Who Needs a Medicare Health Insurance Plan?

When it comes to medical insurance and Medicare, it is easy to get confused with what you need and what you don’t. Medicare is the USA’s national health insurance plan that covers some specific age groups and demographics.

Medicare health insurance plans can help with the cost of your health care; however, it is important to know that it doesn’t cover all of your medical expenses, and it doesn’t cover long-term care, either.

You Have Options

You can choose to have original Medicare, Part A and Part B coverage, or you can purchase and Medicare supplement insurance from a private insurance company.

Components of Medicare

Your Social Security will already enroll you in original Medicare, Part A, and Part B. But you must understand what both parts entail.

  • Medicare Part A is hospital insurance. This will help pay for any of your inpatient care in a hospital or for a very limited time at a skilled nursing facility. This must be following a hospital stay. Part A also pays for some healthcare.
  • Medicare Part B, or medical insurance, will help pay for the services if you receive from doctors and a range of other healthcare providers. This includes home health care, durable medical equipment, preventative services, and outpatient care.

Some parts of Medicare are run out by private insurance companies, and these will follow the rules set by Medicare.

  • Medigap, which is supplemental policies will help pay Medicare out of pocket co-payment, deductible expenses, and other insurance.
  • Medicare advantage plan, which used to be known as part C, includes all benefits and services covered in Part A and Part B. This covers prescription drugs and additional benefits such as hearing, dental, and vision. These are all bundled together in one plan.
  • Medicare Part D, known as Medicare prescription drug coverage, helps cover your prescription drugs' cost.

Most people aged 65 or older are typically eligible for free medical hospital insurance; this is Part A. This counts if they have worked and paid for Medicare taxes for long enough. You can enroll in Medicare medical insurance as described above, also known as Part B, by paying a monthly premium.

If you are in a higher income tax bracket, you might pay a higher monthly party premium. It is important to read about Medicare premiums and the rules of higher-income beneficiaries.

Who Can Get Medicare?

Generally, a Medicare health insurance plan is available for people aged 65 and older. Younger people with disabilities and people with any stage of renal disease have to be permanent kidney failure requiring dialysis for transplant.

For Part A, if you are 65 older and you or your spouse worked and paid Medicare taxes for 10 years, you are eligible.

You can get Part A at 65 without paying premiums if the following criteria apply to you.

  • You are receiving retirement benefits from Social Security, or a Railroad Retirement Board
  • You or your spouse had Medicare government employment
  • You are eligible to receive Social Security or Rail benefits, but you have not filed for them

If you or your spouse happens to not pay and you’re aged 65 or older, and a permanent resident or citizen of the United States if you might be able to purchase the Medicare Part B.

If the following criteria applied to you.

  • You are on kidney dialysis or a kidney transplant patient
  • You are entitled to secure Social Security or Railroad Retirement Board disability benefit for at least 24 months. If you have Lou Gehrig’s disease, your Medicare benefits start the same month you get disability benefits.

Most people don’t have to pay a premium for Part A, everyone must pay for Part B if they want it. Its monthly premium is easily deducted from your Social Security, civil servant retirement cheque, or rather the time it.

If you do not get any of these payments, Medicare will send you a bill for Part B of your premium every three months.

What is a Special Enrollment Period?

If you have medical insurance coverage and a great health plan based on your spouse's or your current employment, you most likely do not need to apply for Medicare Part B at age 65.

You and your spouse might qualify for a special enrolment period, SEP. That will let you sign up for Part B doing the following criteria.

The eight months begin with a month after your grip health plan current coverage for your employment is based on ends. This will be whichever one comes first.

Any month that you remain covered under your group health plan and you continue to be employed.

Do I Need to Sign Up for Medical Insurance Part B?

Because you must pay a premium for Part B Medicare coverage, it was possible to turn this down.

If you do choose not to enroll in Medicare and then later decide to do so, you’re covered even most likely to be delayed, and you might have to pay a higher monthly premium.

Your premium will go up by 10% for each of the 12 months you are eligible for Part B that you did not sign up. This is unless you qualify for the SEP, it is a special enrolment period for Medicare.

Medicare Cards

Your medical care card has a Medicare number unique to you.

You will get this once you applied for your medical card. If you did not receive your red white and blue Medicare card, there might be something that needs to be updated on your current contact details. Example your mailing address.

You can update your mailing address by signing in or creating a personal my Social Security account online.

Medicare, the centers for Medicare and Medicaid Services CMS, manage Medicare. They will send you a welcome to the Medicare package in the mail. This will include your Medicare card.

Along with your Medicare card, you will also receive a Medicare handbook; this will give you all the important information about your Medicare health insurance plan choices.


Tropical Storm Isaias: Filing an Insurance Claim

Today, many of you were hit by Tropical Storm Isaias, and some of you have been left without power and potential property damage.

If you’ve experienced property damage, we want to provide you with what to do next. See below:

  • Contact your carrier
  • Document everything with pictures and video
  • Make necessary repairs to reduce further damage

While you are doing this, please make sure you are doing so safely. If you have minor damages, are not sure if you should call your carrier or still have questions, you can always contact us by:

We are here to help, so please stay safe and take care!


a doctor and nurse team meeting with a female patient

What to Know about Insurance for Physicians in New Jersey

Physicians, doctors and other medical personnel who own their own practices or clinics know all too well that it’s a fine line to straddle between being a caregiver and a business owner.

It’s a unique situation to be in; your number one priority is naturally your patients, and giving them the very best in care. Yet, you are running a business, and as such, you have to look after that business.

You have to pay attention to details such as ensuring bills are paid, that staff is looked after, that expenses are being met and that you’re protected in the case of any situation arising.

One of the most important things for a physician who owns a practice or clinic to protect themselves (and their business) is a medical insurance policy.

Insurance for physicians in New Jersey (and elsewhere) is easy enough to obtain, and you’ll find plenty of plans available to you. But which one to choose?

The best thing to do when choosing a medical insurance plan for your practice is to look at what you need to get out of an insurance plan - what types of protection are most important for you and your staff?

We’ve listed a few different types of physician’s insurance below.

Professional Liability Insurance

It might not be fun to think about, but any physician who owns a clinic or practice should have this in place. Professional liability insurance, sometimes referred to as malpractice insurance, protects you in the instance that you’re sued by a patient for negligence, malpractice, or harm.

This type of insurance for physicians in NJ includes several different types within that umbrella, so you should take the time to do your research and determine which one is right for you.

These include individual and group policies from traditional private insurers, individual or group policies provided by a medical risk retention group, as well as coverage provided by an employer, such as a hospital (if you own your own practice, this will likely not apply to you).

Professional liability insurance/medical malpractice insurance will take care of costs associated with lawsuits and legal issues, including your legal defense, settlements, lawyer fees, and more.

Many smaller practices would go completely under if they had to pay these out of pocket, so having this plan in place is incredibly important.

Property Insurance

Every business owner should retain property insurance to protect his building and the property contained within.

Property insurance plans will help protect against things like natural disasters, accidents, and more, so that your clinic or practice and all the expensive medical equipment, supplies and so on, can be replaced.

Most clinics have very costly and elaborate medical equipment and without a property insurance plan, you could be on the line to replace it all. Property insurance is a must for any business owner, but especially one in the medical field.

Workers' Compensation Insurance

Naturally, your staff works hard to ensure that safety precautions are always taken on the job.

You’re all healthcare professionals, after all. But accidents happen and in the case that one of your nurses or other staff are injured on the job, you should have a workers' compensation plan in place to protect them (and you).

Workers' comp pays for medical bills, treatment and even lost wages for the injured employee, so they can recover comfortably without worrying about costly medical bills.

In the case of death, workers' compensation will pay out a settlement to the employee’s family.

Workers' comp offers a level of protection and peace of mind to valued staff, who know they’ll be taken care of if they get hurt. This also protects you, the employer, from having to pay out on these bills yourself.

A different but somewhat-related type of insurance is Practice Overhead Insurance. Practice overhead insurance for Physicians in NJ isn’t as commonly known, but it offers great protection for you if you need to step away from your clinic or practice for a short period of time, usually because of a disability or illness.

Practice overhead insurance will cover utility costs, rent/practice payments, payroll, taxes and other related business costs so your staff can keep the clinic running in your absence.

Auto Insurance

Most people don’t automatically think of auto insurance as being part of a business insurance plan.

If you use your vehicle for business purposes - such as driving to the hospital for consultations, traveling to purchase medical supplies or medications, making house calls, or even just commuting to and from work - you can put your vehicle under your business medical insurance policy.

Often you’ll find that you qualify for discounts when you do this, and your vehicle will be protected if you get in an accident, experience theft or damages, and more.

Life Insurance

In some policies, life insurance can help protect your business and livelihood in the event of your untimely passing.

If you wish your practice to continue on, your life insurance policy can provide loved ones/inheritors with a nest egg to help keep the business going.

Individual Health Insurance

Undoubtedly, you’d like to provide your valued staff (and yourself) with a great health insurance plan that includes all the benefits they need for affordable premiums.

It goes without saying that as a healthcare provider, you want your staff to have the very best in healthcare. There are great group plans out there that include vision and dental plans, disability insurance, and more; and don’t have expensive co-pays or deductibles.

It’s worth taking the time to look around, compare quotes and find the very best group health plan for your entire team.

