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Legal

Legal information

Welcome to the AmeriHealth website — amerihealth.com. AmeriHealth provides its website to you subject to the following Terms and Conditions which govern your use of the site. By viewing or using the material on the site, you indicate that you understand and agree to the following provisions:

1. Terms and conditions of use

AmeriHealth provides its website to you, subject to the following Terms and Conditions, which may be updated by us at any time and without notice. Unless stated otherwise, changes will be effective when they are posted. You can review the most current version of the Terms and Conditions at any time by clicking on the link entitled Legal Information located on our home page — amerihealth.com. You will also see links to our Legal Information Statement on other pages comprising our site.

2. No solicitation or offer of medical services or advice

This site is designed to provide general information about AmeriHealth and its products and services. Information on the site is not intended to constitute an offer to sell or a solicitation of any particular product or service. Some products and/or services may not be available in all states, and in many instances may be offered only through employers and other plan sponsors. No material contained on the site should be construed as medical advice and/or treatment. No physician/patient relationship is created between AmeriHealth and you by reason of your use of the site or under any circumstances. Individual inquiries about sensitive or confidential matters should be addressed to appropriate health care professionals.

3. No legal advice

Nothing contained, expressed, or implied in this site is intended as, nor shall be construed or understood as, legal advice, guidance, or interpretation. No attorney-client relationship is created between AmeriHealth and you by reason of your use of this site or under any circumstances. If you have questions about any law, statute, regulation, or requirement referenced in this site, you should contact your own legal counsel.

4. Description of the portals

AmeriHealth currently provides certain users with access to information such as individual and group health insurance benefits, enrollment, network providers, and claims information through its member, provider, employer and broker portals. The information is provided to employers, members, brokers, and providers as an accommodation and it is not intended to serve as formal notice or publication. You understand and agree that the site and the portals are provided "as-is" and that AmeriHealth, except as expressly required by law, assumes no responsibility for the timeliness, deletion, misdelivery, or failure to provide any information on its site.

5. Registering to use the employer or member portal

Given the nature of the transactions and confidential information available through the portals, AmeriHealth has created certain security procedures, including the use of passwords and user identification numbers, to assist in keeping your information confidential. By registering to use a portal and logging on with your password and user identification number, you agree to provide us with true, accurate, current, and complete information about yourself as requested and to maintain and promptly update your information to keep it accurate, current, and complete. AmeriHealth reserves the right to terminate your access to our site and/or to a portal at any time and for any reason.

6. Portal accounts, password and security

You may open a portal account online using your member identification number. Once you establish an account you will be asked to create a password that you will need to access your information. You are responsible for maintaining the confidentiality of the password and are fully responsible for all activities that occur under your password. You agree to immediately notify AmeriHealth of any unauthorized use of your password or other breach of security and to exit from your account at the end of each session. AmeriHealth cannot and will not be liable for any losses or damages arising from your failure to comply with this section. Except where expressly authorized by law, you certify that you are not using another person’s password or user identification to gain access to a portal. You agree not to falsely state or otherwise misrepresent your affiliation with a person or entity to obtain access to a portal. You also agree not to copy or disseminate, electronically or otherwise, personal or confidential information found on a portal.

7. AmeriHealth Privacy Policy

The information you provide to us is subject to our Privacy Policy. You can review the most current version of the Privacy Policy at any time by clicking on the link entitled Privacy Policy located on each page of our site and our home page, amerihealth.com.

8. Hold harmless

You agree to release and hold AmeriHealth and its subsidiaries and affiliates, and all of their directors, officers, agents, principals or other partners, and employees, harmless from any claims, demands, losses, liabilities, damages, costs, and expenses, including reasonable attorneys' fees, made by any third party due to or arising out of your use of the site or a portal, your violation of these Terms and Conditions, and/or your violation of law.

9. General practices regarding use and storage

You acknowledge that AmeriHealth may establish general practices and limits concerning use of its site and the portals. You acknowledge that AmeriHealth reserves the right to terminate access to a portal for any reason, including, but not limited to those accounts that are inactive for an extended period of time. You further acknowledge that AmeriHealth reserves the right to change its general practices at any time, in its sole discretion, with or without notice.

10. Modifications to AmeriHealth.com or the portals

AmeriHealth reserves the right at any time and from time to time to modify or discontinue, temporarily or permanently, its site or the portals (or any part thereof) with or without notice. You agree that AmeriHealth will not be liable to you or to any third party for any modification, suspension, or discontinuance of the site or the portals.

