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 »
Disruption Resulting from COVID-19
March 31, 2020
On March 19, 2020, Department of Banking and Insurance Commissioner Caride issued Bulletin No. 20-04, encouraging insurers to take into consideration the difficulties residents have endured and will continue to endure until the spread of COVID-19 is controlled. Specifically, the bulletin encourages insurers to relax due dates for premium payments, extend grace periods, waive late fees and penalties, allow forbearances and payment plans, and to essentially work with policyholders to make sure insurance policies don’t lapse. As a result, employer plan sponsors that are facing economic hardship can discuss their options with insurers.
Bulletin No. 20-04 »
Insurance Commissioner Requires Coronavirus Testing Without Cost Sharing
March 17, 2020
On March 10, 2020, Department of Banking and Insurance Commissioner Caride issued Bulletin No. 20-03, requiring insurers to waive all cost-sharing payments for the screening and testing for COVID-19. Insurers must also provide coverage for out-of-network testing in the same manner as it is provided in-network. Additionally, when a COVID-19 vaccine is formulated, insurers are encouraged to offer that vaccine without cost sharing. Employers can notify plan participants who may need to receive testing that the testing will be provided without cost sharing.
Bulletin No. 20-03 »
Additional 1095-C Filing Guidance for Employers with Employees Who Reside in NJ
February 19, 2020
In connection with NJ’s individual mandate (which took effect in 2019), employers with employees who reside in NJ must file (or coordinate filing with their carrier) IRS Form 1095-C (or 1095-B, in some instances) with NJ. We have covered the filing requirements previously in the January 22, 2020, edition of Compliance Corner. NJ previously announced that employers must file electronically using the NJ Division of Revenue and Enterprise Services’ MFT SecureTransport service. This has caused angst among employers, since many employers may have only a handful of NJ-residing employees for whom they must report, and many employers may not be able to meet the appropriate formatting and technical requirements to file through the NJ SecureTransport service.
The additional guidance clarifies that there is a new manual process for employers that had fewer than 50 employees living in NJ during 2019. Under the manual process, the employer essentially keys in the Form 1095-C information for each NJ resident. The manual process, which uses the “Fillable Form NJ-1095” is outlined under the “Transmitting 1095 Returns” section at the below link. In addition to considering the new manual process, employers should reach out to their payroll provider or their IRS 1095-C filing vendor to see if the provider/vendor can assist with the NJ filings. While most provider/vendor contracts likely don’t address new state filings such as the NJ filing, it’s possible the provider/vendor would agree to add those services to the contract.
NFP Benefits Compliance will continue to monitor the NJ filing requirement issue, and report future developments here in Compliance Corner.
Updated Guidance for Employer Health Coverage Filings
January 22, 2020
On December 13, 2019, the state of New Jersey published updated guidance relating to the New Jersey shared responsibility requirement (the requirement for New Jersey residents to carry minimum essential health insurance coverage or pay a tax penalty — a state individual mandate). 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 must file information with the Division of Taxation on or before March 31, 2020. Importantly, the state has no plans to offer filing extensions.
The updated guidance states that out-of-state employers who employ New Jersey residents have the same filing requirements as in-state businesses. The guidance includes important information on what forms are required and from whom. Specifically, employers must file the following:
- Small fully insured employers are not required to file anything with NJ (the carrier will send 1095-B)
- Small self-insured employers will file Forms 1095-B with NJ
- Large fully insured employers will file Forms 1095-C with NJ
- Large self-insured employers will file Forms 1095-C with NJ
Employers are required to submit forms electronically — there is no paper filing option available. Employers will need to file electronically to the state using the Division of Revenue and Enterprise Services’ MFT SecureTransport service. The guidance includes instructions on how to register for an account and use the service.
Employers with employees in New Jersey should review the updated guidance and determine their filing obligations. Employers should file by March 31, 2020.
Updated Guidance »
Updates to Family Leave Act Law Took Effect Recently
September 04, 2019
Recently, New Jersey made some changes to the Family Leave Act (FLA) law. Beginning June 30, 2019, New Jersey FLA applies to all employers with 30 or more employees anywhere worldwide (previously it was 50 or more employees). The change was a result of a law passed previously this year (HB 3975, described in the March 9, 2019, edition of Compliance Corner). New Jersey also recently updated its fact sheet and FAQ, both of which reflect the applicability change from 50 to 30 employees.
Fact Sheet »