These are just a handful of the many types of physicians insurance/medical insurance plans you may be interested in. With some luck, you may be able to find a comprehensive and affordable plan that consists of several or even all of these types of insurance.

Definitely take the time to determine which insurance policies for physicians in NJ are best to protect your clinic or practice, your experienced staff, and of course, yourself. If you’re in the New Jersey area, contact Central Jersey Insurance Associates to find out more.


Coronavirus return to work resources bundle graphic

Coronavirus Return To Work Resources Bundle

As states begin to loosen restrictions and many businesses and individuals are getting back to work, or are at least planning to do so in the coming weeks, we wanted to make sure everyone is prepared as possible.

With that in mind, we compiled a bundle of re-opening information to benefit general workplaces, as well as several industry-specific resources for businesses in retail, hospitality, manufacturing, healthcare and more.

You can download the entire bundle here. For information on each individual resource, continue reading below.

General Workplace Guidance

Fisher Phillips LLP: 5 Steps to Reopen Your Workplace

Fisher Phillips, LLP, has compiled a list of five steps to reopen your workplace, according to the CDC's latest guidance.

OSHA: Guidance on Preparing Workplaces for COVID-19

This detailed packet from the Occupational Safety and Health Administration (OSHA), contains recommendations as well as descriptions of mandatory workplace safety and health standards.

CDC: Guidance for Cleaning & Disinfecting

An overview from the Centers for Disease Control and Prevention (CDC) on general guidelines for cleaning and disinfecting public spaces, workplaces, businesses, schools and homes.

CDC: Devising a Cleaning & Disinfecting Plan

A more thorough version of the above CDC guidelines, with details on developing, implementing, maintaining and revising your plan.

CDC: Reopening Workplaces During the COVID-19 Pandemic

Questions to ask yourself as an employer when deciding if you should return to work and to help protect workers, especially those at high risk of illness.

Vehicle Cleanliness

Wheels, Inc.: Vehicle Cleanliness Tips

Vehicle cleanliness tips from Wheels, Inc., a large, privately-held automotive fleet leasing and management company.

Industry-Specific Resources

Along with the general business resources above, we've compiled several industry-specific resources and guides. Check them out at the links below.

Retail Stores

OSHA: COVID-19 Guidance for Retail Workers

In this OSHA alert, retail employers can find tips can help reduce their employees’ risk of exposure to the coronavirus.

Hospitality & Hotels

American Hotel & Lodging Association: Hotel Cleaning Standards

The American Hotel & Lodging Association (AHLA) has published a guide with the latest enhanced industry-wise hotel cleaning standards in response to COVID-19 to keep employees and guests safe.

Manufacturing & Factories

OSHA: COVID-19 Guidance for the Manufacturing Industry Workforce

For employers and workers in the manufacturing industry, the following tips from OSHA can help reduce the risk of exposure and illness.

Construction & Contractors

JE Dunn Construction: Safety Slide Deck

This template from JE Dunn Construction Group highlights what their own personnel will be doing in their general approach to COVID safety and preparedness.

OSHA: COVID-19 Guidance for the Construction Workforce

When working in the construction industry, these tips can help reduce the risk of exposure to Coronavirus.

NFPA: Construction Site Safety During Emergencies

Buildings under construction, alteration or demolition are facing new challenges. Here's how owners can safely prepare, execute efforts and minimize risk.

NFPA: Guidance for Maintaining Fire Protection & Life Safety Systems

This guide from the National Fire Protection Association (NFPA) highlights how to maintain fire protection and life safety systems in both occupied and vacant residential and commercial properties.

Healthcare & Medical

CDC: Get Your Clinic Ready for COVID-19

Here are 10 precautions you can take before, during and after seeing patients in a medical practice.

CDC: Medical Office Preparedness Planner - Primary Care Providers

From the CDC, this tool provides thorough preparedness planning resources for primary care provider medical offices.

NJ Office of the Attorney General: COVID-19 Advisory for Dental Professionals

The New Jersey Office of the Attorney General Division of Consumer Affairs (State Board of Dentistry) published a COVID-19 advisory for NJ dental professionals.

Golf Courses

We Are Golf - Back2Golf

To return the game of golf responsibly, allied organizations have established “Back2Golf,” a plan outlining operational guidelines for the golf’s 16,000-plus golf facilities that adhere to nationally established protocols and best practices.

USGA: COVID-19 Golf Course Care

The United States Golf Association (USGA) has created this resource page to provide useful information for everyone within the golf community on how to play and manage the game safely.


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Essential Considerations for Returning to Work - Video & PDF

Webinar Summary:

Recently, Governor Murphy sketched out the benchmarks New Jersey will have to reach before the COVID-19 lockdown can be lifted. The stay at home order will remain in place until further notice, but the Governor said he expects the timeline for reopening to be measured in weeks, not months.

Returning to work will bring new legal and practical challenges for employers in all industries. The New Jersey Agents Alliance and its Member Agencies are pleased to invite you to a complimentary webinar by Clark Hill and HR/Advantage Advisory Services and hope that you will join us for an engaging discussion on the following topics:

  • Safely returning your employees to the workforce
  • Relevant federal and state guidance
  • Best practices for dealing with vulnerable workers, refusal/reluctance to work, and employee anxiety
  • COVID-19 positive workers and claims of workplace exposure
  • Why it’s important to formulate your workplace policies now
  • How we can help

Please share any questions that you may have about your returning workforce when you register.


Two white males in a fender bender

How You Can Find Affordable Car Insurance in NJ

Having car insurance is mandatory in most states. The same applies to New Jersey, and if you are planning to drive in New Jersey, you will be required to carry the least level of liability coverage.

If you are looking for affordable car insurance in NJ, you need to exercise some patience. Car insurance rates differ from one company to the other; therefore, it is wise to compare quotes from various insurance agencies instead of settling for the first price you get.

But first, you need to know some of the ways to get the cheapest car insurance rates.

The Basic Types of Affordable Car Insurance in NJ

If you are shopping for car insurance, you will probably need to understand the common types of car insurance. There are three main types of car insurance coverage, namely;

Liability Insurance

This type of coverage pays for injuries and deaths caused to third-parties. Also, it pays for any other damage to other people’s property due to a car accident that you caused.

Car liability insurance is mandatory in New Jersey, and drivers are required to buy at least the minimum amount of liability coverage that has been set by the state laws to protect them.

There are two other components under the liability insurance, these are the bodily injury liability, which helps pay for costs related to another person's injuries if the accident was your fault, and the property injury liability, which helps you pay for the damage you caused to another person’s property.

Collision Insurance

This type of car insurance pays for your vehicle's damage after an accident, no matter whose fault it is. Collision insurance coverage helps pay to replace or repair your car if it has been in an accident with another car or objects such as trees.

Additionally, this type of insurance will cover you when your car has been in a single-car accident that involved rolling or falling over. However, this coverage has a deductible, which you are supposed to pay before the cover can kick in.

You have the liberty of choosing the amount of collision deductible you want to pay when purchasing your coverage. Collision coverage has limits, which in most cases, is the value of the car. The limit is the maximum amount of money the insurance company will pay towards a covered claim.

Comprehensive Car Insurance

Comprehensive insurance helps pay for damages incurred due to theft, vandalism, and damage by natural disasters. The coverage paid is deductible, and is the amount you will pay out of your pocket before the insurer repays you for a covered claim.

This type of car insurance coverage is usually an optional coverage, but if you’re going to lease or pay off your vehicle, your lender might need it. Other types of car insurance coverage include;

  • Gap coverage
  • Classic car insurance
  • New car replacement coverage
  • Towing and labor cost coverage
  • Uninsured motorist coverage
  • Medical payments
  • Glass breakage
  • Rental

How to Find the Best Car Insurance Coverage

Accidents can happen any time, and when they do, insurance is what keeps your finances safe.

Regardless of whether the accident was your fault, your car insurance should be able to assist you. But in order to protect yourself without paying too much, you need to consider some factors that will help you choose the right coverage for your car.

Additionally, you should know how to choose a good insurance company that will have the ability to handle your claims. Although the process can be confusing, the following steps will make it easy.

Personal Liability and Personal Injury

When shopping for car insurance, always put the safety of your loved ones first. You should prioritize personal injury and personal liability coverage.

Remember that during an accident, the first thing that is always asked for is health insurance. Lack of medical coverage will lead to high out-of-pocket expenses to pay for all medical expenses.

Shop Around

Most insurance companies spend a lot of time advertising to convince people how they offer the best insurance rates in the industry.

The best way to make sure that you get the best and the most affordable car insurance in NJ is by comparing insurance rates from several companies.

Shopping around for car insurance is important; don’t just take the first price that you see.

Inquire About Discounts

There are several auto insurance discounts available. The three main insurance discounts are,

  • Vehicle discounts, which are discounts involving your car
  • Driver discounts, which are discounts that have something to do with your driving habits
  • Policy discounts, which include multi-policy discounts and discounts for paying your insurance premiums upfront.

All the above discounts lower insurance rates for you, and some companies even offer credits during a pandemic like the COVID-19. However, make sure you compare rates and choose wisely.

Have Good Credit

Car insurance companies in New Jersey use credit scores to help them determine the risks. Drivers who have a poor credit usually end up paying higher insurance premiums.

Insurance companies use credit scores to determine your likelihood of filing claims in the future. In New Jersey, the monthly price increase for poor credit is $178, while the yearly price increase for poor credit is $2,216.

