Coastal Financial Group, Inc.
150 River Road, Suite E-3Horizon Blue Cross Blue Shield of New Jersey has added a Maternity Health Coach program to its existing 24/7 Nurse Line and PRECIOUS ADDITION programs to provide a wider range of personal support for eligible mothers.
New Maternity Health Coach Program Available(pdf)
Click here to view the webpage
Starting January 1, 2014, the Affordable Care Act (ACA) prohibits health plans from including “excessive waiting periods.” A waiting period is the amount of time an eligible enrollee has to wait before coverage is effective. “Excessive” is considered a waiting period longer than 90 days. This provision applies to all plans, including grandfathered plans.
We will comply with any state law that limits waiting periods to less than 90 days.
We are updating our systems internally to ensure that all plans are in compliance. Any existing Small Group plan with a waiting period longer than 90 days will be changed to a compliant waiting period upon renewal in 2014, as shown in the table below. A plan sponsor may also choose a different compliant waiting period at renewal by notifying us in writing.
The table below explains how we will make updates.
| Current Wait Period | Coverage Begins On | New Wait Period | Coverage Begins On |
| 91+ days | Immediately Following Wait Period | 90 days | Immediately Following Wait Period |
| 3+ months | Immediately Following Wait Period | 2 months | Immediately Following Wait Period |
| 61+ days | 1st or 15th of the month after wait period | 60 days | 1st or 15th of the month after wait period |
| 2+ months | 1st or 15th of the month after wait period | 1 Month | 1st or 15th of the month after wait period |
The mandate also includes a special rule related to individuals in a waiting period prior to applicability date. If the member is subject to a waiting period that exceeds 90 days it will no longer be valid. The mandate also includes a special rule for employees who work variable hours where employers can use a measuremet period to determine eligibility.
Throughout the next few months, we will be including an insert to bills provided to all Small Group Plan Sponsors detailing the upcoming change. We are also placing a message on the eBilling application for all plan sponsors.
Thank you for your continued partnership. We ask that you relay this information on to your clients to ensure everyone is informed. If you have any questions, please contact your local Aetna Sales Executive.
Horizon BCBSNJ Brief Notes V. 22, No. 932: Horizon BCBSNJ offers tools to improve members experiences
Applies to: All markets
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Making it easier for our members to do business with us
Horizon BCBSNJ offers tools to improve members’ experiences
Horizon Blue Cross Blue Shield of New Jersey understands our members lead busy lives and that having access to their health care information, when they need it, is important. With this in mind, Horizon BCBSNJ offers tools to improve our members’ experiences.
Call back tool
Now, when your clients’ employees call Member Services during times of high call volume, they no longer have to wait on hold for the next available Member Services Representative. Instead, members will have the option to request a call back at a scheduled time or when the next Member Services Representative is available. This new call back feature gives members more control and flexibility when interacting with us.
Virtual ID card
Your clients’ employees don’t have to worry if they lose their ID cards or leave it at home. They can easily view and/or print a replica of their Horizon BCBSNJ ID cards when signing in to Member Online Services at HorizonBlue.com. They can also use the Horizon Blue App to view their ID cards.
Year-To-Date Account Balances tool
Member Online Services also gives members access to their real-time, year-to-date deductible amounts and out-of-pocket maximums. Your clients’ employees with active medical coverage can view their account balances, or the account balances for each member of their families. Individual and family year-to-date deductible amounts and out-of-pocket maximums will display, and members can also view in-network and out-of-network services. To access this tool, your clients’ employees can sign in to or register at HorizonBlue.com and then click View Year-to-Date Account Balances.
Using technology to give your clients’ employees options for getting their health care information is another way Horizon BCBSNJ is Making Healthcare Work.
If you have questions, please contact your Horizon BCBSNJ sales executive or account manager.
The Affordable Care Act (ACA) requires employers across all segments to provide their employees with a written notice of the existence of public health insurance exchanges and eligibility for premium tax credits or cost sharing (if applicable for employer’s plan), regardless of whether the exchange is operated by the state or the federal government.
To help you support your clients, here are some frequently asked questions and answers about the Notice of Coverage:
Employers must send a notice to all full- and part-time employees, whether or not they are on the employer’s group health plan. Employers do not have to notify employees’ dependents or others who are eligible for coverage but are not employees.
Current employees must be notified by October 1, 2013. New employees hired on or after October 1, 2013, must receive this notification within 14 days of their start dates.
The U.S. Department of Labor (DOL) created model notices that your clients can use to notify their employees.
Aetna encourages employers to speak with their own legal counsel when considering whether to use the model notices provided.
