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Compliance Corner

State Updates

COVID-19 Exchange Special Enrollment Period

February 02, 2021

On January 29, 2021, Commissioner Caride released Bulletin No. 21-03, providing a special enrollment period (SEP) on the state exchange as a part of New Jersey’s ongoing response to the COVID-19 pandemic. The SEP will be in effect from February 1, 2021, through May 15, 2021. Individuals may only elect coverage through the state exchange (Get Covered New Jersey) during open enrollment or special enrollment periods.

During this SEP, individuals who are not already enrolled in an individual health benefits plan can apply for coverage through the exchange or directly through carriers. The SEP will also allow individuals who are already enrolled in a health benefits plan to replace their coverage with coverage on the exchange. The coverage will be effective no later than the first of the next month after an individual’s enrollment.

Although this change affects the individual market, employers should keep this in mind as it would likely create a qualifying event that would allow for an employee to potentially drop employer coverage (for themselves or their dependents) to go on the New Jersey exchange.

Bulletin No. 21-03 »

Coverage for COVID-19 Immunizations

February 02, 2021

On January 7, 2021, Commissioner Caride issued Bulletin No. 21-01, which provides guidance to health insurers on preventive health services, including COVID-19 immunizations. The bulletin prohibits carriers – including those administering self-funded plans – from charging any cost sharing for qualifying coronavirus preventive services delivered in-network or out-of-network. Additionally, the Department of Banking and Insurance expects carriers to assess their readiness and take all steps to ensure that insureds have access to COVID-19 immunizations and their administration. When vaccines require multiple doses, carriers should communicate to insureds that they need to get both doses of the same vaccine. Carriers should also provide information to providers on how to submit claims for reimbursement of the immunizations.

Although this bulletin is directed towards insurance carriers, employers based in New Jersey should familiarize themselves with this guidance as individuals begin to access COVID-19 immunizations.

Bulletin No. 21-01 »

Insurers Required to Pay Annual Tax on Health Premiums

August 18, 2020

On July 31, 2020, Gov. Murphy signed Assembly Bill No. 4389 into law. The bill imposes an annual 2.5% state tax on the premiums collected by most health insurers. As background, the ACA imposed a tax on health insurers (known as the HIT tax) that has been repealed and will no longer be levied in 2021. This NJ tax will essentially take the place of that federal tax.

Specifically, the tax would be levied on insurers and the funds would be passed on to a health insurance affordability fund that will be designed to subsidize premiums for low-income individuals and to bolster the state’s reinsurance pool. The bill also seeks to reduce racial disparities in coverage for the uninsured. To those ends, the bill also requires a report examining how the policy increases affordable healthcare options, reduces the uninsured rate and affects racial disparities in health insurance coverage.

While the law applies to insurers, it’s widely expected that insurers will pass this additional tax to consumers through health plan premiums. The tax is set to become effective in January 2021. We will continue to follow any developments with this law.

Assembly Bill, No. 4389 »

Guidance on COVID-19 and Worker Benefit

June 14, 2020

On March 16, 2020, the Department of Labor & Workforce Development released guidance on how the state’s earned sick leave, temporary disability insurance (TDI), and family leave insurance laws apply in regards to the coronavirus emergency. The FAQs provide details on when employees may use their earned sick leave or family leave for purposes of COVID-19-related leave.

For example, if an individual or their loved one has tested positive for COVID-19, has symptoms, has been exposed to it through their work, or has been advised by a healthcare provider or public health authority to quarantine, they may use earned sick leave, but can only apply for TDI after exhausting unemployment benefits. Additionally, if employees have children that are home from school because the school is shut down for cleaning or decontamination or if the person’s business is ordered closed due to a public health reason, then they may be able to take leave under the earned sick leave law.

Employers should review this guidance in order to properly communicate with employees regarding the potential for leave or benefits under New Jersey law.

Worker Benefits, Protections and the Coronavirus (COVID-19): What NJ Workers Should Know »

Insurers Must Offer 60-Day Grace Period

June 09, 2020

On May 28, 2020, Commissioner Caride released Bulletin No. 20-27, requiring insurers to provide a 60-day grace period for the payment of health and accident policies. The bulletin directs insurers to extend an emergency grace period for the payment of premiums to their policyholders pursuant to the governor’s emergency declaration. Policyholders may elect to begin the emergency grace period retroactively on April 1, 2020, or May 1, 2020, and during the 60-day period, coverage must remain in force and claims must be paid and not pended. Additionally, after the grace period ends, the policyholder must be given the option to repay the missed premiums over the remaining months of the policy (but for not less than six months).

