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Point-of-Service (POS) — Groups 51+
AmeriHealth Forms Online — New Jersey
Forms are in PDF format.
Option
Copay
Integrated Rx
POS $15/$30 $0 Day
$15
POS $15/$30 $200 Day
$15
POS $20/$40 $0 Day
$20
POS $20/$40 $300 Day
$20
POS $30/$50 $0 Day
$30
POS $30/$50 $400 Day
$30
POS Coinsurance $20/$40/90%
$20
POS Coinsurance $30/$50/70%
$30
POS Coinsurance $30/$50/80%
$30