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New Jersey News

affiliated physicians

The 4QTR New Business rates are now available to quote.  Log on to the portal to obtain a quote for October, November and December effective dates.

PDF icon2SM Click here to download the full pdf document

Aetna

Aetna is offering 15 month Aetna Funding Advantage (AFA) contracts for 12/1/18 and 1/1/19 effective dates.  This is for members new to Aetna. NJ based 5-50 size groups are included in this roll out. Click below of the full update and the Quote Cover Sheet.

horizon blue cross blue shield

Horizon BCBSNJ has worked with their Compliance Department to further improve how they interact with brokers and groups when writing new business and within their certification process. Horizon BCBSNJ has worked with their Compliance Department to further improve how they interact with brokers and groups when writing new business and within their certification process. 

While Horizon’s eligibility policies and NJ regulations remain the same, they have amended their Certification processes, which will assist Horizon BCBSNJ in driving further efficiencies in the market and making it easier to do business!

Please carefully review the attached Small Group Certification Scenarios (Please note the these may not apply to all situations. Changes in the process, or documentation required, may change group by group depending on each groups individual scenario/circumstance).

Any general questions regarding these changes can be sent to your dedicated sales team and will be answered within 2 – 3 business days.  Note that final approvals on new business are subject to review of full documentation submission for the specific group according to the existing timelines for new business.

PDF icon2SM Click here for the Small Group Certification Scenarios

horizon blue cross blue shield

Conversion deadline for 8/15/18 renewing groups or off anniversary conversions is Wednesday 8/8/18 at 12:00 noon. Any groups that are submitted after this deadline will be moved to a 9/15/18 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.Conversion deadline for 8/15/18 renewing groups or off anniversary conversions is Wednesday 8/8/18 at 12:00 noon. Any groups that are submitted after this deadline will be moved to a 9/15/18 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 nlevinson@fnanj.com ; Conversion paperwork should not be send to Horizon’s certification department.

affiliated physicians

The release of the APEHP October 2018 renewals will be delayed, with an anticipated delivery in the second week in August. You and your client will receive the renewal notification and documents via email.

PDF icon2SM Click here to download the full pdf document