51+ Brochure_10_21.indd - AmeriHealth New Jersey Health

Your Guide To Health Insurance
Networks, Plans, and Programs - Large Group
AmeriHealth New Jersey and Large Groups
Why AmeriHealth New Jersey for Public Sector?
AmeriHealth New Jersey is the only health insurer focused solely on the state of New
Jersey. We live here. We work here. And we’re involved in the communities here. This
gives us a better understanding of our brokers, customers, and members, and the issues
they face with New Jersey health insurance.
At AmeriHealth New Jersey, we are committed to our public sector customers. We pride
ourselves on providing affordable, comprehensive health care to more than 40,000
members in more than 90 school boards and municipalities throughout the state.
But what really makes us different is our people. Whether you’re a commercial business,
or in the public sector, north, or south, the AmeriHealth New Jersey 51+ team is
dedicated to helping you find a health insurance plan that meets the unique needs of
your business.
AmeriHealth New Jersey provides large group customers in both the commercial and
public sector markets with:
•Rewarding Onsite Employee Wellness Programs — the AmeriHealth New Jersey
Commit2Wellness® program provides resources to help members make better
choices and lead healthier lives, at home and at work.
•Innovative Product Flexibility — our comprehensive line of products feature
options that can fit your business’s unique needs.
Here are some of the reasons why public sector organizations choose AmeriHealth
New Jersey:
•AmeriHealth New Jersey’s Equal to or Better Than Guarantee — We will
meet or beat any competitor’s plan design.
•A diversified portfolio of health benefits to accompany your current health
benefits package. If you’re looking for lower cost options we have well-priced,
alternative plan designs.
•Individualized Account Management — AmeriHealth New Jersey public sector
clients benefit from the key accounts customer service team, and a dedicated
account management representative to assist with everything from member
claims to monthly billing.
•Unique tools like Utilization Reporting for 100+ groups. This robust experience
package will breakdown your AmeriHealth New Jersey Renewal and illustrate
how your group used their health benefits.
If you’re looking for low-cost options with unprecedented service and value-added
programs read more about AmeriHealth New Jersey.
We live here. We work here.
And we’re involved in the
communities here.
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AmeriHealth New Jersey Networks
Wide network of participating
physicians and hospitals.
AmeriHealth New Jersey exclusively serves New Jersey-based employer groups, and offers
a variety of high-quality networks featuring physicians, hospitals, and ancillary providers
at low price points — making health insurance more affordable.
National Access
AmeriHealth New Jersey provides access to physicians, facilities, and ancillary services
throughout the continental United States. With National Access members can receive
services from more than 690,000 physicians and 3,800 hospitals at their in-network
benefit level.1
Sussex
Passaic
Bergen
Morris
Warren
Essex
Sussex
Hudson
Union
The National Access network is available with AmeriHealth New Jersey PPO, EPO, and
POS Plus plan designs.
Middlesex
Berks
Bucks
Hunterdon
Hunterdon
Monmouth
Ocean
Ocean
Chester
Burlington
Burlington
Camden
Camden
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Mercer
Community
Advantage
Delaware
Gloucester
Gloucester
New
Castle
Atlantic
Salem
Atlantic
Salem
Cumberland
Cape
May
Cumberland
Kent
The Local Value network is available with AmeriHealth New Jersey HMO, HMO Plus,
POS, POS Plus, EPO, HSA, and all coinsurance plan designs.3
Middlesex
Monmouth
Philadelphia
Delaware
Somerset
Mercer
Montgomery
Local Value is a unique network that offers a subset of our Regional Preferred network
for employers looking for a more affordable option. It represents the best value for the
price-conscious and provides additional options while lowering premiums. The Local
Value network currently represents 82% of the New Jersey-based Regional Preferred
network without compromising exceptional quality, access, and service.3
Hudson
Union
Somerset
Lehigh
Local Value
Quality access, for less.
4
Essex
Hunterdon
Lancaster
Bergen
Morris
Warren
Northampton
Regional Preferred
The largest network of doctors, hospitals, and labs in the state of New Jersey.2 Members
have access to participating physicians and providers in New Jersey, Pennsylvania,
and Delaware.
