Attention! Updates have been made to this
article.
As small and large groups enroll or renew with our POS Plus or HMO Plus
plans with a November 1, 2018, coverage effective date, members will receive
new ID cards that include the Plus designation noted, as shown below.
Providers will be able to access an image of the updated member ID card
through the Eligibility and Benefits Inquiry transaction on the NaviNet?
web portal. After navigating to the Eligibility and Benefits Detail
screen, select the link View Current Member ID Card to view the card
image on or after the member?s new coverage effective date.
Plus plan details
As a reminder, there are important differences between the HMO Plus and POS
Plus plans and traditional HMO and POS plans.
Referrals
Plus members never need a referral to seek care from participating
providers. HMO Plus and POS Plus members may visit any AmeriHealth New Jersey
participating provider, within their respective
network, without obtaining a referral from their primary care physician
(PCP).* ID cards for these members clearly
state that referrals are not required, as shown above.
Using a PCP
HMO Plus and POS Plus members can select any participating AmeriHealth New
Jersey PCP, within their respective
network, who can provide routine and preventive care services and assist
members in finding participating 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
through AIM Specialty Health?.
In-network care vs. out-of-network
care
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 that 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.
*For example, a member with
Local Value Network coverage must use a provider within the Local Value Network
to achieve in-network coverage.
For more information
If you have questions regarding AmeriHealth New Jersey HMO Plus or POS Plus
plans, please call Customer Service at 1-888-YOUR-AH1 or contact your
Provider Partnership Associate.
NaviNet is a registered trademark of NaviNet, Inc.