a black nurse standing next to a black patient sitting in a wheel chair

Medicare Open Enrollment: Tips to Sign Up on Time

Medicare Open Enrollment is an annual event that runs from Sunday, October 15, 2020 through Thursday, December 7, 2020, where anyone can add a Medicare health insurance plan in their life.

However, not everyone can qualify for this enrollment. Anyone looking to apply for Medicare must be turning 65 years in the next three months, or they're 65, or they just turned 65 years in the last three months.

This open enrollment aims to help the existing users re-evaluate and compare their Medicare coverage plan against others in the market.

Equip yourself with all the knowledge about Medicare, and by doing so, you'll finally get the Medicare benefits you deserve. So, here is all you need to know about the upcoming Medicare Open Enrollment.

What Comprises Medicare?

Medicare Part A: Here, you're required to acquire hospital insurance covering all your inpatient matters. This includes a short period of hospital stay and can pay for some of your healthcare bills.

Medicare Part B: In this case, you should obtain medical insurance responsible for any services you receive from doctors or any other medical practitioners.

This plan covers some services that include preventative services, durable medical equipment, home health care, and outpatient services.

Medigap: This category acts as a supplemental policy that covers your medical bill to a certain amount, then you top up the rest.

Medicare Advantage Plan: This plan brings together all the benefits enjoyed in Part A and Part B. Before, this plan was called Part C. Services received in this category include paying for prescription drugs and other extra services like hearing, dental, and vision.

Medicare Part D: This plan is purely for covering your prescription drugs' amount.

Note that anyone 65 years old or above can qualify for Part A of the Medicare plan. Plus, they must have been paying for medical insurance for quite some time.

Additionally, if you want to be eligible for Medicare Part B, you should enroll for insurance coverage, whereby you'll be required to pay a monthly premium.

Who Needs Medicare

Apart from individuals aged 65 and above, other groups of people can benefit from this Medicare Open Enrollment.

For instance, anyone with disabilities and those experiencing renal diseases have been diagnosed with permanent kidney failure and require a transplant.

Besides, disabled groups are entitled to secure Social Security or Railroad Retirement Board disability benefits for no less than 24 months.

Key Factors to Note

Having health insurance doesn't limit you from enrolling for Medicare coverage. Also, you don't have to wait until you're 65 years of age to apply for Medicare.

You can sign up for Medicare Part A, which doesn't require you to pay for its premium, plus enrolling into the system now gives you a better chance when you're ready to sign up for Part B.

You need to also keep in mind that if you're eligible to apply for Medicare, you should do so during the set time; otherwise, you risk having to pay a fine. However, if it's not possible for you to apply during that period, here is what will happen:

Late enrollment penalty: If you're always late to enroll for Part B, you'll be incurring a 10 percent increment in your Part B premium amount.

But if you have health insurance that can allow you to delay enrolling in Part B, then you're sorted. The longer you take to pay Part B premium, the higher the penalty you’re expected to incur.

Special enrollment period: In case you're over 65 years, and you have been using health insurance, but suddenly you retire or get laid, and you can't pay for it anymore, you can apply for Medicare.

Such a scenario triggers a special enrollment period (SEP) where it's allowed for you to sign up for Medicare without incurring a penalty.

In addition to that, if you're moving to a different region, you automatically qualify for SEP, and you should make the changes as soon as they open for enrollment.

Common Mistakes That Will Cost You More

Not going through numerous Part D plan options: If you have been using the same Part D drug plan, it's understandable if you choose to stick to it for years.

However, chances are you're missing out on other better options from other insurance companies.

Review several plans, and you might land one that is cost-effective and worth your time. Plus, medical needs change with time, and it's only fair if you change your plan with them.

Not checking if the terms of your plan changed: By September, you should have received the annual notice for any changes in your Part D plan.

The notice should clearly state the changes that will be implemented in the following year. Ensure you’ve checked the details of the notice to see if you'll be affected in any way.

Almost every year, the drug plan formularies change, and depending on the group you're placed in, it will determine the amount you will pay. Basically, the higher the group tier you're in, the higher the amount of money you’re expected to pay.

