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No referrals required for AmeriHealth New Jersey HMO Plus and POS Plus members

July 1, 2013

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.

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