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New Jersey News

horizon BCBS

Conversion deadline for 1/1/19 renewing groups or off anniversary conversions is Friday 12/21/18 at 12:00 noon. Any groups that are submitted after this deadline will be moved to a 2/1/19 effective date.  Horizon has determined that if a group is accepting their existing ACA plan renewal, no paperwork is necessary.   Conversions without all required documentation or submitted after deadline face the risk of losing their requested conversion date and being moved to the next month.

 This is for ALL PRE-ACA to ACA CONVERSIONS regardless if they have sent in their certification previously to Horizon and were advised they could renew as is by Small Group certification. All paperwork should be emailed to TeamFarronNJ@fnainsurance.com or FNATeamFasanella@fnainsurance.com.  Conversion paperwork should not be send to Horizon’s certification department.

horizon blue cross blue shield

Horizon BCBSNJ has recently evaluated the amount of retro termination exception request that have been submitted in 2018 from all the Master Brokers.  Effectively immediately, Horizon BCBSJ will be adhering to their Underwriting Regulations for all retro termination requests.  Click below for their Underwriting Regulation.

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horizon BCBS

Horizon Blue Cross Blue Shield of New Jersey is pleased to announce that Richard Burton, Sales Manager, will join the Public Sector Account Management team effective December 3, 2018.  Richard brings close to 30 years of experience in sales and account management, and has worked in the Mid-Size, Dental and State Health Benefits Program markets.  Congratulations Richard!

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horizon BCBS

Dear Broker, renewal is a great time to look at Horizon’s OMNIA suite of products as well as the SEHPP Ancillary Bundle as options for your Small Groups.  Please see attached marketing material.

Conversion deadline for 12/15/18 renewing groups or off anniversary conversions is Monday 12/10/18 at 12:00 noon. Any groups that are submitted after this deadline will be moved to a 1/15/19 effective date.  Horizon has determined that if a group is accepting their existing ACA plan renewal, no paperwork is necessary.  Only if a group is converting to a completely different ACA plan alternative or if they are moving from a pre-ACA plan to an ACA plan would conversion paperwork be necessary. It is imperative that complete paperwork as mandated above be submitted in as timely a manner as possible.  Conversions without all required documentation or submitted after deadline face the risk of losing their requested conversion date and being moved to the next month.

It is important to review the paperwork requirements and process for groups that are converting from a pre-ACA plan to an ACA plan.  All groups converting from a pre-ACA to an ACA plan are required to send in, with the conversion form, new 2018 certification paperwork including applicable tax documentation as noted below and waivers.   This is for ALL PRE-ACA to ACA CONVERSIONS regardless if they have sent in their certification previously to Horizon and were advised they could renew as is by Small Group certification.  All paperwork should be emailed to TeamFarronNJ@fnainsurance.com or FNATeamFasanella@fnainsurance.com.  Conversion paperwork should not be send to Horizon’s certification department.

AmeriHealth Logo2012sm

Effective January 1, 2019, AmeriHealth New Jersey will adjust the pricing methodology used for generic drugs purchased through mail order for commercial fully insured plan members with our prescription drug benefits. Maximum allowable cost (MAC) will be added to the pricing model to better align mail order prices with the market driven prices at retail pharmacy stores. For more information on this upcoming change, please read the announcement below.

PDF icon2SM Click here to download the full pdf document