Community Advantage Network
AmeriHealth New Jersey, along with Cooper University Health Care, Shore Medical
Center and Cape Regional Medical Center, are working together to offer you affordable,
high-quality health care coverage. Our Community Advantage plans are tailored to meet
the needs of individuals and employers based in Atlantic, Burlington, Camden, Cape
May, and Gloucester counties.4 We have developed these plans to provide South Jersey
with new options that focus on affordability, while offering access to exceptional
patient care.5
Passaic
Cape May
Sussex
The Local Value network
currently represents 82% of
the New Jersey-based Regional
Preferred network.
1
Coverage provided by Multiplan PHCS National Network. AmeriHealth New Jersey members accessing care in the AmeriHealth
New Jersey service area must use the Regional Preferred network.
2
Data derived from analysis of information provided by a third party vendor and is subject to change.
3
The Local Value Network is not available in Hunterdon County.
4
Community Advantage plans are only available to individuals and employers based in Atlantic, Burlington, Camden, Cape May,
and Gloucester counties.
5
Tier 1 professional and facility providers are an enhancement to your benefits. Tier 2 professional and facility providers are
AmeriHealth New Jersey Local Value network providers..
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Popular Large Group Plans
AmeriHealth New Jersey offers a wide variety of health plan options that are easy-to-use and cost-effective.
HMO
Health Maintenance Organization (HMO) members select a primary care physician (PCP)
to coordinate all their medical needs, including referrals for specialty care. AmeriHealth
New Jersey HMO members have no claim forms and low out-of-pocket expenses.
HMO Plus6
HMO Plus members must select a PCP, but never need a referral to see a participating
specialist. HMO Plus offers the benefits of a standard HMO plan with the freedom to
choose a particular doctor or hospital.
HSA
Health Savings Accounts (HSA) are member-owned personal savings accounts which
can be funded by the group or the member, and must be offered in conjunction with a
federally qualified high deductible health plan. HSAs provide a tax-advantaged vehicle
for paying qualified medical expenses. Under an HSA arrangement, the member owns
the account, so if they change jobs the account goes with them. AmeriHealth New
Jersey offers HSA services to members with PPO and EPO products, through a preferred
relationship with The Bancorp.7
Explore AmeriHealth New Jersey’s Prescription Drug Plans
AmeriHealth New Jersey offers great flexibility with our featured prescription drug
plans. Offering prescription drug plans provides your employees with access to covered
medicines like antibiotics, contraceptives, asthma inhalers, self-injectable drugs, and
more. Pair a drug plan like one of these with an AmeriHealth New Jersey health plan:
PPO
Preferred Provider Organization (PPO) members maximize their coverage by accessing
care through an expansive network, but also have the freedom to seek care from nonnetwork providers. Members have no need to select a PCP to coordinate care, and never
need a referral to see a participating specialist.
The Select Drug Program, also known as a
3 Tier Drug product provides members with
3 tiers of coverage: generic, preferred and
non-preferred brand drugs.
The 50% series features a coinsurance benefit
instead of paying fixed copays.
50% series options:
3 Tier Drug plan options:
POS6
Point-of-Service (POS) plans combines all the benefits of an HMO and PPO. POS
members have access to the highest level of benefits when care is provided or referred
by a PCP (referred care). But POS members also have the option to seek care directly
from physicians or hospitals in or outside the AmeriHealth New Jersey network, with
applicable deductibles and coinsurance (self-referred care).
POS Plus6
POS Plus members can maintain freedom of choice and select their own doctors
and hospitals. Under the POS Plus plan it is not required that members select a PCP,
although it is highly recommended. But POS plus members never need a referral to
access care in or out-of-network.
Generic
copay
Preferred
brand copay
Non-preferred
brand copay
Generic
copay
Brand copay
Max member
costshare
$7
$35
$50
$7
50%
$125
$10
$40
$60
50% (generic brand)
$15
$35
$50
$125
Making health insurance
more affordable.
EPO
Exclusive Provider Organization (EPO) members have the freedom to choose their own
doctors and hospitals from our participating provider network without selecting a PCP
and receive services without referrals. AmeriHealth New Jersey EPO members must use
network providers in order to access their benefits.
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This health plan is also available with a Coinsurance plan design.
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amerihealthnj.com
The Bancorp Bank of Wilmington, DE, is a federally qualified bank offering HSA trustee services. It is not affiliated with AmeriHealth.
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Ancillary Services
AmeriHealth New Jersey works with industry leaders to provide customers with dental,
vision, prescription, and specialty insurance coverage.
