Tier 1 Advantage - Facility Tiering

Tier 1 Advantage EPO plans are offered in collaboration with facilities and hospital partners throughout the state. Tier 1 Advantage plans allow members to pay lower out-of-pocket costs for hospital and facility services by using a participating Tier 1 Advantage facility. Tier 2 is available through the AmeriHealth New Jersey Local Value network. 2,3

Tier 1 Advantage Hospital tier placements for 20181

The following hospitals are part of Tier 1 Advantage. Hospitals denoted T2 are Tier 2.

A

AtlantiCare Regional Medical Center ? ARMC City Campus ? ARMC Mainland Campus Atlantic Health System

Hackettstown Medical Center Atlantic Health System T2 ? Chilton Medical Center ? Hackettstown Medical Center ? Morristown Medical Center ? Newton Medical Center ? Overlook Medical Center

C

Cape Regional Medical Center Capital Health T2 ? Capital Health Medical Center ? Hopewell ? Capital Health Regional Medical Center CarePoint Health T2 ? Bayonne Medical Center ? Christ Hospital ? Hoboken University Medical Center CentraState Medical Center T2 Children's Hospital of Philadelphia (CHOP) T2 Cooper University Hospital

D

Deborah Heart and Lung Center

E

Englewood Hospital and Medical Center

H

Hackensack Meridian Health ? Bayshore Medical Center ? Hackensack University Medical Center ? Jersey Shore University Medical Center ? JFK Medical Center ? Mountainside Medical Center ? Ocean Medical Center ? Palisades Medical Center ? Pascack Valley Medical Center ? Raritan Bay Medical Center ? Riverview Medical Center ? Southern Ocean Medical Center Hackettstown Regional Medical Center Holy Name Medical Center Hunterdon Medical Center T2

I

Inspira Health Network T2 ? Inspira Medical Center? Elmer ? Inspira Medical Center? Vineland ? Inspira Medical Center? Woodbury

J

Jefferson Health New Jersey T2 ? Jefferson Cherry Hill Hospital ? Jefferson Stratford Hospital ? Jefferson Washington Township Hospital JFK Medical Center

L

Lourdes Health System ? Lourdes Medical Center of Burlington County ? Our Lady of Lourdes Medical Center ? St. Francis Medical Center

R

RWJBarnabas Health ? Clara Maass Medical Center ? Community Medical Center ? Jersey City Medical Center ? Monmouth Medical Center ? Monmouth Medical Center ? Southern Campus ? Newark Beth Israel Medical Center ? Robert Wood Johnson University Hospital ? Robert Wood Johnson University Hospital Hamilton ? Robert Wood Johnson University Hospital Rahway ? Robert Wood Johnson University Hospital Somerset ? Saint Barnabas Medical Center

S

Shore Medical Center T2 Saint Clare's Hospital St. Joseph's University Medical Center St. Luke's Hospital ? Warren Campus T2 St. Mary's General Hospital T2

T

The Memorial Hospital of Salem County Trinitas Regional Medical Center

U

University Hospital University Medical Center of Princeton at

Plainsboro

V

Valley Health System ? The Valley Hospital T2 Virtua Health System ? Virtua Marlton Hospital ? Virtua Memorial Hospital ? Virtua Voorhees Hospital

1 This list subject to change. 2 Tier 1 providers are an enhancement to your benefits. Tier 2 providers are AmeriHealth New Jersey Local Value network providers. 3 The Local Value network is not available in Hunterdon County.

Tier 1 Advantage is available

in 20 out of 21

counties.

Tier 1 Advantage Outpatient surgery and rehabilitation center tier placements for 20181

The following hospitals are part of Tier 1 Advantage. Hospitals denoted T2 are Tier 2.

