As previously communicated, AmeriHealth HMO, Inc. and AmeriHealth Insurance Company of New Jersey (AmeriHealth New Jersey) have begun offering new qualified health plans both on and off the Health Insurance Marketplace. These commercial products are available to small groups and individuals for coverage beginning January 1, 2014. Starting January 1, 2014, you may begin to see members with these new products. Their member ID cards will include standard information, such as the network name and basic copayments for primary care and specialist services. In addition, these products will follow our current administrative, claims payment, and medical policies. Providers participating with AmeriHealth New Jersey will be participating providers for these products by virtue of the network in which they are currently contracted. Participating providers will be reimbursed in accordance with their payment rates for commercial products.

EPO tiered products

Included in these new commercial products are two tiered EPO products: Cooper Advantage. This product was developed for residents and small employers headquartered in Burlington, Gloucester, and Camden counties. Members who purchase this product will have access to participating providers in the Value Network. Within that network, facility and professional providers will be assigned to one of two tiers. Tier 1 will be comprised of mostly Cooper facilities and physicians, and members will have lower out-of-pocket costs for most services when using these providers. Tier 1 Advantage. This product will be available to New Jersey residents and employers statewide. Members who purchase this product will have access to participating providers in the Value Network. Within that network, hospitals and ambulatory surgical centers will be assigned to one of two tiers based on cost. Lower-cost facilities will be placed in Tier 1, and members will have lower out-of-pocket costs for most services when using Tier 1 providers. When seeing members covered under either of these two tiered products, please take into consideration the benefit tier placement for facilities that you are affiliated with or may refer members to, as this will affect members? out-of-pocket costs. You can review benefit tier placements by searching for specific providers on our website at www.amerihealthnj.com by selecting the Search button under Find a Provider. Note: The NaviNet^® web portal will be updated to provide the correct tier cost-sharing for members with these products. Please continue to use NaviNet as you do today to confirm member eligibility and benefits. For more information about these commercial products, please refer to the November 2013 edition of Partners in Health Update. If you have any questions, please email our Provider Relations Services team at ahnjProviderRelations@amerihealth.com.

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