Dental
AmeriHealth New Jersey partners with United Concordia Dental to offer
large group employers one of the largest dental networks, and over 40
years of experience in group dental insurance.8
When you add the United Concordia Dental plan to your health benefits you’re adding
a strong network of dentists, personal service, and innovative programs to promote
healthy smiles. United Concordia Dental offers a full range of PPO plan designs with a
variety of funding and contribution options. Along with an innovative program that ties
oral maintenance to overall improved health and lower medical costs, Smile for Health® — Wellness.9
Vision
Affordable vision benefits from AmeriHealth New Jersey Vision Care
can help you offer your employees more comprehensive health care
coverage. AmeriHealth New Jersey Vision Care, administered by Davis Vision10, gives
members access to more than 37,000 ophthalmologists, optometrists, as well as
regional and national retailers, including Visionworks11 optical retail centers. Choose
the vision plan that takes care of your employees and your budget with affordability,
easy implementation, convenience, and outstanding service with a dedicated account
management team. Choose AmeriHealth New Jersey Vision Care to take advantage of:
• Fully covered designer brands — select any frame from the exclusive Davis Vision
Collection covered in full.
• A free one-year unconditional warranty against breakage on all Davis Vision
supplied eyeglasses.
• Replacement contact lenses from Lens123® offering the guaranteed lowest prices
from top manufacturers.
• Discounts on Laser Vision Correction Services at participating Davis Vision laser
correction providers.
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Rx Mail Order
Save time and money with prescription
mail order service. Filling your
prescriptions has never been so
quick and convenient with our
mail order service administered
by FutureScripts®.
Why should you use mail order service?
•
Minimize trips to the pharmacy with
delivery to you within 14 days.
•
Save time by managing your prescription refills online or with a
quick phone call.
•
Get email alerts to refill your prescription.
•
Order refills, check order status, and pay your bill online.
•
Manage prescriptions for you and your family.
•
Enjoy free standard shipping!
Guardian
The Guardian Life Insurance Company of America (Guardian®) offers highquality specialty products such as Life, Disability, Accident, and Critical
Illness insurances, which offer your employees financial protection from
unforeseen hardships and expenses. You can choose to offer Guardian
products to complement your AmeriHealth New Jersey core medical
benefits. Guardian’s product line offerings and high quality services help enable you to
customize benefit programs to meet your employees’ needs.12
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United Concordia dental products are underwritten by United Concordia Life and Health Insurance Company and
administered by United Concordia Companies, Inc. United Concordia Life and Health Policies cover dental benefits only.
9
Jeffcoat, M. et al. Periodontal Therapy Reduces Hospitalizations and Medical Costs in Diabetics Abstract, American
Association of Dental Research, March 23, 2012.
10
Administered by Davis Vision, an independent company.
11
An AmeriHealth affiliate has a financial interest in Visionworks.
12
Guardian Insurance products are underwritten and issued by The Guardian Life Insurance Company of America, New York, NY.
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AmeriHealth New Jersey Programs
Guest Advantage
Medical coverage that travels with you.
The following programs will accompany your AmeriHealth New Jersey health
insurance plan:
Urgent Care Program
It’s not always possible to plan your health care needs. That’s why AmeriHealth New
Jersey offers out-of-area urgent care coverage. Urgent care is when you need immediate
medical attention for an unforeseen illness or injury, such as abdominal pain, fevers, and
sprains. If members experience an urgent care condition while temporarily outside the
service area, they are covered under AmeriHealth New Jersey’s Urgent Care Program.
Enjoy the peace of mind that comes from knowing you have reliable, comprehensive
medical coverage when outside the AmeriHealth New Jersey service area for a prolonged
period of time.
Guest Advantage allows members who have applied and been accepted to receive the
same covered services outside the AmeriHealth New Jersey service area as they would
when care is provided in-network by participating providers.
COBRA
Team up with AmeriHealth New Jersey to simplify your COBRA administration.
AmeriHealth New Jersey can offer you COBRA administration services through our
preferred arrangement with AmeriHealth Administrators, a national third party
administrator. AmeriHealth New Jersey and AmeriHealth Administrators offer these
unique benefits:
•
Medical coverage that
travels with you.
More than 20 years of COBRA administration experience
• Dedicated account management team to help HR stay on top of required activities
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•
Specialized customer service team to answer questions for COBRA participants
•
Monitoring of regulatory requirements to support compliance
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259 Prospect Plains Road, Bldg. M, Cranbury, NJ 08512-3706
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© 2014 AmeriHealth | 18027 | 2014 October
AmeriHealth Insurance Company of New Jersey | AmeriHealth HMO, Inc.