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HorizonBlue-Logo-Updated-Jan15 2013

 

Horizon Conversion Reminder
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 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:

•         Schedule C: for single owner, sole proprietor plus 3rd qtr 2016 WR-30 for employees.
•         K-1(s): for partnerships (must total 100% ownership) plus 3rd qtr 2016 WR-30 for employees.
•         Form 1120 including Schedule G for 2015: for corporate entities (for C and S corps) plus 3rd qtr 2016 WR-30 for employees.
•         NJ State WR30 (Quarterly Wage Report): most recent completed quarter for all employees. As of 10/1/16, 3rd qtr WR-30s will be required for 4th qtr 2016 conversions.
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 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.