CWA negotiated a better plan to replace NJPlus.  This plan is a PPO with all of the NJPlus benefits except that it will not require a referral from a primary care physician, it will have a nationwide network, and more doctors in New Jersey.  The cost of a co-pay to the doctor will go up to $15 a visit.

 

The actual agreed to plan design that we negotiated is below and you can compare each feature to NJ Plus.

 

 

 

 

Plan Features                          NJ Plus Now                                                                          New NJPlus PPO  

 

                                In network                              Out of Network                      In network                              Out of network

 

 

Service area             NJ, FL parts                           Unrestricted                            Nationwide                        Unrestricted  

                                 Of NY and PA

 

 

Hospital                  100%                                       70% after deductible               100%                                       70% after deductible                                                              

Inpatient

 

 

All Doctors             $10                                         70% after deductible               $15                                          70% after deductible                                                                              

Office Visits           

 

Specialists               Requires referral from             70% after deductible               No PCP referral required         70% after deductible                                         

Primary Care Physician

(PCP)                                                                                                                                                                     

 

Chiropractic            100% after                              70% after deductible               100%                                        70% after  deductible

                                $10 co pay                              limited to 30 visits                  $15 copay                               limited to 30 visits                                                 

limited to 30                            a year                                      limited to 30                            a year

                                visits a year                                                                             visits a year

 

Hospital                  100% after $25 copay            Subject to 70/30                      100% after $50 copay            100% after $50 copay

Emergency Rm        but only if reported                see in network                         No PCP  required                  No PCP required                           

                                To primary care physician    

                                (PCP)  within 48 hours

                                otherwise 70/30 split

                                and deductible        

 

Immunizations        100% after copayment           70% after deductible               100% after copayment           70% after deductible

 

Maternity               100% after 1st visit copay      70% after deductible                100% after 1st visit copay   70% after deductible

 

Physical exams        100% after copay                   not covered                             100% after copay                   Not covered

 

Well baby                100% after copay                   not covered                             100% after copay                   Not covered

 

Radiation                 100%                                       70% after deductible               100%                                       70% after deductible

 

Hospice                   100%                                       70% after deductible               100%                                       70% after deductible

 

Physical/Speech

Therapy                  100% after copay                   70% after deductible               100% after copay                   70% after deductible

 

Lab Tests                100%                                       70% after deductible               100%                                       70% after deductible

 

Vision Exam            100% after copay                   not covered                             100% after copay                   not covered

 

Alcohol abuse         treated as any illness               treated as any illness               treated as any illness               treated as any illness

(inpatient)

 

Drug abuse              treated as any illness               treated as any illness               treated as any illness               treated as any illness

 

Alcohol abuse         100%                                       70% after deductible               100%                                       70% after deductible

(out patient)

 

Mental Health         100% up to 25 days a year     50 days with 50% deductible    100% up to 25 days a year    50 days with 50% deductible

(in patient)

 

Mental health          90% up to annual/lifetime       70% up to annual/lifetime    90% up to annual/lifetime         70% up to annual/lifetime limit

(outpatient)             maximums                               maximums                               maximums                               maximums

 

Home Healthcare    Services, supplies covered      Same as in network coverage    Services, supplies                 Same as in network coverage

                                With pre-approval                  but at 70% with deductible       covered with pre-approval     but at 70% with deductible

 

Disease                    asthma, kidney disease           asthma, kidney disease           asthma, kidney disease           asthma, kidney disease

Management           pulmonary disease,                 pulmonary disease                  pulmonary disease,                 pulmonary disease,

(voluntary)              coronary artery disease,          coronary artery disease           coronary artery disease           coronary artery disease

                                diabetes, heart failure              diabetes, heart failure              diabetes, heart failure              diabetes, heart failure

 

 

Private Duty           When ordered by                    When ordered by                    When order by                        When ordered by

Nursing                   physician                                physician                                physician                                physician

(must be

medically

necessary)

 

Deductibles             None                                       $100 year/$200                       None                                       $100/$200 per

                                                                                Hospital admission                                                                 hospital admission

 

 

Deductibles             None                                       $250 per year/                         None                                       $250 per year/

(Family)                                                                  $200 per hospital                                                                    $200 per hospital

                                                                                admission                                                                                admission

 

 

Maximum Out        $400 per year                          $2000 per year                        $400 per year                          $2000 per year

Of pocket

(individual)

 

 

Maximum Out        $1000 per year                        $5,000 per year                       $1000 per year                        $5000 per year

Of Pocket

(Family)

 

 

Maximum                Unlimited                                $3,000,000                              Unlimited                                $3,000,000

Lifetime

Coverage