Raise Your Deductible

Deductibles are the amount of money you pay before your insurance policy starts working. Choose higher deductible when buying a comprehensive or a collision insurance coverage; this way, you will be saving more money.

Reduce Coverage on Old Cars

Try as much as you can to skip the comprehensive and collision coverage of your old car. The maximum payout limit is limited by the value of the car. Therefore, if your car is old and has a low market value, going for comprehensive insurance or collision insurance will be a waste of money.

Bottom Line

By obtaining car insurance, you will have peace of mind when driving. You will be saved from expensive legal charges, and more importantly, the auto insurance will protect you from losing your property and make it simpler to replace or repair damages.

To get an affordable car insurance policy in NJ that covers all your needs, contact Central Jersey Insurance Associates today.


two red road signs, one says good and one says bad

What Separates The Worst & Best Business Insurance Providers?

Business insurance is essential if you'd like to operate a legal business.

Insurance is something that many people are familiar with as most need it for their vehicles and homes.

Medical insurance is also common, and many are provided coverage by their employer. Business insurance, on the other hand, isn't necessary for anyone besides business owners.

When you start a business, you must get the best business insurance. This ensures that your company and employees are protected.

In most cases, you'll be obligated to get it before you can operate. However, with so many options and the power of marketing, figuring out what makes a good insurance provider can be difficult.

Keep on reading to learn more about what makes the best business insurance providers stand out above the rest.

What do the Best Insurance Providers do?

Insurance plays a major role in the sustainability of many individuals and businesses.

They're responsible for providing people with services whenever they suffer from negative events. These events typically force them to stop doing things they'd regularly do.

For example, a business that suffers roof damage may have to stop operating until they repair it. Another example would be a homeowner that has to leave their home because it flooded.

While these are common issues that people go through, insurance providers cover much more than that.

Depending on the insurance you get, you'll get a maximum amount of coverage that will cover damages and fees until that point. So if your insurance provides $50,000 of medical expenses, you'd be able to stay in a hospital and receive medications until your expenses pass $50,000.

Business insurance focuses on covering employees and a company's property.

If an employee is injured because of a work event, the business insurance will pay for their medical expenses. This insurance will also cover property damages similar to that of homeowner's insurance.

Employee insurance (workers' compensation) is often included within a business insurance policy.

However, some providers will separate them so they can earn more money. This coverage allows employees to continue receiving money and treatment when they're out of work.

Continue reading to learn more about what the best insurance providers offer.

Provide Customer Service

The main thing that separates the best insurance providers from the worst is customer service.

When it comes to getting insurance, you'll want a provider you know you can trust. Unfortunately, many providers do whatever they can to avoid giving compensation to those that are insured.

You'll find that the worst insurance providers are those that don't have 24/7 customer support lines or they take too long to respond. When an emergency occurs, it's difficult to contact them because they don't offer many options to their policyholders.

With the best insurance providers, you'll be able to contact them whenever you need as they'll offer several contact methods and 24/7 support. Some companies will offer exclusive contact options – such as a phone number or email – for their policyholders.

This lets them guarantee service to those in need.

Provide Coverage

Most people choose an insurance provider based on their coverage options.

Some insurance companies offer several types of insurance. For example, an insurance provider that offers auto, homeowner's, and business insurance.

Although a provider may offer different types of insurance, the most important thing to look at is how much they cover.

Some of the worst providers will offer several types of insurance to get more customers. While doing this, they'll offer low coverage at high premium rates.

When you see an insurance company that offers a large sum of coverage for lower rates, you'll know they're one of the best providers. However, you'll have to compare several providers to determine which one would be best to meet your needs.

Follow Processes & Procedures

While it would be nice to explain your situation to an insurance provider and get a check instantly, that's not how insurance providers work. Instead, they'll employ several procedures to determine whether you need compensation.

This process helps people find out who is a good insurance provider because you'll know if they're trying to help you. A provider's procedures will vary depending on their business model and the type of insurance.

When it comes to bad insurance providers, they may do something like come by the scene where the damages/accident occurred for a short period. Leaving abruptly isn't a good sign because it may be that they're trying to downplay the event, concluding that you don't need compensation.

A good insurance provider will immediately respond to your call and may send someone to check out what happened.

The person they sent will ask you and others about what happened and collect evidence. If they don't send someone to meet you, they'll ask you to send evidence to them.

The best insurance providers don't try to argue with their policyholders. They also aren't biased towards people that pay higher premiums, so you can expect the same customer service if you pay for lower coverage.

Get The Best Business Insurance Today

Whether you currently own a business or would like to start one, you'll need to get a good insurance policy. Business insurance is all about keeping a business operating and helping employees get back to work when they've been injured.

By getting the best business insurance, you can cover your business without breaking the bank. With affordable rates and large coverage, you won't have to worry about unexpected expenses. If your property is damaged or an employee gets hurt, you'll get help.

Contact us today to learn more about our insurance options. We can answer any questions you may have!


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COVID-19 Small Business Resources Tracker

This page will be home to all of the COVID-19 resources we create and acquire from our trusted partners, outside of anything pertaining to group health insurance, which you can find on this page.

We'll be posting periodic updates and new information as we receive it and share it all with you via email and social media posts.

We recommend you bookmark this page and check back daily for the latest news.

Executive Order #123

On April 9th, Governor Phil Murphy signed Executive Order No. 123, extending grace periods during which certain insurance companies, including health insurers, life insurers, and property and casualty insurers, cannot cancel policies for nonpayment of premiums.

As part of its passing, the following are being put in place:

  • Extends minimum grace periods: A minimum 60-day grace period will be required for health and dental insurance policies, and a minimum 90-day grace period will be required for life insurance, insurance premium-financing arrangements, and property and casualty insurance, which includes auto, homeowners, and renters insurance. Insurance companies will be required to notify policyholders of this emergency grace period and to waive certain late fees, interest, or other charges associated with delays in premium payments as directed by the Commissioner of Banking and Insurance. Insurers will also be required to provide each policyholder with an easily readable written description of the terms of the extended grace period. The extended grace periods will not apply to employer-funded health plans, which under federal law, are regulated exclusively by the federal government.
  • Requires insurance companies to pay claims during the grace period: Insurance companies will be required to pay any claim incurred during the emergency grace period that would be covered under the policy. The Order further prohibits insurance companies from seeking recoupment of any claims paid during the emergency grace period based on non-payment of premiums.
  • Ensures that unpaid premiums are made payable over a lengthy period: To ensure that policyholders are not required to make a lump sum payment on unpaid premiums at the end of the grace period, any unpaid premium will be amortized over the remainder of the policy term or a period of up to 12 months, as appropriate and as directed by the Commissioner of Banking and Insurance.

(Published by NJ.gov on 4/9/2020)

The CARES Act & Company Sponsored Retirement Plans

One of our preferred financial partners and President of Absolute Conclusions, LLC, Mark McLafferty, recently discussed the CARES Act, which was passed as a result of the Coronavirus pandemic, and updates for individuals regarding Company Sponsored Retirement Plans.

Watch the video below to hear what he had to say, and continue reading after that to learn more.

(Video Published 4/2/2020)

There have been several changes is legislation making it easier for companies and individuals that participate in certain retirement plans to access money.

There are three important components that we would like our clients to be aware of; loan limits have been doubled, there is no 20% withholding, and 2020 required distribution rules have been removed.

Read further details below.

10% Early Withdrawal Penalty Tax Waived

Waives the 10% early withdrawal penalty tax under IRC Sec. 72(t) on early withdrawals up to $100,000 from a retirement plan or IRA for the following individuals:

  • Those diagnosed with COVID-19
  • Whose spouse or dependent is diagnosed with COVID-19
  • Who experiences adverse financial consequences as a result of being quarantined, furloughed, laid off, having work hours reduced
  • Those unable to work due to lack of child care due to COVID-19
  • Closing or reducing hours of a business owned or operated by the individual due to COVID-19
  • Or other factors as determined by the Treasury Secretary

The legislation also permits those individuals to pay tax on the income from the distribution ratably over a three-year period and allows individuals to repay that amount tax-free back into the plan over the next three years.

Those repayments would not be subject to the retirement plan contribution limits.

Retirement Plan Loan Limits Doubled

Doubles the current retirement plan loan limits to the lesser of $100,000 or 100% of the participant’s vested account balance in the plan.

Individuals with an outstanding loan from their plan with a repayment due from the enactment of CARES through Dec. 31, 2020, can delay their loan repayment(s) for up to one year.

Required Minimum Distribution Rules Waived

Temporarily waives of required minimum distribution rules for certain retirement plans and accounts.

This provision waives, for the 2020 calendar year, the required minimum distribution rules for certain defined contribution plans (not defined benefit plans) and IRAs.

The legislation also includes special rules regarding the waiver period to, in essence, hold harmless those individuals (and plans) who took advantage of the RMD waiver for 2020.Allowance of partial above-the-line deduction for charitable contributions and modification to limitations on charitable contribution during 2020.

This provision encourages contributions to charitable organizations during 2020 by permitting an above-the-line deduction of up to $300 for cash contributions, whether an individual itemizes their deductions or claims the standard deduction.

