Your Guide To Health Insurance Networks, Plans, and Programs - Large Group

Transcription

1 Your Guide To Health Insurance Networks, Plans, and Programs - Large Group

2 AmeriHealth New Jersey and Large Groups 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. 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. Why AmeriHealth New Jersey for Public Sector? 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. 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. 2 amerihealthnj.com 3

3 AmeriHealth New Jersey Networks 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. Wide network of participating physicians and hospitals. 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 benefi t level. 1 Sussex Passaic Warren Morris Essex Bergen Hudson Sussex Passaic Bergen The National Access network is available with AmeriHealth New Jersey PPO, EPO, and POS Plus plan designs. Northampton Lehigh Hunterdon Somerset Union Warren Morris Essex Union Hudson 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. Local Value Quality access, for less. 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 Lancaster Berks Chester Delaware Montgomery Delaware New Castle Kent Bucks Philadelphia Mercer Camden Gloucester Salem Cumberland Middlesex Burlington Atlantic Cape May Monmouth Ocean Hunterdon Community Advantage Salem Gloucester Somerset Middlesex Mercer Camden Cumberland Burlington Atlantic Cape May Monmouth Ocean The Local Value network is available with AmeriHealth New Jersey HMO, HMO Plus, POS, POS Plus, EPO, HSA, and all coinsurance plan designs. 3 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 Sussex 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. The Local Value network currently represents 82% of the New Jersey-based Regional Preferred network. 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 benefi ts. Tier 2 professional and facility providers are AmeriHealth New Jersey Local Value network providers.. 4 amerihealthnj.com 5

4 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 Plus 6 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. 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. 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: 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. 3 Tier Drug plan options: The 50% series features a coinsurance benefit instead of paying fixed copays. 50% series options: POS 6 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). Generic copay Preferred brand copay Non-preferred brand copay $7 $35 $50 $10 $40 $60 Generic copay Brand copay Max member costshare $7 50% $125 50% (generic brand) $125 POS Plus 6 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. 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. $15 $35 $50 Making health insurance more affordable. 6 This health plan is also available with a Coinsurance plan design. 7 The Bancorp Bank of Wilmington, DE, is a federally qualified bank offering HSA trustee services. It is not affiliated with AmeriHealth. 6 amerihealthnj.com 7

5 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 Vision 10, gives members access to more than 37,000 ophthalmologists, optometrists, as well as regional and national retailers, including Visionworks 11 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. 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 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 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, 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. 8 amerihealthnj.com 9

6 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 10 Specialized customer service team to answer questions for COBRA participants Monitoring of regulatory requirements to support compliance amerihealthnj.com 11

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