Health Savings Account (HSA) — Groups 2 – 50

AmeriHealth NJ Forms Online — Benefits at a Glance

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Option	Copay	Integrated Rx	Last Updated
HSA $2,000/90% HDHP, No Rx	90%		2012-02
HSA $2,000/90% HDHP, Rx after Ded, $7/$35/$50 integ. Rx	90%	x	2012-02
HSA $2,500/70% HDHP, No Rx	70%		2012-02
HSA $2,500/70% HDHP, Rx after Ded, $7/$35/$50 integ. Rx	70%	x	2012-02