Originally Published on 3/27/20 by: EsinerAmper, LLP

Paycheck Protection Program – Applies to Businesses with Under 500 Employees

  • Provides $349 billion in funding for loans, which can be forgiven
  • Covers the period February 15, 2020, through June 30, 2020
  • Loans will cover:
    • (i) payroll costs
    • (ii) continuation of health care benefits
    • (iii) employee compensation (excluding that portion of compensation in excess of $100K for any individual employee)
    • (iv) mortgage interest obligations
    • (v) rent
    • (vi) utilities and
    • (vii) interest on debt incurred before the covered period.
  • Loan amount will equal 2.5 x the average total monthly payroll costs, up to $10 million.
  • The interest rate may not to exceed 4%.
  • No personal guaranty required
  • No collateral required
  • For eligibility purposes, requires lenders to determine whether a business was operational on February 15, 2020, and had employees for whom it paid salaries and payroll taxes, or a paid
  • independent contractor
  • All or a portion of the loan may be forgivable and debt service payments may be deferred for up to 1 year.
  • Borrowers shall be eligible for loan forgiveness equal to the amount spent by the borrower during an 8-week period after the origination on:
    • (i) rent
    • (ii) payroll costs for workers (excluding that portion of compensation in excess of $100K for any individual employee) including group healthcare expenses
    • (iii) interest on a mortgage
    • (iv) utility payments
  • The amount forgiven may not exceed the principal of the loan.
  • The amount forgiven will be reduced proportionally by any reduction in employees
  • If an employer re-hires workers previously laid off, the employer will not be penalized for having a reduced payroll at the beginning of the period.

Emergency Economic Injury Disaster Loans (“EIDLs”)

  • For the period between January 31, 2020 and December 31, 2020
  • EIDL eligibility is greatly expanded to include any business with not more than 500 employees operating under a sole proprietorship or as an independent contractor
  • EIDLs may be approved solely on the bases of an applicant’s credit score or by use of alternative methods to gauge the applicant’s ability to repay.
  • Applicants may request an advance of up to $10,000 within three days after the Administrator receives the application, subject to verification that the entity is eligible under this program,
  • which can be used for any purpose under §7(b)(2) of the Small Business Act and is not subject to repayment, even if the loan request is ultimately denied.
  • The requirement of personal guarantees for loans up to $200,000 is waived
  • The requirement that the applicant must be in business for a year is waived, but the business must be in operation on January 31, 2020)
  • The credit elsewhere test is waived.
  • This loan can be in addition to the Paycheck Protection Program

Deferment of Existing SBA Loan Payments

  • Covers loans made by the SBA under
    • The SBA Business Loan Program (including the Community Advantage Pilot Program, but excluding the new payroll loan program established under Section 1102); or
    • Title V of the Small Business Investment Act; or
  • SBA Administrator will make the loan payments for borrowers, including principal, interest and any associated fees, owed in a regular servicing status, for:
    • Loans made before this bill was enacted not on deferment for the six-month period beginning when the next payment is due
    • For loans made before this bill was enacted that are on deferment, for the 6-month period beginning with the next payment due after deferment
    • For loans made within 6 months of enactment of this bill, for 6 months after the first payment is due
  • Delay of Payment of Employer Payroll Taxes
    • Employers responsible for paying 6.2% Social Security Tax on employee wages will be allowed to defer paying their share.
    • Half of the deferred amount will be due December 31, 2021, balance due December 31, 2022
  • Additional Tax Benefits for Businesses
    • Modification of Net Operating Losses eliminated 80% limitation and allowing carryback for five years (allows for filing of amended returns for prior years)
    • Modification of the limitation on losses for Non-Corporate Taxpayers, such as individuals, estate and trusts. May allow non-corporate taxpayers to deduct all excess business losses through the end of the 2020 tax year.
    • Acceleration of Refundable Alternative Minimum Tax Credits to tax years 2018-2019
  • Employer Student Loan Payments
    • Employers can provide student loan repayment benefit to employees on a tax-free basis, up to $5,250 annually to each employee.
    • Applied to payments made after the enactment date and before January 1, 2021.

Originally Published on 3/31/20 by: Byrnes, O’Hern & Heugle, LLC


COVID-19 Business Health Insurance Guide graphic

COVID-19 Health Insurance Guide

How to use this guide

Updates are being announced hour to hour from the Department of Labor, the Department of Insurance, as well as the individual carriers with regulation updates pertaining to the COVID-19 pandemic.  During such a stressful time in general, this can be quite overwhelming as a business owner.

Our team has accumulated the most up to date information and consolidated Frequently Asked Questions (FAQs). Below, please find some important information pertaining to these changes.  In addition, you will find some excellent information in regards to the continuation of benefits, as well as the modified Family Leave Act, and how it now applies to small businesses.

Health Insurance Carrier COVID-19 Updates

Please select your current health carrier. Updated as of 3/31/2020

Original Source: Savoy Associates

COVID-19 Antibody Testing

All Commercial and Medicaid plans will cover serological (antibody) testing with no member cost-share, as required under recent legislation.

Small Group New Business Submission Extensions

Exceptions

Off Anniversary plan downgrades are available through July 31, 2020. Businesses that temporarily close will be allowed to continue their AFA plan provided premiums are paid monthly based on the assumption that the business will reopen after the COVID-19 pandemic. Business that close permanently Aetna will waive the 30-day advance termination requirement upon group request. Such a request must be received prior to the termination date. Special Enrollment period, Aetna has is offering a SEP for employees who previously waived coverage, the enrollment opportunity is being offered from April 6-17th for an April or May 1, 2020 effective date.

Furlough/Layoffs Special Rules

Furloughed (temporarily laid-off) employees and those with reduction in hours will be temporarily allowed to stay on the medical plan provided premium the option to remain insured is offered to all impacted employees. Employees who are terminated, should be terminated from the group health plan and offered State Continuation/COBRA. Upon rehire, wait period will be waived. These exceptions will expire on July 31, 2020.

Premium Grace Periods

Aetna will work with AFA plan sponsors to extend grace periods for the months of March, April and May. Group must contact the Answer Team to establish the extension. Fully-Insured NY Small Groups: Aetna will
not terminate any NY small employer group for non-payment of their health insurance premiums through
June 1, 2020. During the extended grace period, claims will continue to be paid and please know your small
group customers will not be sent to collections or to collection reporting agencies. Aetna is available to
discuss your payment and plan options, to do so call your broker or Aetna at 1-800-297-7145.

IN-Network Diagnostic Testing for COVID-19

Member Cost-Share Waived 

Small Maintenance Medications

Waiving early refill limits on 30-day supply of maintenance medications. CVS waiving charges for home delivery of medications.

Telemedicine

Member cost-share waived,through 6/6/2020

Carrier Resources

https://www.aetna.com/individuals-families/member-rights-resources/need-to-know-coronavirus.html

COVID-19 Diagnostic & Antibody Testing

AmeriHealth will cover the cost for testing including antibody testing that is ordered by your physician or
state health department through December 31, 2020.

Small Group New Business Submission Extensions

Not applicable at this time

Exceptions

Prior authorization requirements are being waived for acute inpatient admissions from the emergency department for members with a COVID-19 diagnosis and for transfers from acute inpatient facilities to post-acute facilities.

Furlough/Layoffs Special Rules

AmeriHealth New Jersey will honor employer requests to continue coverage for employees furloughed or temporarily laid off as a result of impacts of COVID-19. This exception applies to fully-insured and self-funded business. This exception will not be valid on or after September 30, 2020. Contact your Sales Team for additional details.

Premium Grace Periods

Fully-Insured groups may elect to defer April or May premium payments. To be eligible, all premium payments must be current through March for an April deferral or through April for a May deferral. To apply for the deferral groups must submit a signed Deferred Premium Program Agreement. In addition, Large Group (51+) must provide an attestation from their senior financial officer or CPA stating that the group has experienced financial hardship caused by COVID-19. Please contact your Savoy sales team for further details. IMPORTANT DEADLINES: APRIL deferral requests must be submitted to Savoy in full by 4:00PM on Monday, April 20, 2020. May deferral requests must be submitted to Savoy by 4:00PM on May 15, 2020.

Testing & Treatment

Member cost share is being waived for in-network, inpatient, acute care treatment for COVID-10. In addition, member cost share is being waived for emergency room visits when a member is admitted for COVID-19 treatment. This means members will have no out of pocket costs for COVID-19 inpatient hospitalizations. These changes are in effect from March 30, 2020 through December 31, 2020.

Maintenance Medications

Waiving early refill limits on 30-day supply of maintenance medications expired June 30, 2020.

Telemedicine

Expanded telemedicine coverage allows members to have virtual visits with their regular doctors at no cost for all services, not just COVID-19 services through December 31, 2020.

Carrier Resources

https://www.amerihealthnj.com/html/index.html

COVID-19 Antibody Testing

Cigna will cover FDA-authorized COVID-19 diagnostic serology tests without cost-share when billed with CPT codes 86328 and 86769. As of April 22, 2020, there are four Emergency Use Authorized (EUA) FDA-approved serology tests that measure antibody levels for COVID-19. Cigna encourages providers to review the FDA website for the most up-to-date list of approved tests.

Cigna intends to reimburse these tests consistent with CMS pricing. However, CMS has not yet released pricing for these codes. Savoy will provide additional updates regarding reimbursement when this information becomes available. Claims submitted for these codes prior to the codes being priced and added to Cigna’s claims system may be held to ensure proper processing and reimbursement.

