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What’s covered?

We want to help you live your best life. That’s why we cover services to help you reach your health goals. We have experience that you can count on. And we’re always ready to help you on your path to better health. Check the Summary of Benefits to see an overview of benefits and services offered. 


Download the Summary of Benefits (PDF)

Learn more about your plan

The Evidence of Coverage is a great resource. It has everything you need to know about your health plan. You’ll also find phone numbers, addresses and much more. 

More than standard benefits

Living your best life means taking care of the whole you. See all the ways we can support your health, now and in the future. You can enjoy much more than the standard benefits that Medicare and NJ FamilyCare (Medicaid) offers.

Fitness 

 

SilverSneakers® is a fitness program. Members can use fitness centers and attend classes at no added cost. Find a SilverSneakers spot near you.

 

It’s never too late to get active with healthy exercise. Your fitness benefit can help improve your overall health. You can also learn to make healthier choices. This benefit includes:

 

  • Membership at a fitness club or exercise center through a fitness center network

  • Orientation to the fitness center and its equipment

     

  • Access to the SilverSneakers website and a phone number for customer service and support

     

  • At-home fitness kits for members who don’t live near a fitness center that takes part in SilverSneakers or for those who prefer to exercise at home

Over-the-counter (OTC) medicine

 

Enjoy up to $210 of OTC drugs and supplies every 3 months. We’ll mail you a catalog of approved OTC products. Then, you can order online or over the phone. We’ll send the products to your home at no cost. You’ll want to use up your allowance, as it doesn’t roll over. 

 

You may also get certain OTC products at some CVS Pharmacy® locations. 

 
See what you can order from the OTC catalog (PDF)

Telehealth

 

Need help with non-urgent illnesses and conditions, like allergies, minor injuries or flu? With MinuteClinic® Video Visits, you can get this care 24 hours a day, 7 days a week. 

 

If a COVID-19 Public Health Emergency is in effect, we offer telehealth visits with a network Primary Care Provider (PCP) who offers telehealth services.

 

Members should contact their provider for information on what telehealth services they offer and how to schedule a telehealth visit. 

Standard benefits in your plan

Your benefits give you all the support you need to reach your health goals.

Managed Long Term Services and Supports (MLTSS)

Sometimes, you need extra care to feel healthy. If you meet certain clinical and financial requirements, you may be eligible for MLTSS. Get assistance with everyday tasks like taking a bath, getting dressed, making food and taking medicine. Get care where and when you need it.

Need help with your options? You can get help.

Call Member Services

You can call us at 1-844-362-0934 (TTY: 711). We’re here 8 AM to 8 PM, 7 days a week. 

Call the state 

Just call your State Health Insurance Assistance Program (SHIP) at 1‐800‐792-8820.  

Call Medicare

You can also call Medicare at 1‐800‐633‐4227 (TTY: 1-877-486-2048). Someone can help you 24 hours a day, 7 days a week. Or visit Medicare.gov to learn more.  

Members must use participating/network providers, pharmacies, and durable medical equipment (DME) suppliers. No referral is required to receive covered services by in-network providers. Members will be enrolled into Part D coverage under Aetna Assure Premier Plus (HMO D-SNP) and will be automatically disenrolled from any other Medicare Part D or creditable coverage plan in which they are currently enrolled.

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