Plan types & referrals

AmeriHealth New Jersey offers several types of health plans that you can choose from. Each plan works a little differently and is associated with a network of doctors, hospitals, and other health care providers.

The type of plan you choose will affect how you will get care, including whether a primary care physician (PCP) will coordinate your care and whether you’ll need referrals to see specialists.

We invite you to take a closer look at the different types of plans we offer and find the plan that works best for you.

HMO

An HMO (Health Maintenance Organization) plan is best if you have or want a PCP to coordinate your care and refer you to specialists within the plan’s network. Our HMO plans offer coverage for network doctors only. Typically, only emergency services are covered if you go outside the plan’s network.

A variant HMO plan type called HMO Plus is best if you have or want a PCP to help coordinate your care, but you also want the freedom to choose a particular in-network doctor or hospital without a referral. An HMO Plus plan offers coverage for network doctors only.

POS

A POS (Point-of-Service) plan is best if you have or want a PCP to coordinate your care, but you still want the freedom to choose a particular doctor or hospital, in or out of network. With a POS plan, you’ll pay less when you get a referral to an in-network doctor or hospital and more if you choose an out-of-network doctor or hospital.

A variant PPO plan type called POS Plus is best if you have or want a PCP to coordinate your care as well as the freedom to see any specialist you want, in- or out-of-network, without a referral. All POS Plus plans are available with the National Access network.

EPO

An EPO (Exclusive Provider Organization) plan is best if you want the freedom to see any in-network doctor or specialist without a referral. EPO plans don’t require you to choose a PCP, and they don’t cover out-of-network care unless it’s an emergency.

Adding an HSA (Health Savings Account to your EPO plan (EPO with HSA) can save you money if you choose a plan with a high deductible. You can put money into an HSA, and you won’t get taxed for that part of your income. Then you can use that money to pay for approved health costs.

Learn more about HSAs

PPO

A PPO (Preferred Provider Organization) plan is best if you want access to a large network of doctors and hospitals and the freedom to see any doctor or specialist you want, in or out of network, without a referral. You pay lower costs when you see network providers. But you can go outside the network and pay more for your services.

What is a Referral?

A referral is like an official doctor’s note. Your doctor sends a message to the specialist’s office notifying them that you need to see them for medical care. After the referral is received, you can make an appointment with the specialist.

Plan comparison
PCP required
HMO HMO Plus POS POS Plus EPO PPO
   
Referrals required for specialists
HMO HMO Plus POS POS Plus EPO PPO
       
In-network coverage only (except emergency care)
HMO HMO Plus POS POS Plus EPO PPO
     
In- and out-of-network coverage
HMO HMO Plus POS POS Plus EPO PPO
     
HSA option
HMO HMO Plus POS POS Plus EPO PPO
         
If you are an individual or freelancer in New Jersey
AmeriHealth New Jersey has a variety of plans designed to meet different budgets without giving up important needs.

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