Small Group New Business Submission Extensions

Not applicable at this time

Exceptions

Not applicable at this time

Furlough/Layoffs Special Rules

If an enrolled employee working 30 hours or more per week is furloughed or has hours reduced below 30 hours per week, Cigna will agree, at the groups formal request, to allow the employee to remain on the plan for the duration of the extended relief period as long as premium payments are made. “Extended relief period” is defined as the period starting on March 16, 2020 through August 31, 2020. This period may be extended by Cigna in response to evolving external events as well as Cigna’s financial capacity.

Premium Grace Periods

Groups in need of assistance should contact their CIGNA account manager to review.

IN-Network Diagnostic Testing for COVID-19

Member Cost-Share Waived 

Maintenance Medications

No waiver at this time

Telemedicine

Telemedicine is available at the existing benefit level. Cigna has opened a 24-hour telephone HELP line, 866.912.1687, to allow you and your family members to speak with qualified clinicians about how to cope with anxiety, stress, or other issues related to the impact of the COVID-19.

Carrier Resources

https://www.cigna.com/individuals-families/health-wellness/topic-disaster-resource-center

COVID-19 Antibody Testing

FDA approved antibody testing is covered, and member cost-share will be waived.

Small Group New Business Submission Extensions

April 1, 2020 new business submission deadline has been extended to April 8, 2020.

Exceptions

Emblem has opened a special enrollment period for employees who previously waived coverage. The effective date of coverage will be April 1, 2020; applications will be accepted through April 7, 2020. This SEP does not allow for currently enrolled employees to change plans. This opportunity is limited to employees and dependents that previously waived coverage.

Furlough/Layoffs Special Rules

Laid off or furloughed employees that were covered by the plan may remain on the plan until June 30, 2020 without electing COBRA or continuation under state law. The group must continue to pay the monthly premium payments, and employee premium contributions must be the same or less than they were prior to the layoffs or furlough. Coverage must be maintained on a uniform, non-discriminatory basis to all eligible laid off or furloughed employees. At least one employee must remain actively employed. Terminated employees should be offered state continuation/COBRA. Upon rehire, the wait period will be waived.

Premium Grace Periods

Employer groups suffering financial hardship may request a premium extension as mandated by NYS. The process is as follows:

March premium must be paid in full before a group can request the premium grace extension plan. If a group wants to take advantage of the premium grace period, the group, the broker or GA MUST CALL into EmblemHealth’s Broker Service Department at 1-866-614-6040 and advise they have a financial hardship to take advantage of this program.

April premium must be paid in full by 6/1. For May premium, groups will have until 6/1 to pay their premium in full.

If both premiums are not paid by 6/1, EmblemHealth will terminate the groups on 6/2 back to 3/31 (4/1/2020), and with the assistance of EmblemHealth’s Financial Recovery Team, EmblemHealth will pursue any paid claims.

IN-Network Diagnostic Testing for COVID-19

Member Cost-Share Waived

Maintenance Medications

Early refill of prescription is allowed. Members in need of an early refill for your prescription due to the COVID-19 outbreak, please tell your pharmacist to enter the following Submission Clarification Code (SCC): SCC 13. Some pharmacies are not familiar with this new code, so be sure to let yours know about it. If your early refill is rejected even after using this code, please ask your pharmacist to contact the Express Scripts Pharmacy Help Desk at 800-922-1557.

Telemedicine

Telemedicine is available at the normal cost-share.

Carrier Resources

https://www.emblemhealth.com/live-well/covid19/coronavirus

Small Group New Business Submission Extensions

Small Group 1-100, April 1, 2020 new business submission extended to April 8, 2020. Empire is also extending the small group 1-100 recredentialing deadline from 3/31/2020 to 4/8/2020.

Exceptions

Empire opened a Special Enrollment Period (SEP) from now until April 3, 2020 to make benefits available to employees in Fully-Insured Small and Large Groups who previously waived participation in employer-sponsored plans. State eligibility guidelines will apply. This SEP is in response to COVID-19. It’s another way Empire is helping people get the care they need. Who’s eligible? Employees who were eligible for benefits during employers’ Open Enrollment are eligible for this SEP if they had previously waived coverage. How it works: Employers will follow the standard process of sending updated enrollments to Empire, just as they would for any qualifying event or enrollment period, through their elected format of 834s, the EmployerAccess portal, or other approved methods.

Furlough/Layoffs Special Rules

Empire’s requirement for employees to be actively working in order to be eligible for coverage will be relaxed through July 31, 2020 as long as the monthly premium payment is received and at least one employee remains actively employed. Coverage must be offered on a uniform, nondiscriminatory basis to all employees and employee premium contributions must be the same or less than what they were prior to the layoffs. Employees who are terminated from employment should be offered state continuation/COBRA. Employees rehired prior to July 31, 2020 will not have to satisfy a new hire wait period.

Premium Grace Periods

Per a recent New York State insurance regulation, Insureds experiencing a financial hardship due to COVID-19 now have until June 1, 2020 to pay their health insurance premium. Please note, this does not mean the obligation to remit premium is waived or excused for this period. The regulation temporarily changes the grace period for Individual and Small Group fully-insured health insurance policyholders who experience financial hardship due to COVID-19. This applies to commercial Small Group and Individual subscribers except for APTC/subsidy recipients as well as full-payment Child Health Plus subscribers.

Groups must notify Empire that they are experiencing a financial hardship due to COVID-19 that makes it difficult to pay their premium on time, their grace period is extended. They will have until June 1, 2020 to pay premium that was due on March 1, April 1 and/or May 1. Small Group fully-insured policyholders who qualify under the provisions of the regulation are required to give Empire written attestation of hardship due to COVID-19 by sending notice of financial hardship to NYGracePeriod@empireblue.com.

IMPORTANT: The regulation requires insurers as well as agents to directly notify their health insurance policyholders in writing of the emergency regulation by April 21. You can send these notices to your Individual and Small Group clients with Empire coverage to fulfill that obligation.

Individual Letter:

http://image.messageinsite.com/lib/fe5615707d600c747210/m/2/NY_Grace_Period_IND_member_notices_EBS+Letter_SLB.pdf

Small Group Letter:

http://image.messageinsite.com/lib/fe5615707d600c747210/m/2/NY+Grace+Period+EMPLOYER+notice_EBS+Letter_SLB.pdf

Diagnostic Testing for COVID-19

If a member or anyone on their health plan needs to be treated for COVID-19, Empire will cover the care with no copays or cost-sharing as long as they receive treatment from doctors, hospitals, and other healthcare professionals in their plan’s network for care received through December 31, 2020.

Maintenance Medications

Empire is relaxing early refill limits, where permitted. Empire is relaxing early prescription refill limits, where permitted, for members who have Empire pharmacy benefits and wish to refill a 30-day supply of most maintenance medications early. Additionally, members who have a pharmacy plan that includes a 90-day mail-order benefit should talk to their doctor about whether changing from a 30-day supply to a 90-day supply of their prescriptions is appropriate. Members filling 90-day prescriptions can get most of their medications through Empire’s home delivery pharmacy.

Telemedicine

Telehealth visits with healthcare providers in their plan’s network are covered at no cost to members through September 30, 2020. This includes visits that are not related to COVID-19.

The Virtual Care text feature on the Sydney Care mobile app allows members to chat with a doctor. Their first two text sessions are free through December 31, 2020. Additional text visits are $19 each.

Carrier Resources

https://www.empireblue.com/coronavirus/?brandcd=EBCBS

Small Group New Business Submission Extensions

Not applicable at this time

Exceptions

Small Group Policies: Healthfirst is offering a Special Enrollment Period (SEP) to existing small group policyholders. For employees and dependents who previously waived coverage when they were first eligible, or for those who were still within their waiting period, the SEP provides the opportunity to enroll in benefits. Dependents such as spouses and children can be added to an existing account as long as they are enrolled in the same coverage or benefit option as the employee. Request for enrollment must be received no later than: April 5 for coverage effective April 1 and May 5 for coverage effective May 1.

Furlough/Layoffs Special Rules

Not applicable at this time

Premium Grace Periods

http://assets.healthfirst.org/pdf_e440eacac550af1c32a5e233ad063be2?v=0427123041

Businesses experiencing financial hardship due to the pandemic may request a premium grace period extension through June 1, 2020. This guidance only applies to April and May premiums. Healthfirst small groups can submit a request for a premium grace period extension to Employer Services by calling 1-855-949-3668 or by emailing EmployerandBrokerService@healthfirst.org. For your reference, your small group client(s) will receive this letter regarding the premium grace period extension. Premiums for both months will be due in full by June 1st or the group will be terminated.

IN-Network Diagnostic Testing for COVID-19

Member Cost-Share Waived

Maintenance Medications

One-time refill for 30-day supply of chronic medications

Telemedicine

Request a Teladoc visit by phone at 1-800-Teladoc (1-800-835-2362) or by visiting this https://member.teladoc.com/healthfirst

Carrier Resources

https://healthfirst.org/

Small Group New Business Submission Extensions

Not applicable at this time

Exceptions

Annual MSP/MLR Collection Deadline Extension: Highmark Annual Group Client MSP/MLR Employee Count Collection Online Survey: The April 30, 2020 deadline to reply to this notice has been extended due to the ongoing COVID-19 crisis. If a client does not respond to the initial letter by the original deadline, they will receive a second letter, which will provide a new reply by date that will be flexible.

