April 2022
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Market Edge
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News for Small & Large Group | AmeriHealth NJ
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Fixed Funding: Innovative plan solutions now available for New Jersey employers
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AmeriHealth New Jersey is excited and proud to announce that it is offering Fixed Funding benefit design options to New Jersey employers, powered by AmeriHealth Administrators.
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These plans are available now to quote for July 1, 2022 effective dates.
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Fixed Funding offers innovative benefit designs that are flexible, predictable, and cash‑flow friendly — while providing members access to high‑quality care from an extensive network of doctors and hospitals.
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These benefit designs allow the benefits and flexibility of a self‑funded health plan with a predictable monthly payment.
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How a Fixed Funding health plan works:
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- Employers have a consistent monthly payment that covers the cost of administrative fees, stop‑loss insurance premiums1, and an estimated cost of claims (claims fund).
- Throughout the year, AmeriHealth Administrators pays claims out of the employer's claims fund and coordinates any needed prefunding from the stop‑loss carrier.
- If claims are lower than expected and there is a funding balance at the end of the year, after adjusting for the premium rates at termination, 50% is credited back to the employer to be applied to the next year.
- If the total covered claims are higher than expected, the employer’s stop‑loss policy will cover the difference.
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Flexibility through versatile design choices
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With Fixed Funding, employers are offered choices catered to what best suits their members. There are three different product types — EPO, POS NG, and PPO products with HSA availability — as well as 20 benefit solutions.
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Our benefit design options include integrated prescription coverage, as well as two freestanding prescription coverage benefit designs that employers can pair with certain EPO and POS NG benefit designs.
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Provider access is available throughout New Jersey, Delaware, Southeastern Pennsylvania, and New York. National access is available as a buy up.
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Easy, convenient online access for employers and members
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Those participating in the Fixed Funding program will have important and useful plan information at their fingertips.
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Employers can:
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- View benefit information
- Manage member enrollment
- Understand spend and trends
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Members will have access to:
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- Extensive benefit information
- Personalized well‑being platform tools and resources
- Secure AHA Wire® communications
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Additional resources
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AmeriHealth New Jersey has created materials to help employers better understand the value of Fixed Funding:
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Learn more about Fixed Funding benefit designs today!
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For additional information on Fixed Funding, those with renewals from existing AmeriHealth New Jersey fully insured customers should contact their AmeriHealth New Jersey Account Representative.
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For new business, contact the AmeriHealth New Jersey Sales Team.
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1 Aggregate and specific stop-loss coverage is underwritten by AmeriHealth Insurance Company of New Jersey.
* Materials have been updated to provide most recent versions
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