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No referrals required for AmeriHealth New Jersey HMO Plus and POS Plus members
Professional; Facility; Ancillary
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AmeriHealth New Jersey HMO Plus and POS Plus members do not need referrals to
access care. HMO Plus and POS Plus members can select any participating
AmeriHealth New Jersey primary care physician (PCP) who can provide routine and
preventive care services and assist members in finding physicians who can
provide specialty services such as laboratory, physical therapy, and radiology.
With HMO Plus and POS Plus, members can visit any network PCP and pay the PCP
copayment. Please remember that CT, MRI, PET scans, nuclear cardiology
services, and echocardiography services require precertification.
POS Plus members receive the highest level of coverage by utilizing physicians
and hospitals that participate in the AmeriHealth New Jersey network. When POS
Plus members choose to visit providers who do not participate in the network,
they are responsible for additional out-of-pocket costs.
Small Employer Health (SEH) and Large Group (51+) HMO Plus members must use
in-network providers to access benefits.
Unlike in a traditional HMO or POS plan, Plus members never need a referral to
seek care. HMO Plus and POS Plus members may visit any AmeriHealth New Jersey
participating provider without obtaining a referral from their PCP. ID cards
for these members clearly state that referrals are not required.
If you have questions regarding AmeriHealth New Jersey HMO Plus or POS Plus
products, please call Customer Service at []1-800-275-2583[] or contact your Network Coordinator or
Hospital/Ancillary Services Coordinator.