Furlough/Layoffs Special Rules

If an employee/member is laid off or furloughed prior to June 30, 2020, due to COVID-19 business disruption and rehired prior to June 30, 2021, Highmark will waive the waiting period for coverage. For coverage periods through June 1, 2020, we will waive “active at work” requirements for a period of up to 90 days. This enables coverage for employees/members transitioned to part-time or furlough status. The only requirements are that: a. the affected employees/members be currently covered on the plan, b. coverage be offered on a uniform, non-discriminatory basis, c. the premium is paid for the coverage with the same level of employer subsidies previously offered, and d. at least one employee/ member remains in active full-time employment.

Premium Grace Periods

Groups in need of assistance should contact their Highmark customer manager.

Testing & Treatment

Members receiving in-network hospital care for COVID-19 will not incur any out-of-pocket expenses (deductible, co-insurance, and copays). This waiver of member cost-share will remain in effect through May 31, 220. The waiver applies to all fully insured group, ACA and Medicare members. Self-Insured plans must opt-in to this program. The deadline to opt-in in 5pm, Friday April 10, 2020.

Maintenance Medications

No waiver at this time

Telemedicine

Telemedicine and virtual visits will waive cost-sharing and copayments for fully insured and ASO members under Teladoc, Amwell or Doctor on Demand for 90 days. ASO clients have option to opt out. Highmark has also expanded access to both in- and out-of-network teleaddiction services for members in Pennsylvania, West Virginia, and Delaware who are in addiction treatment and need immediate help without any out-of-pocket costs.

Carrier Resources

https://faqs.discoverhighmark/

COVID-19 (Coronavirus) Resource Guide

COVID-19 Antibody Testing

COVID-19 Antibody tests are covered in full, with no member liability, when ordered by a doctor or provider, including telemedicine providers and submitted through an in-network laboratory (CPT Codes: 86328 and 86769). These tests must be FDA approved and the office performing the test must have a Clinical Laboratory Improvement Amendments (CLIA) waiver certification to bill for these services.

Small Group New Business Submission Extensions

Exceptions

Small employer groups that currently offer a single plan option are eligible and allowed to downgrade to a
leaner plan design off anniversary through June 30, 2020.

Furlough/Layoffs Special Rules (Updated 5/14/20)

Horizon is waving the “actively at work” requirement applicable to fully-insured commercial plans. Furloughed employees or those with reduced work hours may remain covered under the group health plan provided medical premiums are paid. Furloughed employees may remain on the plan through June 30, 2020. Employees who are terminated should be offered State Continuation/COBRA. At the employer’s written request, rehire wait periods may be waived for employees temporarily terminated due to COVID-19 through August 31, 2020.

Premium Grace Periods

As detailed in Horizon BCBSNJ’s COVID-19 Resource Guide, per the New Jersey Department of Banking and Insurance (NJDOBI) Bulletin No. 20-13, Horizon BCBSNJ will extend the health and/or dental premium payment grace period for small employer and qualifying large employer (51+) customers.

Deadlines to elect the Emergency Premium Payment Deferral Program are as follows:

April 2020 – All forms must be submitted by 4:00PM on April 30th.

May 2020 – All forms must be submitted by 4:00PM on May 15th.

Small Employer: Horizon BCBSNJ will extend the health and/or dental premium payment grace period for small employer customers from 31 calendar days to 60 calendar days. The emergency grace period may start with either the April or the May coverage, and to the premiums due for those months covered by the emergency grace period. If the small employer group already missed the April premium payment, the group is currently covered under the emergency grace period.

1. Upon request for the group’s extension, brokers should send the Emergency Grace Period Premium
Deferral Program Agreement to the group for review and execution.

2. The executed agreement must be returned to your sales team at Savoy.

3. Savoy will file the request with Horizon BCBSNJ.

Repayment: If the small employer group takes advantage of the emergency grace period, the group will have six months to repay the deferred health and/or dental premiums in full.

Large Employer: Horizon BCBSNJ will extend the health and/or dental premium payment grace period for qualifying large employer customers to 60 calendar days. A large employer qualifies only if it can demonstrate financial hardship directly caused by COVID-19. The emergency grace period may be applied to the April or May premium.

1. Groups must formally request a grace period extension by having either a company official or the group’s CPA complete an Attestation addressed to Horizon BCBSNJ. The attestation should be sent to your Savoy Large Group Account Manager for submission to Horizon BCBSNJ.

2. Upon receipt of the attestation letter, your Horizon account manager will release a Emergency Grace Period Deferral Agreement for completion by the group.

3. Upon receipt of all required documentation, Horizon will send an executed agreement to the Group and/or Broker.

Repayment: If the large employer group (51+) takes advantage of the emergency grace period, the group will have at least six months to repay the deferred health and/or dental premiums in full.

As a reminder, to be eligible to participate in the Emergency Premium Grace Period Deferral Program, all groups, regardless of size, must be in good standing as of March 1, 2020.

Testing and Treatment

Effective immediately and through August 31, 2020, all fully-insured members, including those covered through Medicaid, Medicare Advantage, Individual and Small Group policies as well as members covered by the State Health Benefits Program (SHBP) and the School Employees’ Health Benefits Program (SEHBP), will not pay any cost-share amounts (copay, coinsurance, deductibles) for covered services related to the testing, diagnosis and treatment of COVID-19 for:

• All charges associated with a visit to an in-network or out-of-network primary care physician or urgent care center or Emergency Room (ER) for evaluation of symptoms identified as possible indicators of COVID-19 infection.

• All in-network and out-of-network labs for charges associated with the delivery of services connected to CDC-approved lab studies or tests for COVID-19 for members who know they have been exposed to an individual diagnosed with COVID-19 or with symptoms identified by the CDC as possible indicators of COVID-19 infection.

• All covered benefits associated with inpatient and outpatient care when delivered by in-network professionals and facilities, and when your claim indicates it related treatment to COVID-19.

Maintenance Medications

Waiving early refill limits on 30-day supply of maintenance medications expired June 30, 2020.

Telemedicine

Access to telehealth will be provided 24/7 and member cost share will be waived through June 13, 2020. In addition, 24/7 access to licensed nurses who can assess and assist members with symptoms that are consistent with suspected COVID-19 infection. Those service are available through the company’s free “Horizon Blue” app, the www.HorizonBlue.com online portal, or by phone at 1-888-624-3096

Carrier Resources

https://www.horizonblue.com/coronavirus-2019

COVID-19 INITIATIVES ARE CURRENTLY IN EFFECT UNTIL 12/31/2020 UNLESS OTHERWISE NOTED

Below are Provisions for Fully-Insured Accounts and Members; Self-Funded provisions may differ, Please see
https://www.ibx.com/pdfs/custom/edge/covid-19-self-funded-chart.pdf for further details on Self-Funded.

COVID-19 Testing

The COVID-19 diagnostic test and Antibody test are covered with no member cost-sharing, when directed by the member’s health provider.

Waiving Cost Share

IBC is waiving member cost-sharing for in-network, inpatient acute care treatment associated with COVID-19 diagnoses.

Waiving Prior Authorization

Waiving prior authorization for all inpatient admissions and suspending prior authorization requirements for acute inpatient admissions from the emergency department at in-network facilities for plan members.

Facilities must notify the plan. In effect through July 31, 2020. Waiving prior authorization requirements for post-acute care admissions and suspending prior authorization requirements for transfers from acute in-network, inpatient facilities to in-network, post-acute facilities (long-term acute care, rehabilitation, and skilled nursing facilities) for any diagnoses. Includes in-network transportation prior authorization requirements from acute inpatient facilities to subacute facilities. Facilities must notify the plan. In effect through July 31, 2020.

Furloughed Employees

Provision: IBC will honor employer requests to continue coverage for employees furloughed or temporarily laid off as a result of impacts of COVID-19, as long as premium payments continue to be made by the employer. In effect through September 30, 2020.

Consumer-grade pulse oximeters are covered for members who have a COVID-19 diagnosis, recovering from COVID-19 after being hospitalized, or a patient with respiratory symptoms while waiting for COVID-19 test results, at no member cost share. Prescribed by a health professional. In effect through July 31, 2020.

Wellness Credits: For any group that had wellness credits expiring during the pandemic months, they may be used through December 31, 2020.

Testing & Treatment

IBC is waving member cost share for in-network, inpatient, acute care treatment of COVID-19. This means members will have no out-of-pocket costs for COVID-19 related hospitalizations, and for emergency room visits that result in a member being admitted for COVID-19 treatment. These changes are being extended through June 30, 2020.

Maintenance Medications

Waiving early refill limits on 30-day supply of maintenance medications

Telemedicine

Telemedicine – MDLive® visits cost sharing is waived for all MDLive telemedicine visits. Telemedicine – Primary care (PCP) cost sharing is waived for all telemedicine visits with plan members’ existing PCPs. Telemedicine – regular cost sharing applies for Specialists. Covers telehealth appointments for: specialists; nutrition counseling; and urgent care and video-only visits for physical, occupational, and speech therapy. Telemedicine – Behavioral Health In place, business as usual. Based on benefit design, covers in-network, out-of-area, and out-of-network telemedicine with behavioral health professionals at regular cost sharing.