11. Termination

You agree that AmeriHealth, in its sole discretion, may terminate your password, user identification (or any part thereof), or use of the site or a portal for any reason, including, without limitation, for lack of use or if AmeriHealth believes that you have violated or acted inconsistently with the letter or spirit of the Terms and Conditions. You agree that any termination of your access to the site and/or a portal under any provision of these Terms and Conditions may be effected without prior notice, and acknowledge and agree that AmeriHealth may immediately deactivate or delete your password and user identification and any electronic access to information in your account and/or bar any further access to such files or the site and/or portal. Further, you agree that AmeriHealth shall not be liable to you or any third party for any termination of your access to the site and/or portal.

12. Links

AmeriHealth occasionally provides links to other entities on its websites for your convenience in locating health-related information, services, and products. Please be advised that when you link to these other sites, you are leaving AmeriHealth's website, and that these websites are maintained by organizations that AmeriHealth does not control. Accordingly, a link does not constitute endorsement of the content, viewpoint, policies, products, or services provided or advertised on that website. Once you link to a website not maintained by AmeriHealth, you are subject to the terms and conditions of that website, including, but not limited to its Privacy Policy. Because AmeriHealth has no control over such sites, you acknowledge and agree that AmeriHealth is not responsible or liable for any content, advertising, products, or other materials on or available from such sites. You further acknowledge and agree that AmeriHealth will not be responsible or liable, directly or indirectly, for any damages or losses caused or alleged to be caused by or in connection with use of or reliance on any such content, goods, or services available on or through any such site.

13. Communications with our site

AmeriHealth welcomes your feedback and suggestions about how to improve its products and services and this site. By transmitting any suggestions, information, material, or other content, to AmeriHealth, you automatically grant AmeriHealth the royalty-free, perpetual, irrevocable, non-exclusive right and license to use, reproduce, modify, adapt, publish, translate, create derivative works from, distribute, transmit, perform, and display such materials (in whole or in part) worldwide and/or to incorporate it in to other works in any form or media now known or later developed. Further, AmeriHealth is free to use any ideas, concepts, know-how, techniques, and suggestions contained in any communications you send through the site for any purpose, including but not limited to creating and marketing products and/or services using such information.

14. AmeriHealth's proprietary rights

You acknowledge and agree that the site and/or the portals, and any necessary software used in connection with the site and portals, contain proprietary and confidential information that is protected by applicable intellectual property and other laws. You further acknowledge and agree that the content (including images, text, and the "look and feel" attributes) presented to you through the site and/or portals is protected by copyrights, trademarks, service marks, patents, and/or other proprietary rights and laws. Except as expressly authorized by AmeriHealth in writing, you agree not to modify, copy, rent, lease, loan, sell, distribute, or create derivative works based on the site and/or the portals, in whole or in part. AmeriHealth grants you a personal, nontransferable, and nonexclusive right and license to use the object code of its software on a single computer; provided that you do not (and do not allow any third party to) copy, modify, create a derivative work of, reverse-engineer, reverse-assemble, or otherwise attempt to discover any source code, sell, assign, sublicense, grant a security interest in, or otherwise transfer any right in the software. You agree not to modify the software in any manner or form, or to use modified versions of the software, including (without limitation) for the purpose of obtaining unauthorized access to the site and/or the portals. You agree not to obtain access to the site and/or the portals by any means other than through the interface that is provided by AmeriHealth.

15. Disclaimer of warranties.

You expressly understand and agree that:

  • Your use of the site and/or the portals is at your sole risk. The service is provided on an "as is" and "as available" basis. AmeriHealth expressly disclaims all warranties of any kind, whether express or implied, including, but not limited to the implied warranties of merchantability, fitness for a particular purpose and non-infringement.
  • AmeriHealth makes no warranty that (1) the site and/or portal will meet your requirements, (2) the site and/or portal will be uninterrupted, timely, secure, or error-free, (3) the results that may be obtained from the use of the site and/or portal will be accurate or reliable, (4) any errors in the site will be corrected.
  • Any material downloaded or otherwise obtained through the use of the site and/or the portals is done at your own discretion and risk and that you will be solely responsible for any damage to your computer system or loss of data that results from the download of any such material.
  • No advice or information, whether oral or written, obtained by you from AmeriHealth or through or from the site and/or the portals shall create any warranty not expressly stated in the terms and conditions.