A

Acuity Specialty Hospital of New Jersey Advanced Endoscopy & Surgery Center Affiliated Ambulatory Surgery PC Atlanticare Surgery Center Atlanticare Surgery Center - Cape May Atlantic Coastal Surgery LLC Atlantic County for Endoscopy and Surgical

Specialties (Access) Atlantic Rehabilitation Institute T2 Atlantic Surgery Center

B

Bacharach Institute for Rehabilitation

C

Campus Eye Group Ambulatory Surgery Center Cape Cataract Center Cares Surgicenter Cataract and Laser Institute Centennial Surgery Center Central Jersey Ambulatory Surgical Center Cherry Hill Women's Center Children's Specialized Hospital Coastal Endoscopy Center Coastal Surgery Center Comcare Medical Center LLC County Line Endoscopy and Surgical Center

D

Diamond Institute for Infertility and Menopause

E

Endoscopy Center of Ocean County Endoscopy Center of Red Bank Endoscopy Center of South Jersey Endoscopy Center of Toms River Essex Endoscopy Center T2 Essex Specialized Surgical Institute T2 Eye and Laser Surgery Center Eye Institute of Essex T2 Eye Physicians of Sussex County Eye Surgicenter of New Jersey Eye Surgicenter of New Jersey

F

Fellowship Surgical Center Freehold Surgical Center

H

Hackensack Endoscopy Hackensack Meridian Health

? Central Jersey Surgery Center ? Endoscopy Center of Bergen County ? Endoscopy Center of Hackensack ? Jackson Surgery Center ? Lakewood Surgery Center

? Northern Monmouth Regional Surgery Center ? Shore Rehabilitation Institute ? Shore Outpatient SurgiCenter ? Shrewsbury Surgery Center ? Toms River Surgery Center

H

Hamilton Surgery Center HealthSouth Rehab Hospital of NJ HealthSouth Rehab Hospital of Tinton Falls HealthSouth Rehab Hospital of Vineland Horizon Laser & Eye Surgery Hudson Bergen Medical Center Hunterdon Center of Surgery T2 Hunterdon Endosurgery Center T2

I

Inspira - Oak and Main Surgicenter T2 Inspira - Gloucester County Surgery Center T2

J

JFK Johnson Rehabilitation

L

Lourdes Specialty Hospital

M

Marlton Rehabilitation Hospital Mercer County Surgical Center Metropolitan Surgical Center Minimally Invasive Surgery Center Morristown Surgical Center at Madison Avenue T2 Mt Laurel Endoscopy Center

N

North Jersey Gastro and Endo Center Northern New Jersey Center for Advanced

Endoscopy, LLC T2 Northern New Jersey Eye Institute T2 Northern NJ Endoscopy Center

O

Ocean County Eye Surgery Center Ocean Endosurgery Center Ocean Surgical Center Ocean Surgical Pavillion

P

Paramus Endoscopy Princeton Endoscopy Center

R

Retina Consultants Surgery Center T2 Ridgedale Surgery Center River Drive Surgical Center RWJBarnabas Health

? Ambulatory Surgical Pavilion at Robert Wood Johnson

? Florham Park Endoscopy Center

? 2018 AmeriHealth | 18893 AmeriHealth Insurance Company of New Jersey | AmeriHealth HMO, Inc.

? Gregori Surgery Center ? Hamilton Endoscopy and Surgery Center ? Hanover Endoscopy Center ? Liberty Ambulatory Surgery Center, LLC ? Livingston Surgery Center ? May Street Surgical Center ? Northfield Surgical Center ? Robert Wood Johnson Endosurgical Center ? Saint Barnabas Outpatient Center

S

Same Day Surgery Center Select Specialty Hospital ? Northeast New Jersey Select Surgical at Kennedy (KHS Ambluatory Surgery Center) T2 Somerset Eye Institute South Jersey Endoscopy Center South Jersey Surgicenter Surgical Center of Burlington County Surgical Center of South Jersey Surgicare Surgical Associates of Fair Lawn Surgicare Surgical Associates of Mahwah Surgicare Surgical Associates of Wayne

T

Toms River Surgery Center

U

University Center for Ambulatory Surgery

V

Virtua Health System ? Advanced Surgical Institute ? Bergen Passaic Eye Surgery Center ? Burlington County Endoscopy Center ? Center for Ambulatory and Minimally ? Invasive Surgery ? Endo Center at Voorhees ? Endoscopy Center of Monmouth County ? Gastro-Surgi Center of NJ ? Hand Surgery Center ? Jersey Shore Ambulatory Surgery Center ? Memorial Ambulatory Surgery Center ? Ramapo Valley Surgical Center ? Seashore Surgical Institute ? Summit Surgical Center ? Surgical Specialists at Princeton ? Surgicare of Central Jersey ? Vantage Surgery Center ? Virtua Center for Surgery