Carrier Resources

https://news.ibx.com/coronavirus-2/

COVID-19 Antibody Testing

FDA approved antibody detection tests for COVID-19 will be covered at no cost-share to the member when ordered by a physician or other healthcare provider.

Small Group New Business Submission Extensions

Not applicable at this time

Exceptions

Not applicable at this time

Furlough/Layoffs Special Rules

SPD allows for extended coverage to furloughed employees. Contact your Sales Team for additional details.

Premium Grace Periods

In an effort to assist our employers during this unprecedented time, we will address all requests for additional grace period on a case-by-case basis. Employer groups should call the billing team at 833-639-2669, option 5.

IN-Network Diagnostic Testing for COVID-19

Member Cost-Share Waived 

Maintenance Medications

No waiver at this time

Telemedicine

Member cost-share waived, through 6/6/2020

Carrier Resources

https://membershealthplannj.com/resources/news/

Small Group New Business Submission Extensions

Not applicable at this time

Exceptions

Oscar is extending prior authorizations for any previously approved request to 180 days (from 60 days). For Durable Medical Equipment, the extension is to 90 days (from 30 days).

Furlough/Layoffs Special Rules

Not applicable at this time

Premium Grace Periods

NJ Premium Grace Periods:
• Extended time to pay premium for all of your Individual Clients.

For on-exchange subsidized clients who were in good standing as of 3/1/20 (paid through March), and who have already paid binder in full, Oscar is providing an extended grace period of 120 days. This would begin 4/1/20 or 5/1/20, based on your client’s missed payment date. For your unsubsidized clients in good standing as of 3/1/20, Oscar has extended the current 31-day grace period to 60 days.

• Flexible grace period payment for your Unsubsidized Individual Clients.

Clients who are unsubsidized (on or off exchange, receiving no subsidy) who take advantage of the grace period will have the option to pay unpaid premium in installments, instead of in full. For example, if six months remain on the policy after the grace period and your client has $300 in unpaid premium, they can pay their standard monthly premium plus $50 each month to be paid in full by the end of year. Please have members call their Concierge team at 855-672-2755 to set up a payment plan.

• Extended grace period duration for all of your Small Group Clients.

Small groups in good standing as of 3/1/20 are eligible for an emergency 60-day grace period. The grace period may be applied towards the April or May premium and will continue for 60 calendar days from that date. Note that all NJ small groups with anniversary dates between March through the end of NJ’s emergency order will be eligible for renewal, subject to applicable federal and state law.

• Flexible grace period payment for all of your Small Group Clients.

Oscar is providing a payment plan so that any unpaid premium can be paid in installments. For example, if six months are remaining on the policy, the group will have the option to pay the unpaid premium in six installments in addition to the regular monthly premium through the end of year, same as individual clients (for small groups with less than three months remaining on the policy, Oscar will allow for six months for the deferred premium to be paid). Please have groups call 1-855-672-2784 to set up a payment plan.

NY Premium Grace Periods:

• Extended grace period for Individual and Family Plans.

The grace period has been extended for an additional 30 days, meaning that your subsidized Individual and Family Plan clients now have an extended period where their claims will be paid before termination. Oscar will continue paying claims for the first 60 days of this period. This only applies to Individual and Family Plan subsidized members who entered the grace period as of April 1st (i.e., client was fully paid as of March). Those who entered prior to that date will be held to regular grace period conditions.

• Future eligibility for Individual and Family Plans.

Clients who do not pay all premiums in full during the entire 120-day period will not be eligible to re-enroll in a QHP unless they have an existing QLE.

• Documentation requirements for subsidized individuals.

While Oscar is not requiring proof of COVID-19 financial hardship for premium payment and grace period flexibilities for subsidized on-exchange individuals, everyone seeking to extend their grace period must call Concierge and request to do so.

• Extended grace period for small groups and non-subsidized individuals.

For clients who are fully paid as of March and can demonstrate financial hardship as a result of COVID-19, the grace period will be extended to 11:59PM on June 1, 2020 or the expiration of the applicable contractual grace period, whichever is later. Oscar will continue paying claims during this period.

Testing & Treatment of COVID-19

Member Cost-Share Waived 

Maintenance Medications

Waiving early refill limits on most prescription drugs.

Telemedicine

Member Cost-Share Waived.

Carrier Resources

https://www.hioscar.com/covid19

COVID-19 Antibody Testing

For the duration of the emergency period, UnitedHealthcare will cover antibody detection tests (Serology – IGG/IGM/IGA for SARS-nCOV2 (COVID19) at no cost-share to the member when ordered by a physician or health care provider.

UnitedHealthcare strongly supports the need for reliable testing and encourages employers and members to consider tests that either have FDA approval or an emergency use authorization from the FDA.

Small Group New Business Submission Extensions

Exceptions

UHC is providing fully-insured Small Business and Key Accounts clients with a Special COVID-19 Enrollment Opportunity to enroll employees who did not previously enroll in coverage. The opportunity will allow employees who previously did not elect coverage for themselves (spouses, children) or waived coverage to enroll. The opportunity will extend from March 23 to April 13, 2020. The effective date of coverage will be April 1, 2020. Buy down to a leaner plan, employers have options to downgrade current plan design or add a leaner plan option. Please discuss available options with your Savoy sales team. Plan buy downs and additions to leaner plan design options are available through May 31, 2020.

Furlough/Layoffs Special Rules

Furloughed employees and those with reduction in hours will be temporarily allowed to stay on the medical plan premium provided payment continues and that the option to remain insured is offered to all impacted employees. Employees who are laid-off, should be terminated from the group health plan and offered State Continuation/COBRA. Upon rehire, wait period will be waived.

Premium Grace Periods

For insureds (individual /group) who are experiencing financial hardship as a result of COVID-19 and need assistance, please contact Oxford using the following instructions:

For Groups (small and large) that are experiencing financial hardship as a result of COVID-19 and need assistance, they can request an extension or discuss alternative payment arrangements by calling Oxford Financial Operations team at 1-800-366-4148, TTY 71.

Individual insureds must confirm their intent for an extension of premium payment(s), to do so, please send an email to billing_team@uhc.com with one of the following three responses:

• I hereby attest that I am experiencing financial hardship related to COVID-19 and would like to request a premium payment extension until <insert date>. I understand by doing so that I am contractually committed to pay premium at least through this date.

• I would like to remain on my current premium payment cycle.

• My intention is to have my current coverage lapse. or Policyholder Name, Policy Number, Requested Termination Date, Reason for Termination

Please note that this is simply an extension to pay premium for those in need and not a waiver or forgiveness of the premium.

In-Network Diagnostic Testing & Treatment for COVID-19

Member Cost-Share waived for testing and treatment related to COVID-19 through July 24, 2020.

Maintenance Medications

Waiving early refill limits on 30-day supply of maintenance medications through June 15, 2020.

Telemedicine

Telemedicine is available at no cost for COVID-19 related systems through July 24th and for non-COVID-19 services through June 18th. For groups enrolled on the Oxford platform, members should contact member services to request an online access code for telemedicine services.

Carrier Resources

https://www.uhc.com/health-and-wellness/health-topics/covid-19

Executive Order #123

On April 9th, Governor Phil Murphy signed Executive Order No. 123, extending grace periods during which certain insurance companies, including health insurers, life insurers, and property and casualty insurers, cannot cancel policies for nonpayment of premiums.

As part of its passing, the following are being put in place:

  • Extends minimum grace periods: A minimum 60-day grace period will be required for health and dental insurance policies, and a minimum 90-day grace period will be required for life insurance, insurance premium-financing arrangements, and property and casualty insurance, which includes auto, homeowners, and renters insurance. Insurance companies will be required to notify policyholders of this emergency grace period and to waive certain late fees, interest, or other charges associated with delays in premium payments as directed by the Commissioner of Banking and Insurance. Insurers will also be required to provide each policyholder with an easily readable written description of the terms of the extended grace period. The extended grace periods will not apply to employer-funded health plans, which under federal law, are regulated exclusively by the federal government.
  • Requires insurance companies to pay claims during the grace period: Insurance companies will be required to pay any claim incurred during the emergency grace period that would be covered under the policy. The Order further prohibits insurance companies from seeking recoupment of any claims paid during the emergency grace period based on non-payment of premiums.
  • Ensures that unpaid premiums are made payable over a lengthy period: To ensure that policyholders are not required to make a lump sum payment on unpaid premiums at the end of the grace period, any unpaid premium will be amortized over the remainder of the policy term or a period of up to 12 months, as appropriate and as directed by the Commissioner of Banking and Insurance.

(Published by NJ.gov on 4/9/2020)

Layoff vs. Furlough

What is the difference between layoff and furlough?
Generally, when the employer is furloughing employees this is a situation where the employer/employee relationship is not severed. Conversely, when the employer is laying off employees, the employment relationship is terminated.

Under a layoff, will I lose health benefits?
Under a layoff, the employment relationship is terminated therefore the employee loses eligibility under the plan. This is a COBRA triggering event for the health benefits (medical, dental, vision, health FSA, etc.) Loss of eligibility is also a qualifying special enrollment event for the individual market.

If COBRA is elected and the person does not enroll in individual coverage, they cannot do so until the next annual open enrollment for the marketplace.

