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… Read More
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COVID-19 vaccines are an important step in helping to lessen the spread of the disease. While many adult New Yorkers have been vaccinated, vaccination rates among children remain relatively low. To encourage pediatric vaccination, we are offering New York-situs subscribers whose dependents are enrolled in a fully insured UnitedHealthcare or Oxford plan a $100 pre-paid Target Gift Card. The New York Pediatric COVID-19 Vaccination Reward program is in effect May 5, 2022 through October 1, 2022. Criteria for the New York UnitedHealthcare and Oxford Pediatric COVID-19 Vaccination Reward program Dependent child(ren) must be enrolled on an active subscriber’s New York UnitedHealthcare or Oxford fully insured plan. Dependent must be eligible for the… Read More
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ERISA requires plan administrators to give plan participants in writing the most important facts they need to know about their group health plans, including plan rules, financial information, and documents on the operation and management of the plan. Some of these facts must be provided to participants regularly and automatically by the plan administrator. Others must be made available upon request, free-of-charge or for copying fees.
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With fully insured plans, premiums are paid directly to the insurer. Claims accountA claims account is exactly what it sounds like. A portion of the monthly payment is used to pay for claims submitted by plan members. Stop-loss InsuranceStop-loss is an employer’s safety net. This protects the employer against higher-than-expected claims. With level-funding, employers will never have to pay more than the amount they are responsible for funding the claims account each year. After that, stop-loss insurance kicks in. Administrative costsAdministrative services are provided to the employer so they can spend their time focusing on their business while a third-party administrator handles plan management such as paying claims, customer service,… Read More
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Virtual care visits from MDLIVE® IBC members pay $0 cost-share* You have access to care from therapists, psychologists, and psychiatrists who can help with concerns likeanxiety, depression, and panic disorders. With telebehavioral health from MDLIVE, you pay $0 costshare* for a confidential visit in the comfort of yourhome, or wherever you are. Choose to have your virtual care visit by video chat, using the MDLIVE website or mobile app, or by phone.
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The IRS released the inflation adjustments for health savings accounts (“HSAs”) and their accompanying high deductiblehealth plans (“HDHPs”) effective for calendar year 2023, and the maximum amount that may be made newly available forexcepted benefit health reimbursement arrangements (“HRAs”). All limits have increased from the 2022 amounts, somesignificantly.
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individuals are not eligible for premium tax credits in the Marketplace
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hCare.gov managers are signaling that they think individual coverage health reimbursement arrangements matter. The regulators in charge of the federal Affordable Care Act public exchange system today gave ICHRAs official attention, by adding an ICHRA use reporting requirements for the insurers that sell coverage through HealthCare.gov. Click here for the full story on Think Advisor.com
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The new Expanded Access Special Enrollment Period allows qualifying consumers with an annual household income of up to 200% of the federal poverty level to enroll in a health plan throughout the year. New Jersey’s Governor Phil Murphy and Department of Banking and Insurance Commissioner Marlene Caride have introduced a new “Expanded Access” initiative, which allows residents at certain income levels to continue to enroll in free or nearly free health coverage through Get Covered New Jersey. The new Expanded Access Special Enrollment Period allows qualifying consumers with an annual household income of up to 200% of the Federal Poverty Level (FPL) to enroll in a health plan throughout the year. This population will… Read More
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On March 15, 2022, the President signed government funding legislation, the Consolidated Appropriations Act, 2022 (“CAA-22”), into law. The legislation includes a prospective extension of relief that allows first dollar coverage of telehealth servicesfrom April 1, 2022 through December 31, 2022. This relief allows individuals with High Deductible Health Plans (“HDHPs”)to receive free telehealth services prior to the satisfaction of their minimum deductible and remain eligible to make HealthSavings Account (“HSA”) contributions….
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Depending on a customer’s household income, they may qualify to enroll in coverage through a new Special Enrollment Period and receive financial assistance offered through Pennie! If a customer’s income is equal to or below 150% Federal Poverty Level (see table below), they can enroll in coverage through Pennie at any time of the year. New enrollees will need to take these steps to enroll in coverage under this qualifying life event: Submit a new Pennie application If they meet the criteria in the table below, a Special Enrollment Period (SEP) will automatically open! Once the SEP opens, they will have 60-days to enroll in a plan through Pennie. Once enrolled, coverage will begin the start of… Read More
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Employers in Philadelphia, PA with 25 or more employees must provide up to 40 hours of additional paid sick leave to eligible employees when they are unable to work for certain COVID-19 related reasons. The new measure became effective on March 9, 2022 and will extend through the end of 2023. It covers employees who are unable to work for the following reasons: To care for self or a family member showing symptoms of COVID-19 To care for self or a family member exposed to COVID-19, in order to self-isolate As a result of childcare or school closures To obtain a COVID-19 test or vaccine, or to recover from injury,… Read More
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Changes to the Value and Select formularies for April 1 Independence Blue Cross is making changes to the Value and Select Drug Program® (Select) formularies effective April 1, 2022. Updates are made to the Value and Select formularies quarterly.The updated lists for April 1 are available now on our website. Select the appropriate link to view the Value or Select formulary. The updated list can be found under “Formulary drug documents.” Changes that result in positive member experiences happen quarterly in January, April, July, and October. Examples of these changes include new drugs and generics being added to the formularies, tier changes that can result in lowering member cost‑share, and utilization management removal.Negative formulary changes… Read More
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On March 15, 2022, the President signed government funding legislation, the Consolidated Appropriations Act, 2022 (“CAA-22”), into law. The legislation includes a prospective extension of relief that allows first dollar coverage of telehealth services from April 1, 2022 through December 31, 2022. This relief allows individuals with High Deductible Health Plans (“HDHPs”) to receive free telehealth services prior to the satisfaction of their minimum deductible and remain eligible to make Health Savings Account (“HSA”) contributions….
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Level funding (also called alternate funding) is a group health insurance product available to employers. It behaves just like a fully-insured product, and allows some groups to get coverage at more competitive rates than traditional fully insured ACA plans. How does level funding work? An employer pays a set monthly cost into an account, like a ” premium”. This “premium” money is then used to pay claims for employee health care. If there’s any money left in the account at the end of the plan year, it goes back to the employer. If employee claims spending exceeds the funds in the account, the health insurer covers the difference. If there are any large… Read More
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