Forgetting to separate your Part D plan from that of your spouse: Obviously, it sounds perfect for acquiring the same Part D plan as your spouse since you're considering things like copays and similar rules.

But, you might not have the same health issues as your spouse, and splitting the coverage can end up being less expensive.

Final Thoughts

The Medicare Open Enrollment provides an opportunity to have a healthcare plan at a cost-effective rate. You can plan to switch from one plan to another during that time and still receive its full benefits.

Generally, you should thoroughly review your existing Medicare plan, and in case you're dissatisfied, it's time you make the changes during the open enrollment period. Otherwise, go for a plan that suits all of your medical needs.


a yellow sign in an open area that says open enrollment ahead

Small Business Health Insurance & Open Enrollment in NJ

In any small business, your employees will be your greatest asset, particularly if you want to be successful. Health insurance is, therefore, critical for recruiting and retaining employees.

While compensation is always an attractive and reassuring factor to many, in today's self-reflective world where self-care, health, and general physical and mental well-being are becoming increasingly important, curating a culture of care within the workplace is essential.

Continue reading this article for more on small business health insurance and open enrollment in New Jersey.

The Basics of Health Insurance

Small business health insurance gives your employees the peace of mind that they are being taken care of, keeping them healthier and informed while maintaining employee satisfaction, loyalty, and overall productivity.

It can also help you to attract better candidates during recruitment stages, thanks to potential talent knowing that they will be looked after- an attractive attribute in any business.

Having an excellent health insurance and benefits package will set you aside from your competitors and help you retain your industry's top talent in an increasingly cut-throat climate.

Now that we have established that healthy employees equate to a healthy business, it is essential to do some research as a small business owner. This enables you to take your time to find the coverage that makes the most sense for you as an owner, your business, and your employees.

While the research and actual buying process can sometimes seem long, tedious, and intimidating (particularly when making comparisons), the benefits outweigh any negatives, making it a worthwhile and ultimately beneficial process.

When you own a business, whether it be big or small, there are certain laws that must be adhered to.

For small businesses, health insurance is based on the number of full-time workers currently employed, and to be eligible for business health insurance; all you need is one full-time employee on your payroll.

If you employ 50 or less people full-time, you don't legally have to purchase coverage. However, once your total of employees reaches 51 or more, you are obliged to offer health care insurance and coverage to all full-time members of staff.

Types of Small Business Health Insurance

Small-group insurance has been the traditional option for many small businesses looking to offer health insurance benefits to their employees; however, this isn't the only option.

With three main options to pick from, your decision should be based on what works best for you as a business owner, as well as taking your business set-up into consideration.

Small Group Insurance

The most popular of the three options available, it is geared towards businesses that employ less than 50 full staff members and is purchased directly by employers before offering it to their staff.

In fact, all you need to qualify is one employee, but as it is group insurance, it cannot be purchased by individuals and generally requires around 70% participation to be valid.

The cost of the plan is then shared by all those within the group, including the employees as well as the employer.

Small group insurance members then typically receive the insurance at a lower cost as the insurer's risk is diluted across a group of policyholders, and the group is generally made up of the business employees.

You can sign up for this type of insurance whenever you want, and there is no open enrollment period, meaning that you can enroll at any time of the year as long as you qualify.

It can also be bought directly from most insurance companies, brokers or private exchanges, and once a plan is chosen, the entire group gets the option to accept the coverage or decline it.

HRA

A Health Reimbursement Arrangement (HRA) is a tax-advantaged, affordable alternative to traditional insurance with benefits that include budget control, tax efficiency, and flexible plan design.

As it is an arrangement, as opposed to a conventional account, this coverage option uses reimbursements instead. This means that staff members will pay their medical office or insurance company upfront, and then later submit a claim to get their expenses reimbursed tax-free.

The structure itself is simple, with the employer deciding how much they want to contribute to the arrangement each month.

Once agreed upon, they will provide their staff with information on how the reimbursement arrangement works, and the employees then choose a plan that they feel works best for them.

