Self Funded Health Plan Producer Services | AmeriHealth Administrators

Our Approach to Self-Funding^*

We offer intelligent health – a smart, personal, and innovative approach to health care for self-funded health plans. It’s the combined management of three key aspects of health care: health, plan, and cost. Effectively balancing and optimizing these three components helps manage the health of a population, reduce cost by adding value, and improve the experience of accessing care. It’s an employer’s triple aim.

*AmeriHealth Administrators does not provide legal or tax advice. Please consult with your legal/tax advisor regarding your legal and tax obligations with respect to a self-funded plan.

Why Self-Funded Health Plans?

More and more employers and other organizations are turning to self-funded health plans as their strategic approach to next generation health care coverage. It can help control costs while helping to improve a population's health. Plus, self-funding can offer tax advantages and exemptions from state insurance mandates, potentially saving money and simplifying administration. We call it a win-win.

What is a self-funded health plan?

Employers who self-fund their health benefit plans pay the actual claims incurred by their members – at discounted rates* – rather than pay a premium to an insurance carrier.

Self-funding can provide more flexibility in plan design and lead to cost savings over traditional insured plans.

*Refers to in-network providers

What are the benefits of self-funding?

Access to Claims Data
Helps identify and address cost drivers that can lead to potential savings.

Plan Flexibility
Customize programs for specific businesses and populations.

Can Improve Cash Flow
Pay claims when incurred rather than a monthly insurance premium.

Lower Fees
Administration fees can be lower than insurers’ fees.

Tax Benefits
Exempt from the Affordable Care Act's excise tax on health insurance premiums.

Generally exempt from state benefit mandates
Helps maintain plan continuity and simplify administration across multiple states.

AmeriHealth Administrators can help…

AmeriHealth Administrators helps you develop and administer a cost-effective plan strategy for your specific population.

We give you and your members access to a large selection of high-quality doctors, hospitals, and specialists.

And, we help create a positive experience for you and your members through our customer experience center, account management team, and online resources.

Health Management

AmeriHealth Administrators can help plan members get healthy, stay healthy, and manage chronic conditions. Our clinical services team of registered nurses and trained health coaches uses claims analysis, biometric data, and personal health profiles to help develop interventions that best suit your population.

Clinical Services

We combine insight and compassion to help care for both the population and the individual. Our medical management programs help balance high-quality and cost-effective care, while helping to maximize the member’s overall health.

Wellness

Our suite of wellness program options allows you to customize a plan based on the needs of your population. And, as a result, can reduce health care costs and improve overall health.

Case Management

AmeriHealth Administrators has received Case Management Accreditation from NCQA for our Complex Case Management Program. Earning NCQA's Case Management Accreditation is an indication that a Case Management program is dedicated to care coordination, patient-centeredness and improving quality of care: getting the right care to patients.

Disease Management

We identify members with chronic or unstable conditions and provide them with education, support, and health coaching to help improve their outcomes – and help you better manage health care costs.

Health Utilization Management

AmeriHealth Administrators was certified by NCQA in Utilization Management¹. NCQA Utilization Management Certification is a quality assessment program that focuses on consumer protection and customer service improvement.

Telemedicine

Enjoy convenient, 24/7 access to non-emergency care at lower costs than visits to an emergency room or urgent care center². This virtual care delivery model enables secure consultations with a board-certified physician over a telephone, computer, tablet, or mobile app³.

¹NCQA has reviewed and certified AmeriHealth Administrators' Utilization Management functions only. For complete details on the scope of this review, visit www.ncqa.org.
²Based on AmeriHealth Administrators' average contracted rates for an emergency room or urgent care visit.
³Telemedicine services are for nonemergency conditions only, subject to state regulations, and may not be available in certain states.

Plan Management

Our approach to health plan management is a customer engagement model that provides plan sponsors and their members with consultation, detailed reporting, and administrative support. It’s the human touch and consultation that translates the complex aspects of health care into digestible information that helps educate and improve the experience of accessing care.

Account Management

We know each client is unique, so we listen to you and then tailor programs to support your specific objectives. Our team measures the program’s success, and can recommend potential improvements to help increase your plan’s performance

Administration

Our dedicated implementation team helps to make the onboarding process easy. We walk you through the details, including eligibility, enrollment, and claims.

Intelligent Reporting

Using our intelligent reporting suite, we can help you evaluate plan design changes and other strategies that can help control costs and improve health.

Employer Resources

From our electronic data interchange services to our client support teams, we provide you with the resources to help you better manage your self-funded health plan – both online and off.

Member Resources

Being informed is one key to managing your health. So we provide 24/7 access to plan details and a wide-range of resources designed to help members do everything from finding an in-network doctor to living a healthier lifestyle.

Cost Management

We combine our clinical resources with our customer engagement model to help you design a plan that best fits your population and business objectives. We work with you to craft a health benefits plan that helps reduce costs by providing value through unique plan designs, incentive programs, and risk management vehicles.

Plan Design

Our comprehensive plan designs are tailored to meet your specific needs and bring the combined power of our experts and state-of-the-art technology.

Network Strategies

We connect you to health care providers locally and nationally, providing you access to high-quality care at a competitive rate.

Efficient Administration

Our fraud prevention safeguards help to identify duplicate claims, up-coding, and unbundling as well as incompatible procedures and diagnosis codes to help detect inaccuracies that can affect your bottom line.

Stop Loss

Stop Loss coverage helps protect you against high-dollar claims. And our preferred arrangement integrates with your self-funded health plan.

Self-Funded
Health Plans. For
your company’s
self-interest.^*

Our Approach to Self-Funding^*