AtlantiCare Benefits Book 2020

Medical Plan FAQs

TABLE OF CONTENTS WELCOME.................2 WHAT’S NEW. ...........3 SERVICE CENTERS AND WEBSITES...................4 HOW TO ENROLL.......5 MEDICAL..............6-12 PRESCRIPTION DRUG. ................13-15 ADDITIONAL MEDICAL PLAN RESOURCES........16-18 DENTAL...............19-21 VISION.....................22 LIFECENTER..............23 LIFE INSURANCE. .....24 LONG TERM DISABILITY...............25 VOLUNTARY OFFERINGS. ........26-29 SPENDING ACCOUNTS. ............30 RETIREMENT BENEFITS..................31 WELLNESS. .........32-36 LEGAL NOTICES..37-39 CONTACTS.........40-41 GLOSSARY..........42-43 FAQs...................44-46 FORMS................47-56

Medical Plan FAQs Do I need to choose the PPO plan if I have dependents who live outside of New Jersey? No. In the Horizon Engaged Plan, you have access to the national BC/BS network (Blue Card program), also referred to as the Blue Suitcase, so your out-of-state dependents will have access to their local BC/BS providers. Do I need to choose the PPO plan if I am receiving treatment from a physician or healthcare facility located outside of New Jersey? If your provider participates in the national BC/BS network (Blue Card program), then you do not need to enroll in the PPO plan. You can enroll in the Horizon Engaged Plan. If you are receiving treatment from a provider who does not participate in the Blue Card program, then you will need to decide whether you are willing to pay the additional cost of the PPO Plan. 

What happens if I’m out of the area and need emergent medical services? If an emergency arises and you or your covered dependents are out of the area, you should immediately seek care at an urgent care center or an emergency room. It is important that you notify your insurance carrier promptly following the visit. All three medical plans provide for this type of emergent coverage. Please note: The visit must be emergent, coded as such, and not for routine illness or other non-emergent situations. Why are the contributions between the plans so different? There are a couple of reasons for this difference. The PPO plan provides an out-of-network benefit to participants that the Engaged Plans do not. The Engaged Plans hold a higher level of accountability and require you (and your spouse/partner) to engage in your health.

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