Point-of-Service (POS) Plus — Groups 2 – 50

AmeriHealth Forms Online — New Jersey

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Option	Copay	Integrated Rx
POS Plus $15/$30 $200 Day w/ National Access	$15
POS Plus $15/$30 $200 Day	$15
POS Plus $15/$30 $200 Day	$15	x
POS Plus $20/$40 $300 Day w/ National Access	$20
POS Plus $20/$40 $300 Day	$20
POS Plus $20/$40 $300 Day	$20	x
POS Plus $25/$50 $500 Day w/ National Access	$25
POS Plus $25/$50 $500 Day w/ National Access	$25	x
POS Plus $25/$50 $500 Day	$25
POS Plus $25/$50 $500 Day	$25	x
POS Plus $30/$50 $400 Day w/ National Access	$30
POS Plus $30/$50 $400 Day w/ National Access	$30	x
POS Plus $30/$50 $400 Day	$30
POS Plus $30/$50 $400 Day	$30	x
POS Plus Coinsurance Option 1 w/ National Access Network	$20
POS Plus Coinsurance Option 1 w/ National Access Network	$20	x
POS Plus Coinsurance Option 1	$20	x
POS Plus Coinsurance Option 2 w/ National Access Network	$30
POS Plus Coinsurance Option 2 w/ National Access Network	$30	x
POS Plus Coinsurance Option 2	$30	x
POS Plus Coinsurance Option 3 w/ National Access Network	$30
POS Plus Coinsurance Option 3	$30
POS Plus Coinsurance Option 3	$30	x