16. Limitation of liability

You expressly understand and agree that AmeriHealth shall not be liable for any direct, indirect, incidental, special, consequential, or exemplary damages, including but not limited to, damages for loss of profits, goodwill, use, data, or other intangible losses (even if AmeriHealth has been advised of the possibility of such damages), resulting from: (1) the use or the inability to use the site and/or portal; (2) unauthorized access to or alteration of your transmissions or data; (3) statements or conduct of any third party on the site and/or the portals; or (4) any other matter relating to the site and/or the portals. some jurisdictions do not allow the exclusion of certain warranties or the limitation or exclusion of liability for incidental or consequential damages. Accordingly, some of the limitations of sections 15 and 16 may not apply to you.

17. Notice

AmeriHealth may notify you regarding the use of the site and/or a portal via either email or regular mail. The site and/or the portals may also provide notices of changes to the Terms and Conditions or other matters by displaying notices or links to notices to you generally on the site or the portals.

18. Trademark information

All trademarks, service marks, and logos are proprietary to AmeriHealth. Use or misuse of these trademarks is expressly prohibited and may violate federal and/or state trademark law. Without AmeriHealth's prior written permission, you agree not to display or use in any manner, the trademarks, service marks, and logos found on the site and the portals. You agree not to reproduce, duplicate, copy, sell, resell, or exploit for any commercial purposes, any portion of the site and/or a portal. AmeriHealth enforces its intellectual property rights to the fullest extent of the law.

19. General information

The Terms and Conditions (including this Legal Information Statement) constitute the entire agreement between you and AmeriHealth and govern your use of the site and/or the portals, superseding any prior agreements between you and AmeriHealth. You also may be subject to additional terms and conditions that may apply when you use affiliated sites or software. The Terms and Conditions and the relationship between you and AmeriHealth will be governed by the laws of the Commonwealth of New Jersey, without reference to its choice of law rules. You and AmeriHealth agree to submit to the personal and exclusive jurisdiction of the courts located within New Jersey. The failure of AmeriHealth to exercise or enforce any right or provision of the Terms and Conditions does not constitute a waiver of such right or provision. If any provision of the Terms and Conditions is found by a court of competent jurisdiction to be invalid, the parties nevertheless agree that the court should endeavor to give effect to the parties' intentions as reflected in the provision, and the other provisions of the Terms and Conditions remain in full force and effect. You agree that regardless of any statute or law to the contrary, any claim or cause of action arising out of or related to use of the site and/or the portal or the Terms and Conditions must be filed within one year after such claim or cause of action arose or be forever barred. The section titles in the Terms and Conditions are for convenience only and have no legal or contractual effect.

20. Violations

Please report any violations of the Terms and Conditions by submitting an email.

Links to other websites

AmeriHealth occasionally provides links to other entities on its websites for your convenience in locating health-related information, services and products. Please be advised that when you link to these other sites, you are leaving AmeriHealth's website and these websites are maintained by organizations which AmeriHealth does not control. Accordingly, a link does not constitute endorsement of the content, viewpoint, policies, or products or services provided or advertised on that website. Once you link to a website not maintained by AmeriHealth, you are subject to the terms and conditions of that website, including, but not limited to its privacy policy.

Certain services/treatments referred to in other sites may not be covered under your benefit plan. Please refer to your benefit contract for complete details of the terms, limitations, and exclusions of your coverage.

Provider News Center

The Provider News Center is produced by AmeriHealth HMO, Inc. and its affiliates (I.e., AmeriHealth Insurance Company of New Jersey), and is created to provide valuable information to the AmeriHealth participating provider community. This site may include notice of changes or clarifications to administrative policies and procedures that are related to the covered services provided in accordance with participating professional provider, hospital, or ancillary provider/ancillary facility contracts with AmeriHealth. Suggestions are welcome.

Benefits information

The information contained within this site is not a statement of benefits. Benefits may vary based on state requirements, Benefits Program (HMO, PPO, etc.), and/or employer groups. Providers should call Provider Services for the member's applicable benefits information. Members should be instructed to call the Customer Service telephone number on their ID card.