If I am laid-off, can I enroll in an individual plan instead of COBRA?
Yes. Loss of eligibility is also a qualifying special enrollment event for the individual market.
If COBRA is elected and the person does not enroll in individual coverage, they cannot do so until the next annual open enrollment for the marketplace. You are “stuck” with COBRA, for the remainder of the COBRA period, until the next annual marketplace open enrollment or until you become eligible for new group health plan.

IMPORTANT: The employer should clearly advise that an individual who elects COBRA will have to exhaust it before becoming eligible for Individual coverage and will in essence be “stuck” until COBRA runs out or the next Open Enrollment.  That means they also cannot apply for a subsidy until the next Federal Open Enrollment.  An individual obtaining a subsidy will not harm the employer if the individual is not working.

If I enroll in an individual plan, can I receive a subsidy to help pay for the cost of the plan?
In order to qualify for a subsidy (premium tax credit) there are certain criteria you must meet; most notable is subsidy eligibility is based on income.

Who pays for COBRA coverage?
The employee generally pays the full cost of the insurance premiums. The law allows the employer (COBRA administrator) to charge up to 102 percent of the premium to cover administrative costs.

Employers can choose but are not required to subsidize COBRA for terminated employees.

Under furlough, will I lose health benefits?
All eligible employees are still entitled to benefits while on furlough. If eligibility for health care benefits is maintained during a furlough, the employer can collect the employee’s share of premium to maintain the coverage during a paid or unpaid leave of absence.

How do I pay my employee contribution if I am on furlough?
Premiums may be collected (as determined by the employer’s policy) in one of the following manners:

  • Catch up. Some employers choose to keep employees on leave enrolled in their benefits until they return to active work, and then recoup those payments at the time the employees return to work.  If there is a fairly large premium payment due at the time the employees return to work following the leave, it may be necessary for the employer to take deductions over several payroll periods.  In some cases, state wage and hour laws will limit the amount that can be deducted from pay (thus the cap may be necessary).
  • Pre-pay. If the leave is scheduled in advance, and the employee remains eligible for benefits during the leave, the employer may collect the employee’s share of premium for the rest of the plan year from the employee’s pre-tax earnings before the start of the leave.  However, if the leave is anticipated to span more than one plan year, then the employer cannot collect the premiums for the latter part of the leave since this would violate the cafeteria plan regulations prohibiting deferred compensation.
  • Pay-as-you-go. During the leave, the employer may require the employee to pay the employee’s portion of the premiums to maintain coverage.  Such payments would generally be on an after-tax basis, by remitting payment to the employer, and the employer could require payment no more frequently than regular deduction frequencies for employees during periods of active work.  Most employers collect premiums from employees on leave of absence on a monthly basis.

In cases where there is paid leave, the employer may collect those premiums through salary reductions under the cafeteria plan.  However, for periods of unpaid leave, where the “pay as you go” method for collection is utilized, the employee would remit those amounts to the employer on a post-tax basis.

Families First Coronavirus Response Act

I heard that the new Act includes tax credits. For what size employers does this apply and what is the credit?
First, most importantly, be sure to familiarize yourself with the requirements under the Families First Coronavirus Response Act provisions. You can do so by referring to the chart we have made available in the COVID-19 Resources. Affected employers are employers with 1–499 employees.

Specifically addressing the tax credit, The U.S. Treasury Department, Internal Revenue Service (IRS), and the U.S. Department of Labor (Labor) announced in a News Release on March 20th, that small and midsize employers can begin taking advantage of two new refundable payroll tax credits, designed to immediately and fully reimburse them, dollar-for-dollar, for the cost of providing Coronavirus-related leave to their employees.

Eligible employers will be able to claim these credits based on qualifying leave they provide between the effective date, April 2nd and December 31, 2020. Equivalent credits are available to self-employed individuals based on similar circumstances.

The chart goes into detail about the credit for Paid Sick leave. Note: Eligible Employers receive 100% reimbursement for paid leave pursuant to the Act.

Health insurance costs are also included in the credit.

Employers face no payroll tax liability. And Self-employed individuals receive an equivalent credit.

The next logical question is how quickly will the employer be reimbursed?

If there are not sufficient payroll taxes to cover the cost of qualified sick and childcare leave paid, the IRS Notice released on 3/20 addresses Prompt Payment for the Cost of Providing Leave.

When employers pay their employees, they are required to withhold from their employees’ paychecks federal income taxes and the employees’ share of Social Security and Medicare taxes. The employers then are required to deposit these federal taxes, along with their share of Social Security and Medicare taxes, with the IRS and file quarterly payroll tax returns on Form 941 with the IRS.

Under guidance that will be released later this week, eligible employers who pay qualifying sick or childcare leave will be able to retain an amount of the payroll taxes equal to the amount of qualifying sick and childcare leave that they paid, rather than deposit them with the IRS.

If there are not sufficient payroll taxes to cover the cost of qualified sick and childcare leave paid, employers will be able file a request for an accelerated payment from the IRS. The IRS expects to process these requests in two weeks or less. The details of this new, expedited procedure are expected to be announced this week.


female business owner holding up and open sign

What Types of Commercial Insurance Does My Small Business Need?

Believe it or not, roughly 99.9 percent of the businesses operating in the United States are small businesses.

Those small businesses serve almost every industry you can imagine. However, they all have one thing in common: they need commercial insurance.

The risks that each small business faces differ based on their industry, their location, and their size.

There are some policies that almost every business needs to be fully protected.

Before you can invest in coverage, you need to understand the types of commercial insurance available to you.

Here are some absolute must-have policies every business owner needs.

General Liability Insurance

Accidents happen all the time and you can never predict how bad they’ll be.

If a client or customer gets injured on your property, they can sue you for the cost of any medical treatments and expenses incurred from their recovery.

If their personal property gets damaged because of your work, you could also be liable for those repairs.

General liability insurance helps protect you from those lawsuits.

If something happens and your business gets sued for damages relating to a qualified incident, your insurance policy helps pay for the legal fees and settlement amounts.

Keep in mind that it only covers you up to the limit of the policy.

You must pay any remaining expenses out-of-pocket.

Ask your insurance agent about your risks and let them help you determine how much coverage you really need.

Commercial Auto Insurance

Unfortunately, your personal car insurance policy isn’t enough to protect you on the road if you’re using your car for business purposes.

Worse, the insurance company may deny a claim entirely if they find out you’re using the car for business.

That’s where a commercial auto insurance policy can help. It protects you and anyone who uses the car for business.

It’s not a substitute for traditional car insurance.

If you’re using your personal vehicle, you’ll need both policies to stay fully protected and you’ll want coverage for every commercial car in your fleet.

Property Insurance

Owning your business’s building is a huge investment. If something happens, you’re responsible for the full cost of repairs.

Property insurance protects everything inside the building, the building itself, and the grounds the building is on.

If someone vandalizes your property or a fire tears through the first floor of the building, the policy will help cover the damage.

This is one of the types of commercial insurance that can help keep your operating budget in good shape.

Workers’ Compensation Insurance

As an employer, you’re responsible for your employees’ safety anytime they’re at work or performing work-related duties off-site.

If they’re injured as a result of their duties, you’re responsible for paying for their medical treatments.

Workers’ compensation coverage helps protect you and your employees if they’re injured on the job.

The policy covers the cost of their medical treatment and even provides them with a portion of their regular income during recovery.

It’s also a legally required policy for most businesses that hire even part-time employees.

The best thing you can do is invest in a policy before you hire your first employee.

This way, you’ll have protection from the very beginning.

Business Interruption Insurance

What would happen to your business and your employees if you had to close your doors for a few months?

Chances are that it is hard to stay afloat or encourage your employees to stay and not start looking for a new job immediately.

Business interruption insurance helps cover the loss of profits, pays for your employees’ lost wages, and makes it easier for businesses to survive the temporary closure.

It’s a great supplement to property insurance which would help cover the cost of the physical repairs.

Location-Specific Insurance

Property insurance doesn’t cover every type of damage and different locations face different risks.

For example, if your building is next to a major waterway or on a floodplain, you’ll want to invest in commercial flood insurance.

If your building is near a fault line, you may want to invest in earthquake insurance. It all depends on where you’re located.

The best thing you can do is discuss your concerns with your insurance agent.

They’ll be able to look at the risk factors for your building and find the right supplemental policies to keep you safe.

Data Breach Insurance

Almost every business stores some sensitive information on computers.

This can be anything from credit card numbers to clients’ personal contact information.

Unfortunately, that information isn’t always secure.

If someone were to hack into your computer system, that information could get intercepted.

Cybercrime is on the rise and businesses of all sizes are at risk every single day.

In fact, more than 20 percent of small businesses get hacked every year.

Data breach insurance helps protect you from damage caused by cybercriminals.

It gives you the resources you need to recover that sensitive information and establish better safety measures against future attacks.

Life Insurance

As a business owner, the success of your company is on your shoulders.

You’re in charge of its growth and future plans.

Think about what would happen if you weren’t around to make sure it succeeds.

Would the company have enough capital to survive on its own merits?

Would your family and loved ones still have the resources they need to make ends meet?

Life insurance policies allow you to protect both your loved ones and your company’s future.

If you pass away, the policy can give your beneficiaries the money they need to preserve your legacy.

Get the Right Types of Commercial Insurance

Every business is unique.

They face different risks and have different needs.

That means that the types of commercial insurance right for your business may not be the same as others in your industry.

Contact us to schedule an appointment with our experienced insurance agents.

We’ll help you find the best coverage options for your business and your needs.