New Jersey News
Aetna (AFA) Webinar for August
Think bigger with Aetna Funding Advantage (AFA) for New Jersey based 5-50 sized employers An Aetna Funding Advantage® webinar for those who missed the July in-office seminars Join Aetna and learn how Aetna Funding Advantage* (AFA) can help Small Group employers. They will discuss their most recent product enhancements and best practices.
Click here to download the full pdf document
AmeriHealth Medicare Exclusion
Medicare Exclusion mailing for group members to begin. Starting the week of July 24, AmeriHealth New Jersey will start mailing letters with an FAQ on a monthly basis to all fully insured and self-funded group members who are, or will soon be, eligible for Medicare and whose group benefit includes the Medicare Exclusion. Eligible members will be encouraged to enroll in Medicare Parts A and B by a specified date, in order for them to maximize their health plan benefits and minimize expenses.
Earn Extra Money in NJ
Oxford Broker eBulletin: Capitalize on Change in New Jersey to Earn Extra Money
Highlights
Many stakeholders have expressed concerns about a major carrier exiting the small group fully insured health insurance market in New Jersey. Brokers may already have customers asking to explore other health insurance coverage in response to this announcement. We have developed a compensation program for producers who move this business to a UnitedHealthcare subsidiary medical product.
Producer compensation program overview
• Audience: Medical groups with up to 50 eligible employees from an exiting carrier in New Jersey
• Compensation: Additional compensation of $20 for each enrolled employee
• Product Offerings: UnitedHealthcare subsidiaries: Oxford® and All Savers® Alternate Funding
• Effective Dates: Aug. 1, 2017 - Dec. 31, 2017. The additional compensation will be paid based on the Dec. 31, 2017 enrolled employee count of the eligible groups.
Getting a quote is easy!
• Brokers are directed to contact their Account Executive or General Agent to get an Oxford or All Savers Alternate Funding quote.
• New Jersey groups with 15 - 50 employees who are receiving a fully insured renewal and a medically underwritten alternate funding quote from an exiting carrier, will have medical questionnaires waived as long as the broker provides us with the alternate funding quote from the exiting carrier.
Additional Information
• The broker eBulletin will be posted to the Highlights section (post login) of the oxfordhealth.com Broker portal.
Attachments - Click below
• Broker eBulletin
• New Jersey Additional Compensation Overview
• Commitment to New Jersey Flier
Highlights
Many stakeholders have expressed concerns about a major carrier exiting the small group fully insured health insurance market in New Jersey. Brokers may already have customers asking to explore other health insurance coverage in response to this announcement. We have developed a compensation program for producers who move this business to a UnitedHealthcare subsidiary medical product.
Producer compensation program overview
• Audience: Medical groups with up to 50 eligible employees from an exiting carrier in New Jersey
• Compensation: Additional compensation of $20 for each enrolled employee
• Product Offerings: UnitedHealthcare subsidiaries: Oxford® and All Savers® Alternate Funding
• Effective Dates: Aug. 1, 2017 - Dec. 31, 2017. The additional compensation will be paid based on the Dec. 31, 2017 enrolled employee count of the eligible groups.
Getting a quote is easy!
• Brokers are directed to contact their Account Executive or General Agent to get an Oxford or All Savers Alternate Funding quote.
• New Jersey groups with 15 - 50 employees who are receiving a fully insured renewal and a medically underwritten alternate funding quote from an exiting carrier, will have medical questionnaires waived as long as the broker provides us with the alternate funding quote from the exiting carrier.
Additional Information
• The broker eBulletin will be posted to the Highlights section (post login) of the oxfordhealth.com Broker portal.
Attachments - Click below• Broker eBulletin
• New Jersey Additional Compensation Overview
• Commitment to New Jersey Flier
AmeriHealth Member Appreciation
Join AmeriHealth for a Member Appreciation Night at iPlay America in Freehold, NJ, 5 - 9 p.m. on Friday, July 28. This exclusive event will offer our members free iRide Plus Bands (a maximum of 4 per family), which includes free admission and access to the following attractions: Go Karts, Spinning Coaster, Bumper Cars, Jump Around, Happy Swing, Dizzy Dragon, Skyscraper, Kite Flyer, and the Carousel! Click to find out how to access this special offer.
Click here to download the full pdf document
Horizon Conversion Deadline 7/15
Conversion deadline for 7/15/17 renewing groups or off anniversary conversions is Monday 7/10/17 at 12:00 noon. Any groups that are submitted after this deadline will be moved to a 8/1/17 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 2017 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 nlevinson@fnanj.com. ; Conversion paperwork should not be send to Horizon’s certification department.
