal doctor)
 
Choose a doctor from the plan's network. If you have not talked to Member Services, call to choose a personal doctor right away.
Referral Process:
(What to do to see a specialist)
 
Your personal doctor will give you a written referral to see a specialist when needed.
Obstetrician/Gynecologist Services:
(What to do to see an OB/GYN)
 
No referral is needed to see an OB/GYN in the AMERIGROUP network for annual well woman exams, pregnancy or family planning.
Seeing a Dentist:
(What to do to see a dentist)
 
Choose a dentist from the network. No referral is needed.
For Plan D, coverage is limited to preventive services for children under 12.
Eye Care and Glasses:
(What eye care services are provided)
 
No referral is necessary for eye exam. Selected frames and lenses are covered in full: once per year through 18 years and younger. A $100 allowance is given
towards contact lenses: once per year through 18 years and younger.
For Plan D, one pair of eyeglasses or contacts covered in a 24 month period or as medically necessary. Eye exams, including one routine eye exam per year.
Emergency Care:
(Who you should call first and where you should go in case of an emergency. When are emergency room visits covered)
 
If possible, contact your personal doctor when an emergency occurs. If life threatening, go to the nearest emergency room. Follow-up care must be provided by the child's personal doctor.
Other Benefits:
(Other things the HMO offers)
Certain over-the-counter drugs and vitamins, when prescribed by a doctor. Nurse-On-Call 24 hours to answer questions.
 
Pharmacy:
(What pharmacies can be used)
You may use any pharmacy in the Amerigroup network showing the “PCS” symbol. Please contact Member Services at 1-800-600-4441 to locate the pharmacy nearest you.
Member Services:
(Customer helpline number)
1-800-600-4441. Multi-lingual Member Services.
TTY/TDD 1-800-852-7899

 

SERVICES PROVIDED


To visit the Horizon NJ Health website, click here

Where Medical Care is Provided:
(Where you go to get health care)
 
Private doctor's offices, health centers, hospital based centers, or Federally Qualified Health Centers.
Choosing a Doctor:
(What are the choices for a personal doctor)
 
Choose a doctor from the plan's network. If you have not talked to Member Services, call 1-800-543-5656 to choose a personal doctor right away.
Referral Process:
(What to do to see a specialist)
 
Your personal doctor will give you a referral to see a specialist when needed.
Obstetrician/Gynecologist Services:
(What to do to see an OB/GYN)
 
You can use any OB/GYN in the plan's provider network. Plan members do not need a referral to see an OB/GYN.
Seeing a Dentist:
(What to do to see a dentist)
 
Choose a dentist from the plan's provider network. No referral is needed to see the child's primary care dentist.
For Plan D, coverage is limited to preventive services for children under 12.
Eye Care and Glasses:
(What eye care services are provided)
 
Plan A, B, C members are eligible for 1 eye exam and $100 allowance for eyeglasses or contact lenses every benefit year.
Plan D members are eligible for 1 eye exam (including routine care) and $100 allowance for one pair of eyeglasses or contact lenses every 24 months. No referrals are needed for an eye exam. Exams, frames and lenses are available through network providers.
Emergency Care:
(Who you should call first and where you should go in case of an emergency. When are emergency room visits covered)
If possible, contact your personal doctor when an emergency occurs. If life threatening, go to the nearest emergency room. Follow-up care must be provided by the child's personal doctor.
Other Benefits:
(Other things the HMO offers)
The MomÍs GEMS prenatal program for pregnant members. The Asthma Relief Management Program. Health and member education available to all members. The Social Case Management Outreach program designed to help members with special medical and social needs. Multi-lingual member support/services staff. For Plans A, B, C over-the-counter medicines and vitamins, as prescribed by your doctor.
Plan D members do not receive the over-the-counter benefit.
Pharmacy:
(What pharmacies can be used)
You can use any pharmacy in the “PAID” pharmacy network. They are identified by the “PAID” symbol on the pharmacy door or you can call Member Services to find a “PAID” pharmacy in the network.
Member Services:
(Customer helpline number)
Multi-lingual Member Services Helpline, 24 hours, 7 days a week,
1-877-765-4325.
TDD 1-800-684-5505

 

SERVICES PROVIDED

To visit the University Health Plans Website click here
 
Where Medical Care is Provided:
(Where you go to get health care)
 
Private doctor's offices, hospital based health centers, or Federally Qualified Health Centers.
Choosing a Doctor:
(What are the choices for a personal doctor)
Choose a doctor from the plan's network. If you have not talked to Member Services, call to choose a doctor right away.
Referral Process:
(What to do to see a specialist)
 
Your personal doctor will give you a referral to see a specialist when needed.
Obstetrician/Gynecologist Services:
(What to do to see an OB/GYN)
 
You can use any OB/GYN from the plan's network. No referral is needed for two well visits a year.
Seeing a Dentist:
(What to do to see a dentist)
 
No referral is needed to use a dentist in the network. For Plan D, coverage is limited to preventive services for children under 12.
Eye Care and Glasses:
(What eye care services are provided)
 
Exams, selected frames and lenses available through network provider. No referral is needed for exam for eyeglasses.
For Plan D, one pair of eyeglasses or contacts covered in a 24 month period or as medically necessary. Eye exams, including one routine eye exam per year.
Emergency Care:
(Who you should call first and where you should go in case of an emergency. When are emergency room visits covered)
If possible, contact your personal doctor when an emergency occurs. If life threatening, go to the nearest emergency room. Follow-up care must be provided by your personal doctor.
Other Benefits:
(Other things the HMO offers)
Prenatal, Asthma, Hypertension, Diabetes and Immunization programs and Wellness Workshops. Certain over-the-counter medicines as prescribed by the child's doctor.
Pharmacy:
(What pharmacies can be used)
You can use any pharmacy in the “PAID” pharmacy network. Contact Member Services to locate a pharmacy nearest you.
Member Services:
(Customer helpline number)
Call 1-800-JOIN-UHP
(1-800-564-6847)
24 hours, 7 days a week.
Multi-lingual—English, Spanish, Portuguese.

TDD 1-800-414-7592

 

 

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