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Plans & Benefits: NJ FamilyCare

Let us help you with your NJ FamilyCare benefits

Amerigroup is proud to serve NJ FamilyCare members in New Jersey. We’ll help arrange for you and your family to get the covered benefits you need to stay healthy.

Benefits Overview

Find out more about NJ FamilyCare benefits for you and
your family.

Benefits Overview

Copays

NJ FamilyCare C and D members have copays (usually $5 to $10 per visit or $10 to $35 for emergency room visit) for certain services. The amount of the copay is listed on your member ID card. NJ FamilyCare D members must also make a monthly premium payment to the state based on their monthly income. Your NJ FamilyCare Health Benefits Coordinator can tell you if you owe a monthly premium payment.

When NJ FamilyCare C and D members reach their family cost‐share limit, they will no longer have a copay. See our member handbook for more details.

Eskimos and Native American Indians under the age of 19 don’t have premium payments or copays.

Healthy Rewards

is a program that pays you for taking control of your health. You can get your $15 over-the-counter (OTC) benefit four times a year. You can also earn gift cards for completing healthy activities.

These include:

  • Prenatal and postpartum visits.
  • Screenings for diabetes management, breast cancer and lead

Opt-in today to start getting your benefit!

To learn more and enroll, visit www.myamerigroup.com/HealthyRewards or call 1-877-868-2004 (TTY 711).

Find out more information about:

  • How the program works.
  • Rewards available for you.
  • How often you can earn a reward for each activity.
  • When you will receive your Healthy Rewards and OTC debit card.
  • Stores where you can spend your reward dollars.
  • And more!

You must opt-in the Healthy Rewards program to:

  • Receive your benefit.
  • Earn rewards for your healthy activities.
Eligibility & Enrollment

Get the benefits you need — doctor care, hospital care, health
screenings and more. Find out if you’re eligible and how to choose
Amerigroup. Also, visit NJ FamilyCare online to learn more.

Eligibility & Enrollment

Pharmacy & Prescription Drugs

Amerigroup works with Express Scripts to provide your pharmacy benefit. We cover a wide range of prescriptions and many over-the-counter medicines.

Depending on your plan you may have a copay for prescriptions. See the list below to find out if you have a copay:

  • NJ FamilyCare A, B and ABP members don’t have a copay for prescriptions.
  • NJ FamilyCare C members pay $5 for brand-name drugs and $1 for generic drugs.
  • NJ FamilyCare D members pay $5 for a 34-day supply (or less) of all prescriptions and $10 for a supply more than 34 days. Over-the-counter drugs aren’t covered for NJ FamilyCare D members.

Search for name brand and generic drugs
that are on your formulary:

Searchable Formulary

You can search for your drug by:

  • Typing the name (at least first three letters) of the drug in the search box
  • Using the A-Z list to search by the first letter of your drug

If you need a drug that isn’t listed on our formulary, you or someone you choose to act for you can request a formulary exception. Just email submitmyexceptionreq@amerigroup.com.

ESI Reimbursement Form

Pharmacy & Prescription Drugs

Preferred Drug List

Preferred Drug List - Duals

Prior Authorization

You can email and ask us for an exception at
wrkgp-submitmyexceptionreq@anthem.com.

Common Over-the-Counter (OTC) Medicines

Half Tablet Program Preferred Drug List

Drug Interactions and Side Effects

Learn more about drug interactions or side effects on the
ESI Drug Information website.

ESI Online Registration

ESI Mail Order Form

When You Need a Referral or Authorization

Sometimes your doctor will need us to approve certain services. This is called preapproval. You may also need to get a referral from your primary care provider before receiving certain services.

Referrals and Authorizations

About the Plan

Find out more about the health care programs we offer and where.

About the Plan

Frequently Asked Questions (FAQs)

We have the answers to your questions about your NJ FamilyCare benefits and services.

Dental Benefits

Oral exams and having your child’s teeth cleaned are at no cost to you. With your Amerigroup Community Care benefits, your child gets exams and cleanings twice a year.

When should I begin taking my child to the dentist regularly?

Healthy habits start early. We recommend the following schedule to help keep your child’s teeth healthy:

  • Schedule your first dental visit when your child is between 6 months to a year old or soon after the eruption of the first tooth.
  • Your child should see his or her dentist at least twice a year for oral exams and cleanings and complete all recommended treatment.

Amerigroup is a culturally diverse company. We welcome all eligible individuals into our health care programs, regardless of health status. If you wish to submit a concern or complaint to the Amerigroup Beneficiary Rights Ombudsman, please call 1-877-440-4085 (TTY: 711).