Voorhees Surgery Center

W

Watts Plastic Surgery Center Weisman Childrens Rehabilitation Hospital

LLaanngguuaaggeeTaTgalginleins easndanNdonNdoisncrdimisicnraimtioinnaNtoiotinceNotice

Language Assistance Services Spanish: ATENCI?N: Si habla espa?ol, cuenta con servicios de asistencia en idiomas disponibles de forma gratuita para usted. Llame al 1-800-275-2583 (TTY: 711).

Chinese: 1-800-275-2583 Korean: : , . 1-800-275-2583 . Portuguese: ATEN??O: se voc? fala portugu?s, encontram-se dispon?veis servi?os gratuitos de assist?ncia ao idioma. Ligue para 1-800-275-2583.

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French Creole: ATANSYON: Si w pale Krey?l Ayisyen, gen s?vis ?d pou lang ki disponib gratis pou ou. Rele 1-800-275-2583.

? 2018 AmeriHealth | 2017 November AmeriHealth Insurance Company of New Jersey | AmeriHealth HMO, Inc.

Tagalog: PAUNAWA: Kung nagsasalita ka ng Tagalog, magagamit mo ang mga serbisyo na tulong sa wika nang walang bayad. Tumawag sa 1-800-275-2583. French: ATTENTION: Si vous parlez fran?ais, des services d'aide linguistique-vous sont propos?s gratuitement. Appelez le 1-800-275-2583.

Pennsylvania Dutch: BASS UFF: Wann du Pennsylvania Deitsch schwetzscht, kannscht du Hilf griege in dei eegni Schprooch unni as es dich ennich eppes koschte zellt. Ruf die Nummer 1-800-275-2583.

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Japanese: 1-800-275-2583 Persian (Farsi):

: 1-800-275-2583 .

.

Navajo: D77 baa ak0 n7n7zin: D77 saad bee y1n7[ti'go Din? Bizaad, saad bee 1k1'1n7da'1wo'd66', t'11 jiik'eh. H0d77lnih koj8' 1-800-275-2583.

Urdu:

: .1-800-275-2583

Mon-Khmer, Cambodian: - 1-800-275-2583

(OVER)

Language Taglines and Nondiscrimination Notice

Language Taglines and Nondiscrimination Notice

Discrimination is Against the Law This Plan complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. This Plan

SdbeomceasounksoeitnoegfxrcaClucedees, scpoaelotoirp,olennaotrRiotenreasalototurhigreicmne, adGgifefue,irddeinseatlybility,

or sex.

This Plan provides: Free aids and services to people with disabilities to communicate effectively with us, such as: qualified sign language interpreters, and written information in other formats (large print, audio, accessible electronic formats, other formats). Free language services to people whose primary language is not English, such as: qualified interpreters and information written in other languages.

If you need these services, contact our Civil Rights Coordinator. If you believe that This Plan has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with our Civil Rights Coordinator. You can file a grievance in the following ways: In person or by mail: ATTN: Civil Rights Coordinator, 1 9 0 1 M a r k e t S t r e e t , P h i l a d e l p h i a , P A 1 9 1 0 3 , By phone: 1-888-3773933 (TTY: 711) By fax: 215-761-0245, By email: civilrightscoordinator@. If you need help filing a grievance, our Civil Rights Coordinator is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW., Room 509F, HHH Building, Washington, DC 20201, 1-800368-1019, 800-537-7697 (TDD). Complaint forms are available at .

? 2017 AmeriHealth | AmeriHealth New Jersey General Taglines | 2016 November AmeriHealth Insurance Company of New Jersey | AmeriHealth HMO, Inc.

Y0041_HM_17_47643 Accepted 10/14/2016

? 2018 AmeriHealth | 2017 October AmeriHealth Insurance Company of New Jersey | AmeriHealth HMO, Inc.

Taglines as of 10/14/2016

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