Links to third-party websites

The third-party websites mentioned on this site are maintained by organizations over which AmeriHealth exercises no control, and accordingly, AmeriHealth disclaims any responsibility for the content, the accuracy of the information, and/or quality of products or services provided by or advertised in these third-party sites. URLs are presented for informational purposes only. Certain services/treatments referred to in third-party sites may not be covered by all benefits plans. Members should refer to their benefits contract for complete details of the terms, limitations, and exclusions of their coverage.

Provider disclaimer

AmeriHealth does not use specific quality measures, member experience measures, or cost-related measures to select practitioners or hospitals to participate in the network.

Designated sites disclaimer:
HMO/POS members are required to use sites designated by their PCP for services, which could include radiology, physical therapy and lab. Members need to speak to the PCP about their designated sites.

Provider disclaimer:
Data name, gender, specialty, practice locations (medical group affiliations), languages spoken, accepting new patients, and hospital affiliations are submitted by the provider during the credentialing process. Your Health Plan verifies board certification through the American Board of Medical Specialties (ABMS) website upon credentialing and every three years during the re-credentialing process. Your Health Plan also requests providers to review all of this data for accuracy and updates this data at that time if changes are reported by providers. Additionally, your Health Plan updates all data, except practice locations (medical group affiliations), every three years during the re-credentialing process. Providers will update their practice location information when a change occurs and may update all other data at any time. A limitation includes provider self-reported changes that may not be reported to the Health Plan. Your Health Plan refers members to a telephone number or website address for the most up-to date information on the provider or to ask a question regarding participating practitioners/providers.

Explanation of displayed items:

  • Specialty: The field or purpose of a health care provider.
  • Medical Group Affiliations: A list of all medical groups with which he provider is affiliated.
  • Languages Spoken: Languages other than English that are spoken by the provider.
  • Hospital Affiliations: Hospitals where the care provider has clinical privileges.
  • Board Certifications: Board certification, which is achieved through testing and peer evaluation, demonstrates a physician's expertise in a particular specialty and/or subspecialty of medical practice. This information may change between re-credentialing cycles.
  • Accepting New Patients: The medical group is open the new patients.

You may find the board certification status of a practitioner on the following web sites:
The American Board of Medical Specialties or American Osteopathic Association.

Hospital disclaimer:
Your Health Plan validates the Name (name of the hospital), Location (location(s) affiliated with the facility) and phone number (contact information of the locations) of the hospital with whom it contracts. The initial assessment is conducted upon the hospital joining the network, and then every 3 years through the reassessment process. This validation is done as per the assessment/reassessment form that is completed and attested by the hospital. Although, the health plan does not verify the demographic information on an on-going basis, it does validate the information when submitted by the hospital during the term of the contracting period and during the re-contracting/reassessment process. Directories are updated within 30 calendar days of when new information is identified through reassessment, the roster process and from provider self-reported changes. A limitation includes provider self-reported changes that may not be reported to the Health Plan. Your Health Plan refers members to a telephone number or website address for the most up-to date information on the provider network or to ask a question regarding participating practitioners/providers.

Accreditation is granted when a hospital has met the requirements from an assessment against nationally recognized guidelines. Your Health Plan validates the accreditation status with an appropriately recognized accrediting body (i.e., Joint Commission, AOA, DNV, HFAP, CIHQ or CARF) for regional hospitals with whom it contracts. The initial assessment is done upon the hospital joining the network, and then every 3 years through the reassessment process. Although, the health plan does not validate the accreditation status on an on-going basis, it does verify self-reported changes as and when submitted by the hospital. You may find the accreditation status of a hospital on the following web sites: The Joint Commission, AOA, ACHC, CIHQ, CARF.

Your Health Plan makes the quality and patient experience data available to you from recognized sources which includes hospital ratings results from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey sent to a randomized list of patients over 18 years old within six weeks after leaving the hospital. The survey asks what patients think about important measures of care. The Centers for Medicare & Medicaid Services (CMS) is responsible for overseeing the survey and makes the results available to the public. A limitation includes if patients neglect to participate in the survey and results are subjective. Results are updated quarterly and reflect the most recent four quarters of data. More information is available at http://www.hcahpsonline.org. Your health plan also monitors and reviews quality data and indicators for hospitals including but not limited to complaints and occurrences on an ongoing basis.

Y0041_H5361_AH_13412_C_2023
Website last updated: 7/12/2023

AmeriHealth Medicare coverage issued by AmeriHealth Insurance Company of New Jersey.