With HRA, employees also don't have to recognize income taxes, and reimbursements can be made by employers needing to pay payroll tax.

HRA's are flexible, meaning that you can sign up for one at any time, and employees can sign up for their plans without waiting for open enrollments when the HRA is new.

Self-Funded

This is when self-insured employers pay for claims themselves, and are also known as self-insured plans.

An option typically used by large corporations, it can also be used by small business owners to control their healthcare spending and, therefore, save on costs. The employer sets up the special fund and sets aside a chosen amount of money to pay out later should an employee make a health claim.

Benefits include a more adaptable and customizable plan for employees, no pre-funding of health coverage, and an exemption from state health insurance premium taxes.

A self-funded plan is also more affordable than its traditional counterpart, and there are fewer regulations, allowing small business owners to customize the plans to their unique needs and requirements as a business.

However, self-funded plans come with higher risks because the responsibility is placed solely on the business for paying out the claims. This means that if a major claim was to be filed, the company could leave themselves open to potential bankruptcy and financial ruin.

Open Enrollment

Employees have the option to change their health insurance plans and medical coverage every year during what is commonly referred to as the open enrollment period.

For small business owners, open enrollment lasts for the duration of one to two weeks and is generally a month before the renewal date of the current policy. Employees can make inquiries regarding other health insurance plans, receive materials, and, upon making a decision, enroll.

Staff members can also sign up for new offerings and add, change or drop dependents during this time, with this new coverage usually lasting for a full year, starting and finishing on a specified date.

To learn more about small business health insurance, contact us today.


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.


Essential considerations for returning to work webinar graphic

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.


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.


a hand holding a lit cigarette and breaking it in half

Using Group Benefits & Incentives to Quit Smoking & Vaping

It’s no secret that it is difficult to quit smoking.

A habit that kills over 480,000 each year in the United States according to the Centers for Disease Control and Prevention (CDC), it’s something that needs to be stopped.

Alongside premature deaths, numerous tobacco-related diseases affect millions of people every year; including:

  • Cardiovascular disease
  • Emphysema
  • Various cancer, including lung cancer
  • Diabetes

When you are running a business that has smokers within it, it’s at risk.

Not only will you see many absences because of related conditions, but a decrease in productivity as employees will be distracted with smoking breaks throughout the day.

So, how can you combat this?

Research undertaken by professors at Ohio State University has found that employers can save an average of $5,816 for every employee that quits smoking.

Savings that come from lower healthcare costs, prevented premature deaths and an increase in workplace productivity, this along with saving your employee’s lives make it well worth it.

Although over 50% of people in the US try to quit smoking every year, and there has been a significant drop in the amount of people that smoke over the years, the success rate is only 7.2%.

Source: Statista

To help increase this, there are certain group benefits and incentives that businesses can offer to give their workers the push that they need to try and quit.

These resources are incredibly beneficial, from both financial and health perspectives as aforementioned.

Although these financial incentives might seem expensive in the short term, the end result makes it more than worth the initial investment.

Showcasing how your business can help to transform your worker’s lives, these incentives illustrate the influence of your policies.

The Rise in Vaping

However, it’s not only tobacco that is popular in the US.

Some favor vaping, as they believe that it’s the lesser evil out of the two habits.

With an increase of 50% between 2011 and 2018 that vape according to the World Health Organization, it’s a habit that many younger adults are starting as they believe that it’s less dangerous than its counterpart.

However, according to several sources, including the CDC, vaping has been linked to an outbreak in lung injury.

With a sharp increase in visits to the emergency department across the states (with over 60 confirmed deaths, including 1 in New Jersey), certain employers have taken action by banning the products in their workplaces.

Along with workplace bans, several states have issued both temporary and permanent sales bans or restrictions on vaping products – including New Jersey, Oregon and Rhode Island.

These smoke-free indoor air laws ban vaping in areas where smoking is also banned.

However, not all workplaces have policies that align with the ban.

Which faces employers with whether they will allow vaping in the workplace or if they will ban it.

An Alternative to Quitting Smoking

Many people across the country are opting for vaping as a way of quitting smoking.

