With our Aetna Whole Health New Jersey Network, we offer access in all 21 counties of New Jersey, so you and your families can find care where you need it.
This network includes a team of dedicated clinicians who support our members and engage you throughout your health journey.
- 5,900+ primary care doctors
- 29,000+ specialists
- 33 hospitals
- 240+ urgent care facilities
Know your benefits.
This plan lets you visit any doctor in the Aetna Whole Health NJ network without a referral. It's entirely up to you. Below is a listing of some of the benefits:
Table of plan details. Garden State Health Plan – Aetna Whole Health NJ In network Out of network Deductible $0 $350 Individual
Out-of-Pocket Maximum $500 Individual
Coinsurance 10% 30% Preventive Care Covered at 100% Not covered* Primary Care Doctor Visit $10 30% after deductible Specialist Office Visit $15 30% after deductible Chiropractic (30 visits combined in & out network) $15 Maximum dollar limit $35 Diagnostic - (Labs and X-rays) $0 30% after deductible Emergency Room $125 $125 Urgent Care Center $15 30% after deductible Ambulance 10% 30% after deductible Durable Medical Equipment 10% 30% after deductible Physical Therapy $15 Maximum dollar limit $52 Mental Health Service - Inpatient $0 30% after deductible Mental Health Service - Outpatient $15 30% after deductible
- If you travel outside of New Jersey, you will only be covered for emergency services.
- Out-of-network services are based on 200% of the CMS (Centers for Medicare & Medicaid Services) fee schedule.
- If your out-of-network provider charges more than the allowable amount, you will be responsible for any expenses incurred above that amount, in addition to your out-of-network deductible, coinsurance or copay. Any amount that you pay above the allowable charge will not apply to your out-of-pocket maximum.
- This is not a complete list of all covered services. Exclusions and limitations apply to some services.
- If you have questions about your prescription drug coverage, you can find information on the NJ Divisions of Pensions and Benefit website at https://www.state.nj.us/treasury/pensions/hb-active-sehbp.shtml.
*Annual Ob/Gyn checkup, annual mammography, annual PAP smear and well-child immunizations up to 12 months old covered at standard out-of-network coinsurance level for the plan after applicable deductible.GSHP flyer (PDF)
Who is eligible for the GSHP?
This plan is being offered to all School Employees’ Health Benefit Program (SEHBP) members in the State of NJ for active and under age 65 retirees.
What if I am a Medicare retiree and my dependent is under 65?
If you are over 65, then you would be enrolled in the Aetna Medicare Advantage plan and your dependent would be enrolled in the GSHP.
Find in-network doctors and hospitals with our search tool
Use the custom Provider Search tool to find doctors, hospitals and other health care providers that participate in the Aetna Whole Health NJ network.
- Visit the custom Provider Search
Select the NJ Aetna Whole Health – New Jersey Choice POS11
- Choose what type of provider or facility
Visit your custom Provider Search to find a provider
Garden State Health Plan- Aetna Whole Health NJ
- Custom Gold ID Cards for Garden State Health Plan members
- Remember to use Aetna Whole Health NJ providers
- If you travel outside of New Jersey, you will only be covered for emergency services
We've got your back
We know health care is personal and full of tough questions.
- Educate you on plan benefits
- Select a provider
- Explain the programs specifics
- Help members navigate the health care experience
- Look up claims and answer questions
- Connect you to the right resources
At Aetna, we’re with you wherever you are on your health care journey.Aetna Concierge flyer (PDF)
Table of plan terms and their definition Plan term to know Definition In network A network is a group of health care providers. It includes physicians, specialists, hospitals, surgical centers and other facilities. Providers that participate in Aetna Whole Health NJ network. Out of network Depending on your plan, you usually pay more for out-of-network services. With some plans, you may be responsible for the full cost of out-of-network care unless it’s a true emergency. Deductible The amount you pay for covered health care services before your plan starts to pay. Coinsurance A fixed percentage you pay for a covered health care service. Copay A fixed dollar amount you pay for a covered service. Out-of-pocket maximum This is the most you pay for covered health care services in a plan year. Once you hit your maximum, the plan pays 100% of covered expenses for the rest of the year.