New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 49 - ADMINISTRATION MANUAL › Subchapter 9 - PROVIDER AND BENEFICIARY'S RIGHTS AND RESPONSIBILITIES; ADMINISTRATIVE PROCESS › Section 10:49-9.1 - NJ FamilyCare-Plan C personal contribution to care and Plan D copayments

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Under NJ
				FamilyCare-Plan C, personal contribution to care in the amounts indicated below
				shall be collected by the provider for the services indicated below:
1. Outpatient hospital clinic services: $
				5.00 personal contribution to care for outpatient visits. No personal
				contribution to care shall be charged for well-child visits in accordance with
				the schedule recommended by the American Academy of Pediatrics; lead screening
				and treatment; age-appropriate immunizations; prenatal care; preventive
				services; family planning services; or substance abuse treatment services.
				Specific policies are set forth at
				10:52-4.7.
2. $ 10.00 personal contribution to care for
				each covered emergency room services visit which does not result in an
				inpatient hospital stay.
3.
				Physician services: $ 5.00 personal contribution to care per visit. No personal
				contribution to care shall be charged for well-child visits in accordance with
				the schedule recommended by the American Academy of Pediatrics; lead screening
				and treatment; age-appropriate immunizations; prenatal care; preventive or for
				family planning services, or substance abuse treatment services. Policies
				specific to physician personal contribution to care services are set forth at
				10:54-4.1.
4. Clinic services: $ 5.00 personal
				contribution to care for clinic visits. No personal contribution to care shall
				be charged for well-child visits in accordance with the schedule recommended by
				the American Academy of Pediatrics; lead screening and treatment;
				age-appropriate immunizations; prenatal care; preventive or for family planning
				services, or substance abuse treatment services. Policies specific to clinic
				personal contribution to care policies are set forth at
				10:66-1.6.
5. Podiatric services: $ 5.00 personal
				contribution to care for office visits. Specific policies regarding podiatric
				personal contribution to care are set forth at
				10:57-1.7.
6. Optometric services: $ 5.00 personal
				contribution to care for professional vision care services. Specific policies
				are set forth at
				10:62-1.6.
7. Chiropractic services: $ 5.00 personal
				contribution to care. Covered for spinal manipulation only.
8. Prescription drugs: $ 1.00 personal
				contribution to care for generics and $ 5.00 for brand name drugs. Includes
				insulin, needles and syringes. Specific policies regarding personal
				contribution to care for prescription drugs are set forth at
				10:51-1.12.
9. Psychological services: $ 5.00 personal
				contribution to care. Specific policies for psychologists are set forth at
				10:67-1.6.
10. Certified nurse-midwife services: $ 5.00
				personal contribution to care. No personal contribution to care shall be
				charged for prenatal care, preventive care, or for family planning services.
				See 10:58-1.8 for specific policies
				related to certified nurse-midwife services.
11. Advanced practice nurse: $ 5.00 personal
				contribution to care. No personal contribution to care shall be charged for
				well-child visits in accordance with the schedule recommended by the American
				Academy of Pediatrics; lead screening and treatment; age-appropriate
				immunizations; prenatal care; preventive or for family planning services, or
				substance abuse treatment services. Special policies are set forth at
				10:58A-1.6.
12. Dental services: $ 5.00 personal
				contribution to care applies, unless the visit is for preventive dentistry
				services. Specific policies are set forth at N.J.A.C. 10:57-1.7.