Stepping away from the traditional cessation techniques of nicotine patches and gum, they believe that it will help them to break the habit.

As it’s aimed as a way of reducing the amount of nicotine over time, many e-cigarette companies argue that it’s effective.

However, as vaping is believed to be just as harmful according to research, it’s clear that this could just be their way of continuing their habit.

Conclusive evidence of the effectiveness of vaping as a cessation tool is still underway.

How to Choose an Incentive

When choosing an incentive to encourage employees to quit smoking, you need to think about which ones will engage them.

For example, you could give them the following group benefits:

  • Guaranteed bonuses every few months
  • Discounts on health insurance premiums - something that 16% of employers do according to the 2018 Employee Benefits Survey Report
  • Free cessation aids – such as pharmacotherapy or nicotine-replacement therapy
  • A wellness program - including access to an on-site (or external) health clinic, fitness area and personal coaching
  • Ensuring that all treatments and medications under the U.S. Public Health Service Guideline are covered
  • Eliminate cost-sharing on counseling and medications

How To Create Effective Anti-Smoking Policies

Before rolling out the policies, you need to consider exactly what they include.

For example, will you implement a surcharge the moment that an employee smokes a cigarette outside your office or will you give them a warning before fining them?

You also must consider if your policies will solely include tobacco, or whether they will include vaping.

If you want these bans to be applicable in the long term, you must bring in measures that ensure they stay actioned – such as making your employees take saliva or blood tests.

Any smoking cessation program should be crafted so it covers every psychological, emotional and physical aspects that come with trying to quit.

Giving your employees the right support and resources, they’ll be more likely to stick to it.

If there are any changes to the policies, you’ll also have to communicate them in advance and clearly to your employees.

Anti-Smoking Policies You Can Implement

  • Prohibit smoking in the workplace and on your entire work campus. (alternatively, you can limit it to only outside your building)
  • Publicize group benefits and incentives, whilst ensuring that your business’ health plan includes them
  • Offer several types of modalities
  • Encourage employees to take regular Health Risk Appraisals
  • Educate employees on the risks and promote the incentives
  • Actively encourage employees to participate in events such as World No Tobacco Day and the Great American Smokeout

Acts That Align With Anti-Smoking Policies

  • The Health Insurance Portability and Accountability Act (HIPAA) - under this act, employers are legally allowed to impose surcharges on smokers. However, the act also discloses that as an employer, you should offer cessation resources to your employees (such as the Freedom From Smoking cessation program offered by the American Lung Association).
  • The Affordable Care Act (ACA) - under the ACA, employers can charge employees up to 50% more to cover them with health insurance. However, the act also requires employer-sponsored health insurance to directly cover smoking cessation.

How To Measure the Success of Group Benefits and Incentives

You might wonder, how do I measure the success of the group benefits and incentives to quit smoking?

And while the financial return on investment will not be visible for a while after they are implemented, the physical success of them will be transparent almost straight away.

Not only will you see an increase in productivity in the workplace, but a decrease in absences related to smoking.

Before settling on policies, you must look at these potential benefits and weigh them up against the cost of delivering cessation programs and other incentives.

Ultimately, it’s your choice whether you offer these or not.

But the benefits are undeniable and should not be ignored.


stack of blocks depicting health coverage

What Is Group Health Coverage? Here's Our Complete Guide

Business owners across New Jersey struggle to remain competitive and profitable. It’s hard to keep good employees and keep costs low at the same time. Group health coverage can help you do just that.

Yet, only 41% of small businesses with less than five employees offer insurance. Larger companies with less than 500 employees, about 61% offer insurance.

You can set your business apart by offering top-tier benefits like health insurance to your employees. Ready to learn more?

Read on to find out what group health insurance is and how it can help your business.

What Is Group Health Coverage?

Group health insurance refers to one health insurance policy for a group of people. The group is usually a small business or a trade organization.

How much does group coverage cost? It’s usually lower than if you or your employees were to get individual coverage. Insurance rates are based on risk to insurance companies.

