For a better experience on eHealth.com, update your IE browser or use a different browser. Update IE

Compare health insurance quotes.

Find affordable health insurance and apply online.

Find Plans Now
We're sorry.This plan is no longer available.To see plans that are available and get free quotes,enter your ZIP Code above.
Plan Type EPO
Office Visit for Primary Doctor
Find Doctors
$15 Copay
Office Visit for Specialist $30 Copay
Office Visit for Other Practitioner (Nurse, Physician Assistant) $30 Copay
Annual Deductible Individual: $1,000
Individual (Non-Preferred): $2,000
Separate Prescription Drugs Deductible None
Coinsurance Tier 1 (Preferred): 20%
Tier 2 (Non-Preferred): 40%
Retail Prescription Drugs Generic Drugs: $10 Copay
Brand Name Drugs: 40% Coinsurance
Non-Formulary Drugs: 50% Coinsurance
Specialty Drugs: 50% Coinsurance
Annual Out-of-Pocket Limit Individual: $2,500
Includes deductible
Individual (Non-Preferred): $4,000
Includes deductible
Lifetime Maximum Unlimited
Health Savings Account (HSA) Eligible No
Out-of-Network Coverage No 
Out-of-Country Coverage No.
Office Visit
Primary Care Physician Required Yes
Specialist Referrals Required Yes
Preventive Care Coverage
Periodic Health Exam No Charge
Periodic OB-GYN Exam No Charge
Well Baby Care No Charge
Emergency and Urgent Care
Emergency Room Tier 1: $100 Copay then 20% Coinsurance after deductible
Tier 2: $100 Copay then 40% Coinsurance after deductible
Emergency Ambulance Services Tier 1: 20% Coinsurance after deductible
Tier 2: 40% Coinsurance after deductible
Urgent Care Facility Tier 1: $30 Copay
Tier 2: 40% Coinsurance after deductible
Prescription Drug Coverage
Retail Prescription Drugs Generic Drugs: $10 Copay
Brand Name Drugs: 40% Coinsurance
Non-Formulary Drugs: 50% Coinsurance
Specialty Drugs: 50% Coinsurance
Separate Prescription Drugs Deductible None
Mail Order Prescription Drugs Generic Drugs: $20 Copay
Brand Name Drugs: 40% Coinsurance
Non-Formulary Drugs: 50% Coinsurance
Mail Order Supply 90 day supply
Outpatient Coverage
Outpatient Surgery Tier 1: 20% Coinsurance after deductible
Tier 2: 40% Coinsurance after deductible
Outpatient Lab/X-Ray Tier 1: 20% Coinsurance after deductible
Tier 2: 40% Coinsurance after deductible
Imaging (CT and PET scans, MRIs) Tier 1: 20% Coinsurance after deductible
Tier 2: 40% Coinsurance after deductible
Outpatient Mental Health Tier 1: 20% Coinsurance after deductible
Tier 2: 40% Coinsurance after deductible
Outpatient Substance Abuse Tier 1: 20% Coinsurance after deductible
Tier 2: 40% Coinsurance after deductible
Outpatient Rehabilitation Services (PT, OT, ST) Tier 1: 20% Coinsurance after deductible
Tier 2: 40% Coinsurance after deductible
30 Visit(s) per Year
Inpatient Coverage
Hospitalization Tier 1: 20% Coinsurance after deductible
Tier 2: 40% Coinsurance after deductible
Skilled Nursing Facility Tier 1: 20% Coinsurance after deductible
Tier 2: 40% Coinsurance after deductible
Inpatient Mental Health Tier 1: 20% Coinsurance after deductible
Tier 2: 40% Coinsurance after deductible
Inpatient Substance Abuse Tier 1: 20% Coinsurance after deductible
Tier 2: 40% Coinsurance after deductible
Home Healthcare Tier 1: 20% Coinsurance after deductible
Tier 2: 40% Coinsurance after deductible
60 Visit(s) per Year
Maternity Coverage
Pre & Postnatal Office Visit No Charge
Labor & Delivery Hospital Stay Tier 1: 20% Coinsurance after deductible
Tier 2: 40% Coinsurance after deductible
Pediatric Services
Dental Checkup for Children Not Covered
Vision Screening for Children No Charge, 1 Visit(s) per Year
Eye Glasses for Children No Charge, 1 Item(s) per Year
Major Dental Coverage (Pediatric) Not Covered
Additional Coverage
Chiropractic Coverage $15 Copay, 30 Visit(s) per Year
Durable Medical Equipment Tier 1: 20% Coinsurance after deductible
Tier 2: 40% Coinsurance after deductible
Hospice Tier 1: 20% Coinsurance after deductible
Tier 2: 40% Coinsurance after deductible
Major Dental Coverage (Adult) Not Covered
Vision Coverage (Adult) No Charge for Routine Eye Exam
Out-of-Network Coverage
Out-of-Network Authorization Required N/A
Out-of-Network Annual Deductible N/A
Out-of-Network Annual Coinsurance N/A
Out-of-Network Annual Out-of-Pocket Limit N/A
Additional Information
A.M. Best Rating NR-5 as of 06/23/2010
Electronic Signature for Application Available Yes
Details and documents about this plan
View Plan Brochure Summary of Benefits & Coverage

The Summary of Benefits & Coverage form pertains to the coverage provided by a particular health insurance plan. If you select certain optional benefits while applying for this health insurance plan, a modified Summary of Benefits & Coverage may be available that reflects the optional benefits that you selected. A paper copy of this Summary of Benefits & Coverage is available upon request by calling our toll free number. Click here to view the Uniform Glossary of Coverage and Medical Terms.

Customer reviews

Important notices and disclaimers

  • The benefits matrix is a summary for informational purposes only. Review the evidence of coverage and insurance policy (plan contract) for a detailed description of coverage benefits, limitations, and exclusions. Only the terms and conditions of coverage benefits listed in the policy are binding.
  • The benefits listed may be contingent on your use of physicians, hospitals, and services within the specific insurance company's provider network.
  • The Copayment, Deductible, and Coinsurance amounts are your share of the costs for covered benefits. These amounts are subject to change.
  • Each insurance carrier may have unique Notices, Disclaimers, and Fees. Please check below for information regarding the plans and carriers you selected.
  • The quotes or rates shown above are estimates only. Your premium is subject to change based on the optional benefits you selected, if any, and other relevant factors, such as changes in rates that take effect before your coverage start date. The insurance company always determines your actual premium. Insurance companies reserve the right to change the terms of a policy upon proper notification.
  • The Summary of Benefits & Coverage form pertains to the coverage provided by a particular health insurance plan. If you select certain optional benefits while applying for this health insurance plan, a modified Summary of Benefits & Coverage may be available that reflects the optional benefits that you selected. A paper copy of this Summary of Benefits & Coverage is available upon request by calling our toll free number. Click here to view the Uniform Glossary of Coverage and Medical Terms.

Carrier specific notices, disclaimers and fees

  • Horizon Blue Cross Blue Shield of New Jersey - Horizon Blue Cross Blue Shield of New Jersey works with independent agencies authorized to sell health plans in New Jersey through Horizon Healthcare of New Jersey, Inc. and Horizon Blue Cross Blue Shield of New Jersey.