MANDATORY TAX DOCUMENTATION FOR GROUPS WITH 2-5 ELIGIBLE OR 45 PLUS ELIGIBLE:
• 2017 Schedule C: for single owner, sole proprietor plus most recently completed quarter WR-30 for all employees.
• 2017 K-1(s): for partnerships (must total 100% ownership) plus most recently completed quarter WR-30 for all employees.
• 2017 Form 1120 including Schedule G for 2015: for corporate entities (for C and S corps) plus most recently completed quarter WR-30 for all employees.
• NJ State WR30 (Quarterly Wage Report): most recently completed quarter for all employees.
Groups 6 to 44 eligible do not need to submit tax docs, just the certification with waivers and conversion form.
As you are already aware, certification paperwork goes out at least 120 days prior to a group’s renewal and groups are instructed to return it to Horizon immediately. The letter advises within 15 days. At the time this is done, these groups have not received their renewals so the group has not determined if it will be renewing as is into the existing pre-ACA plan or moving to an ACA plan. For example, if a pre-ACA group has sent in their certification and they are a Husband/Wife group, Horizon is reviewing it based on their pre-ACA regulations and the group will able to renew as is into the pre-ACA renewal offer based on the info Horizon received AT THAT TIME. This is why new certification paperwork including waivers and tax docs (as applicable above) are required with the conversion paperwork for groups converting pre-ACA to ACA. This is especially necessary for groups 5 and under and 45 plus. It is also to closely monitor that Husband/Wife and Owner only groups are renewing as is in a pre-ACA plan and not converting to an ACA plan.
As always, the conversion deadline for renewing groups or off anniversary conversions is 5 business days prior to renewal at 12:00 noon and should be emailed to nlevinson@fnanj.com. ; Horizon has determined that if a group is accepting their existing pre-ACA or 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. Again, if the group is moving from a pre-ACA plan to an ACA plan, they MUST provide new certification including a fully completed 2017 cert form, waivers and tax documentation with the conversion request to prove that they are a valid small group. No husband/wife or owner only groups are eligible for ACA plans. Only one conversion can be made during a 12 month period.
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 2017 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 nlevinson@fnanj.com. ; Conversion paperwork should not be send to Horizon’s certification department.
MANDATORY TAX DOCUMENTATION FOR GROUPS WITH 2-5 ELIGIBLE OR 45 PLUS ELIGIBLE:
• 2017 Schedule C: for single owner, sole proprietor plus most recently completed quarter WR-30 for all employees.
• 2017 K-1(s): for partnerships (must total 100% ownership) plus most recently completed quarter WR-30 for all employees.
• 2017 Form 1120 including Schedule G for 2015: for corporate entities (for C and S corps) plus most recently completed quarter WR-30 for all employees.
• NJ State WR30 (Quarterly Wage Report): most recently completed quarter for all employees.
Groups 6 to 44 eligible do not need to submit tax docs, just the certification with waivers and conversion form.
As you are already aware, certification paperwork goes out at least 120 days prior to a group’s renewal and groups are instructed to return it to Horizon immediately. The letter advises within 15 days. At the time this is done, these groups have not received their renewals so the group has not determined if it will be renewing as is into the existing pre-ACA plan or moving to an ACA plan. For example, if a pre-ACA group has sent in their certification and they are a Husband/Wife group, Horizon is reviewing it based on their pre-ACA regulations and the group will able to renew as is into the pre-ACA renewal offer based on the info Horizon received AT THAT TIME. This is why new certification paperwork including waivers and tax docs (as applicable above) are required with the conversion paperwork for groups converting pre-ACA to ACA. This is especially necessary for groups 5 and under and 45 plus. It is also to closely monitor that Husband/Wife and Owner only groups are renewing as is in a pre-ACA plan and not converting to an ACA plan.
As always, the conversion deadline for renewing groups or off anniversary conversions is 5 business days prior to renewal at 12:00 noon and should be emailed to nlevinson@fnanj.com. ; Horizon has determined that if a group is accepting their existing pre-ACA or 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. Again, if the group is moving from a pre-ACA plan to an ACA plan, they MUST provide new certification including a fully completed 2017 cert form, waivers and tax documentation with the conversion request to prove that they are a valid small group. No husband/wife or owner only groups are eligible for ACA plans. Only one conversion can be made during a 12 month period.
