Ed MacConnell

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.

These plans are available now to quote for July 1, 2022 effective dates.

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.

These benefit designs allow the benefits and flexibility of a self‑funded health plan with a predictable monthly payment.

How a Fixed Funding health plan works:

  • 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.

Flexibility through versatile design choices

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.

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.

Provider access is available throughout New Jersey, Delaware, Southeastern Pennsylvania, and New York. National access is available as a buy up.

Easy, convenient online access for employers and members

Those participating in the Fixed Funding program will have important and useful plan information at their fingertips.

Employers can:

  • View benefit information
  • Manage member enrollment
  • Understand spend and trends

Members will have access to:

  • Extensive benefit information
  • Personalized well‑being platform tools and resources
  • Secure AHA Wire® communications

Additional resources

AmeriHealth New Jersey has created materials to help employers better understand the value of Fixed Funding:

Learn more about Fixed Funding benefit designs today!

For additional information on Fixed Funding, those with renewals from existing AmeriHealth New Jersey fully insured customers should contact their group account manager at Total Benefit Solutions, Inc today (215)355-2121

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