Think of risk like getting a loan from a bank. People with good credit scores will get a better interest rate because they’re more likely to pay the loan back than someone with a bad credit score.

Banks want to protect their profitability, so they’ll charge more for people who are a higher risk. Health insurance companies also calculate their level of risk and profitability.

With individual insurance, there is a higher level of risk to the insurance company, especially if the individual is older. They’re more likely to need to use their insurance more often.

That will result in a higher premium for the individual. Group health coverage allows insurance to absorb risk between more people.

So, in a group of 10 people, some people may need to use their coverage more than others. Since the risk is spread out among more people, insurance companies are able to charge less.

Most group plans have a 70% participation threshold. That means that 70% of your group must participate in the plan. A business with 10 employees (including yourself) must have 7 people take part in the plan.

Are You Required To Provide Health Insurance?

Small business owners usually agree that health insurance can be a big benefit and lower employee turnover. That doesn’t mean that they’re going to provide group health benefits.

Are you obligated by law to provide health coverage? It depends. The Affordable Care Act says that businesses with less than 50 employees don’t have to provide coverage. Those with 50 or more employees do need to provide insurance to employees.

Just because you don’t have to provide health insurance coverage, doesn’t mean that you shouldn’t provide insurance. There are hidden costs to your business by not providing group insurance coverage to your employees.

For starters, how much does employee turnover cost your business each year? One study found that employee turnover costs about $15,000 per employee.

You can retain employees by providing health insurance coverage. Your employees are likely to leave for another position that offers that benefit.

You also need to account for sick days and lost productivity. Employees with health insurance coverage are happier, healthier and more productive.

Finally, there are potential tax credits and deductions for your business. That can lower your tax burden while creating a more productive workforce. In other words, you can be more profitable by investing in group health coverage for your business.

Shared Costs With Employees

When you buy group health coverage, you don’t have to shoulder the responsibility for the entire cost of coverage alone.

Most businesses will share the costs with employees. The percentage that your business pays and your employees pay will depend on a few factors.

You’ll want to weigh the premium costs, the number of employees you need to cover and your eligibility to receive tax credits. There is no set number, but it is something that you and your insurance partner can discuss.

Finding Group Health Coverage

Is your business ready to provide group health coverage? How can you provide the best coverage to your employees? Here are some tips to find the right group health insurance plan.

Gather Your Paperwork

You’ll need to get your paperwork together to apply for group insurance. You’ll need your business name, EIN, industry code, address and payroll records (Quarterly Tax and Wage Report).

A list of employees needs to be part of your application, too. That list needs to have each employee's name, home zip code, gender, birth date, tobacco usage and participation in other health insurance.

Work with a group health insurance agent to find your options. They’ll take your information, look for plans on your behalf and go over your options with you.

You also want to educate your employees on their health insurance plan. Most people know they have coverage, but a very small percentage of people fully understand what is covered or not.

Take the time to educate your employees on the basic terminology. They need to what a deductible is, their monthly premium, their level of coverage and the doctors covered in the group insurance network.

Get Health Insurance For Your Business

Your employees are your company’s biggest asset. Doesn’t it make business sense to not provide health coverage as an employee benefit?

You could lose more money by not providing coverage in the form of lost productivity and employee turnover.

Group health coverage is a way to provide an affordable health insurance option to your employees. You’ll want to bring in the expertise of an insurance agent who can help you find the best group health coverage for you and your employees.

Contact us today to find out about how we help New Jersey businesses with their health insurance needs.


doctor with crossed arms holding stephoscope

Out-Of-Network Health Benefits: How They Work

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Hi everybody! It’s Kate Plageman with Central Jersey Insurance. Most of us have a health plan that has good in-network benefits.

If you do have a plan that has an out-of-network benefit feature, it’s really important that you understand that there can be a lot of hidden costs.

I’m going to give you an example of a claim and how that was likely processed with a typical direct access product with say Horizon Blue Cross Blue Shield of New Jersey.

Say you’re in the hospital and you see a doctor that is out-of-network, does not take any insurance. A lot of orthopedics, dermatologists, psychologists, psychiatrists won’t take any insurance whatsoever. That’s where the out-of-network benefit comes into play.

