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More Family Health
Care Programs |
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Choosing
an HMO
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Select
An HMO Plan
and
Get Detailed Information On Services Provided |
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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.
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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.
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Choosing an HMO
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To visit
the AmeriChoice website, click
here
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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)
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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 |
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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)
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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)
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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.
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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 |
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SERVICES PROVIDED
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To visit
the Horizon NJ Health website, click
here
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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.
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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 |
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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.
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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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