Although this guidance is directed at insurers, employers with policies based on New Jersey would be able to avail themselves of this relief if needed.

Bulletin No. 20-27 »

Coronavirus Testing Requirements Updated

May 27, 2020

On May 13, 2020, Department of Banking and Insurance Commissioner Caride issued Bulletin No. 20-24, updating the requirement for insurers to waive all cost-sharing payments for the screening and testing for COVID-19. This bulletin updates the guidance found in Bulletin No. 20-03 (discussed in the March 17, 2020, edition of Compliance Corner). This bulletin supplements the prior bulletin by expanding carrier required coverage without cost sharing or any SARS-COV-2 molecular test authorized by the New Jersey Department of Health Standing Order. Carriers must treat any such test authorized by the DOH Standing Order as medically appropriate for the individual. Additionally, carriers must not require a prescription or prior authorization, or employ any other medical management, for any SARS-COV-2 molecular test administered pursuant to the DOH standing order.   

Employers can notify their plan participants who may need to receive testing that the testing will be provided without cost sharing.

Bulletin No. 20-24 »

Employer Health Coverage Filings Due Date Extended

April 14, 2020

In response to the COVID-19 pandemic, New Jersey recently announced that employers with employees in New Jersey now have until May 15 to file Forms 1095-C with the New Jersey Division of Taxation. As background, beginning in 2019, the New Jersey Health Insurance Market Preservation Act (HIMPA) requires third-party reporting to verify health coverage information supplied by individual payers of New Jersey’s income tax. Under HIMPA, employers and all other providers of MEC were originally required to file their employer mandate reporting forms with the Division of Taxation on or before March 31, 2020.

This announcement extends that due date to May 15, 2020. Employers with employees in New Jersey should ensure that they file those forms by the new due date.

Updated Guidance for Health Coverage Filings »

COVID-19 Guidance to Insurers in Small and Large Group Markets

April 14, 2020

On April 10, 2020, Commissioner Caride released Bulletins 20-12 and 20-13, providing guidance on COVID-19 to insurers in the small employer market and large employer market, respectively. Among other things, the guidance requires insurers to allow for employees that are working fewer than full-time hours to remain eligible for coverage, to allow rehired employees to resume coverage absent a waiting period, to provide a 60-day grace period to any policyholder that has been financially or physically impacted by COVID-19, and to recognize time off for COVID-19 as time off due to a health factor (as it pertains to actively-at-work clauses).

While this guidance is aimed at insurers, employers should familiarize themselves with the guidance to understand the flexibility that must be provided by insurers.

Bulletin 20-12 »
Bulletin 20-13 »

Extension of Transitional Health Insurance Plans

April 14, 2020

On April 6, 2020, Commissioner Caride released Bulletin 20-10, extending the ability of health insurance carriers in the individual and small group market to continue transitional health insurance plans through December 31, 2021.

As background, on January 31, 2020, CMS provided guidance for a transition policy extension that allows insurers the option to renew non-grandfathered non-ACA-compliant plans, as long as the state allows for such an extension. Such transition policies are not required to be in compliance with certain ACA mandates including community rating, coverage of essential health benefits, prohibition on pre-existing condition exclusions and the annual out-of-pocket maximum limit. This bulletin applies this most recent federal extension to New Jersey and allows the issuer to renew these non-ACA-compliant plans.

Small employers that are interested in renewing their non-ACA-compliant plan should work with their advisors and insurers.

Bulletin No. 20-10 »

Use of Telehealth to Respond to COVID-19

March 31, 2020

On March 22, 2020, Department of Banking and Insurance Commissioner Caride issued Bulletin No. 20-07, providing guidance to insurers regarding the use of telehealth to respond to the COVID-19 pandemic. Among other directives, the bulletin directs carriers to review their telehealth networks, cover telehealth without cost sharing and impose no more restrictive requirements on telehealth than are imposed on in-person treatment. Although this guidance is directed towards insurers, plan sponsors should familiarize themselves with how telehealth will be offered under plans offered in New Jersey.

Bulletin No. 20-07 »

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