So, as an example, you go into the hospital, you see a doctor, you incur a claim, say it’s $5,000 total. That claim will come through to the carrier, in this case Horizon, and be discounted to what is considered to be reasonable and customary on an in-network level, okay?

So, that $5,000 will be discounted to say, $3,000. That’s considered reasonable and customary in-network. That difference between the $5,000 and the $3,000 is on you to pay and you will be responsible for that difference.

The out-of-network provider can balance bill you that. That $3,000 that’s left will then be subject to the out-of-network deductible, which is most commonly separate from your in-network deductible.

So, that usually is around $2,500. So, that $3,000 is now $2,500 on you, So, that $3,000 is now $2,500 on you, and then that difference of $500 will be paid at the coinsurance rate which is usually between 60% and 70%.

So, you may have a benefit of a couple hundred dollars out of that $5,000 claim, yet the provider can balance bill you all of that difference.

So, it’s really, really important that you understand how those benefits work before you get involved with out-of-network providers. Also as a footnote to that, if you have a plan that has out-of-network benefits, the premium is significantly higher than those that have in-network benefits only.

So, it’s just a little tip that I wanted to share with you, buyer beware.

Many professionals with gainful employment have group health plans that offer in-network benefits. This means that in-network health care providers have agreed to discounted rates for those covered by specified insurance companies.

Did you know that some plans also have out-of-network benefits? When seeing an out-of-network doctor, you may still receive a discount from your insurance provider, but won’t get a discounted rate on behalf of the doctor.

Keep in mind there are other hidden costs and complexities that can leave you with a hefty out-of-pocket bill to pay. In this post, we’ll break down the difference between in-network and out-of-network benefits and discuss some situations you may encounter.

Why Don’t All Doctors Accept All Insurance Plans?

There are a number of reasons all doctors don’t just accept all insurance plans. Most of the time, it comes down to cost, meaning the doctor believes that the rate offered by the insurer is not enough to warrant their participation.

Some doctors prefer to keep their networks small, working with only a few, or sometimes one (or no) insurance providers. This helps them simplify operations and increase leverage with patients and potential providers.

Another reason is that insurers may have a limited number of provider slots available, whether they are based on the total number of doctors or the services they provide. For example, they may already have enough in-network orthopedists, or they can’t take on over 100 individual practices and have hit their limit.

That said, several states have “Any Willing Provider” or “Any Authorized Provider” statutes which allow any healthcare provider to be an in-network provider if they meet certain requirements. This prevents insurers from blackballing providers and limiting access based on several factors. Depending on the state, these laws can be broad or limited in scope.

Accepting Insurance vs. In-Network

There’s also a difference between a physician “accepting your insurance” and them being an “in-network” provider.

Often when you call a doctor’s office and ask if they accept your insurance, they will tell you they do. But it’s important to dive a little deeper.

A doctor may accept your insurance carrier, Selective for example, but not your specific plan under Selective. This would make them on out-of-network provider vs. in-network.

This is an important distinction to make before making appointments and seeing particular doctors.

Emergency Care

If there is an emergency and you have insurance, you should have access to out-of-network services. Insurance and healthcare providers can’t require you to pay a higher copayment or coinsurance if you receive emergency care from a hospital not in your network. This is thanks to the Affordable Care Act.

The same applies if you don’t have insurance, and hospitals can’t refuse to give you emergency care. This is all because of the  Emergency Treatment and Labor Act (EMTALA). If you’re still concerned about costs, you might go to an urgent care center of the emergency room.

What Should You Do?

The most important thing to do if you’re not sure about in-network or out-of-network benefits is to speak with customer service for your insurance provider. They can check for you if a doctor you’re looking to see is covered under your current plan.

Many insurance providers also have online portals where you can see which doctors are covered under your plan. It’s also recommended you confirm specific details with your doctors.

Still Confused?

Thinking of seeing a doctor that is out-of-network or still feeling confused? Before you take the leap and see a doctor you’re unsure of, click below and download our helpful guide to better understand the hidden costs.

Download Our Guide

two smiling workers bumping fists over their group benefits plan

Group Benefits Plan: What To Offer Your Employees

Employee benefits are insurance plans that employees gain through a business they work for.

They provide these benefits on a group plan that covers all employees in the company. This costs the business money, but it can provide a significant return on investment. By paying a premium, an employer typically gets insurance at lower rates compared to an individual employee finding their own coverage on the market.

Using group employee benefits, companies can attract the best, highly qualified workers to their business in a competitive job market. With a group benefits plan, businesses can reduce the amount that they will pay to cover individual employees. They are often customizable, so the plan can include the key areas that the employer wants to cover and that are attractive to the team.

 

Benefits Of Group Benefit Plans

For Employees

There are benefits to group insurance for employees. They include:

  • Gaining standard coverage without having to prove eligibility or affordability.
  • Lower costs compared to an individual searching for insurance coverage on the market.
  • Ability to share costs with the employer, leading to cheaper plans for each individual.
  • Access to benefits that are not available outside a group benefits plan including recreational options exclusive to workplace employees.

For Businesses

Group benefits also provide significant benefits to the employer or the business owner, including:

  • Protection of the investment made in their employees. If an employee gets injured or falls ill, expenses can be covered to ensure they can return to work as quickly as possible.
  • Improved levels of tax compensation. Benefits are paid before tax is taken from income, providing more money to employees.
  • Helps improve productivity by eliminating outside burdens for staff.
  • Positive employee satisfaction, commitment and loyalty to your business because they feel they are taken care of.

Primary Benefits Available

There are some standard options businesses can provide to their employees on a group benefits plan. You can watch our video summary below or continue reading:

Health

Health insurance offers support to employees who are dealing with health issues including long-term conditions. It guarantees that employees can get the treatment they need for different medical conditions. It improves their quality of life and ensures that they can get the support they need to be a vital member of the business team. 69% of private industry workers can access this through their employee while it is available to 89% of local and state workers.

Dental

This is one of the most sought after benefits according to employees. Dental allows employees to get regular oral checks and hygiene treatments. It also ensures that they can get the treatment they need for painful conditions such as a root canal.

Vision

Issues with vision can severely impact an employee's ability to work. Eye strain can cause pain and headaches that impact an employee’s level of productivity, ability to work and their general level of wellbeing. With vision insurance, employees can gain treatment including glasses and contact lenses. Sometimes, coverage may also provide for the costs of permanent solutions including laser surgery.

Life

This benefit provides support for the people whom employees leave behind. Life insurance is an attractive possibility for employees who have families and want to make sure that their descendants receive support if they suddenly develop a terminal illness or suffer an accident. 57% of employees working in private companies can access life insurance benefits from their employer.

Disability

Ensures that if an employee suffers from a disability while working for you, they can get the support they need for improved quality of life. This includes the cost of medical expenses, changes they may need to make to their home and the cost of long-term living.

Additional Benefits For Employees

Aside from the main options, there are a variety of other benefits that you should offer your employees.

This includes paid time off, or PTO. Paid time off can include anything from days where an employee is sick to time that they want to take on vacation. Typically, the employer will determine a set number of vacation days employees can take each year, which the benefit plan covers. If an employee wants to take further days, they may, but they will be without pay.

Certain businesses may include telecommuting plans in employee benefits, which come in the form of cell phone plans. It's usually the case where remote workers need to be in contact with the main business office or other colleagues throughout the day.

More businesses are now including wellness programs in group employee benefits to keep their work team healthy and fit. This leads to higher levels of productivity and ensures that job satisfaction improves as employees feel more comfortable and taken care of.

Childcare benefits are another popular option. Childcare can take the form of compensation for employees who need to take time off to care for their children. Alternatively, a business may also set up an on-site childcare system for parents who need options for care while they are at work.

Overall, group benefit plans provide financial advantages for both businesses and staff. They help boost morale and make a company more attractive to new employees. It can reduce staff turnover since employees feel safe and valued in their position. This means they have less reason to seek other opportunities, particularly if the benefits provide long-term support to their families.