Some of the questions within the model notice ask employers to indicate if their plans meet the minimum value standard. If your client’s group health plan does not meet the minimum value standard, their employees may be able to get a tax credit by buying health insurance on a federal or state exchange.
Please note: A health plan meets the ACA’s minimum value standard if it pays for at least 60 percent of each covered employee’s health care costs.
Employers can make this determination by using the Minimum Value calculator available on the Center for Consumer Information and Insurance Oversight (CCIIO) website.
As we count down to the opening of the Marketplaces, we are pleased to offer this special issue of Broker News. Horizon BCBSNJ is dedicated to bringing you the latest information and tools for doing business in the Marketplaces, and we want to help you market your expertise in this changing health insurance environment.
Click here for the special issue of Broker News.
Please contact your Horizon BCBSNJ sales representative with any questions on the Broker News release.
Archives of broker Brief Notes and Broker News can be found at HorizonBlue.com/Brokers/Broker-Brief-Notes.
Thank you!
STATE OF NJ DEPARTMENT OF BANKING AND INSURANCE
BULLETIN NO. 13-14
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TO: ALL HEALTH CARRIERS AUTHORIZED TO ISSUE HEALTH BENEFITS PLANS IN NEW JERSEY THAT ISSUE INDIVIDUAL HEALTH COVERAGE PROGRAM (IHC) COVERAGE AND SMALL EMPLOYER HEALTH BENEFITS PROGRAM (SEH) COVERAGE
FROM: KENNETH E. KOBYLOWSKI, COMMISSIONER
RE: AMENDMENTS TO THE IHC AND SEH RATING RULES UNDER THE PATIENT PROTECTION AND AFFORDABLE CARE ACT (ACA)
The 2010 Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended) establishes requirements that health insurers must follow including, among other things, the way premiums and rebates must be calculated. The ACA also imposes new fees and taxes beginning in 2014. Some of the provisions of the ACA conflict with or nullify the Department’s current Individual Health Coverage Program (IHC) and Small Employer Health Benefits Program (SEH) rules. Additionally, the new fees and taxes are not accounted for in the current rules. The purpose of this Bulletin is to briefly describe the differences between the ACA requirements and current IHC and SEH regulations, and to provide guidance to carriers regarding necessary action in order to comply with the ACA and Federal
regulations pending the Department’s adoption of amendments to its current rules.
Current IHC rules require the use of 5-year rate bands, while the ACA requires one-year rate bands for adults aged 19-63. Current IHC rules permit a maximum ratio of 350 percent between premiums for the highest rated individual policyholder and the lowest rated individual policyholder in the state based on age, while the ACA established 300 percent as the maximum range for adults. Coverage tiers for non-single coverage currently permitted in the IHC rules are not permitted under the ACA or Federal regulations.
Current SEH rules require a separate rate tier when Medicare is primary, which is not permitted by the ACA. Current SEH rules also use separate rating pools for purchasing alliances and nonstandard plans, and use gender as a rating factor. Guaranteed issue and single risk pool requirements under Federal regulations prohibit offerings on different terms to a subset of the SEH market. Therefore, purchasing alliances may not be offered different terms than other small employers.
The ACA prohibits plans from including annual or lifetime limits on Essential Health Benefits. This prohibition conflicts with current IHC and SEH regulatory requirements to offer Basic and Essential plans, which are required by statute.
For rates applicable to all rating periods beginning on or after January 1, 2014, carriers are directed to:
Formulate rates in the IHC market to achieve a required 300 percent maximum ratio between premiums for the highest rated individual policyholder and the lowest rated individual policyholder in the State. Age factor categories should be in the following increments: children ages 0 through 20, one-year age bands for adults ages 21 through 63, and a single age band for adults ages 64 and over;
Formulate rates in the SEH market without regard to gender. Age factor categories should be in the following increments: children ages 0 through 20, one-year age bands for adults ages 21 through 63, and a single age band for adults ages 64 and over.
In the SEH market, Medicare status should not be used as a rating factor. The foregoing changes do not apply to any plan for which “grandfather” status has been established pursuant to 26 CFR 54.9815-1251T, 29 CFR 2590.715-1251 or 45 CFR 147.140.
Existing rating requirements for Basic and Essential plans will be moot as of January 2014, and such plans will not be available for sale.
Finally, the ACA imposes new Federal fees and taxes on insurers that were not anticipated when the current rules were promulgated. New Federal fees and taxes should be excluded from premium for purposes of medical loss ratio (MLR) calculation. The exclusion of new Federal fees and taxes is intended to maintain the status quo in MLR calculation; carriers therefore should not exclude from premium fees and taxes that existed prior to January 1, 2014.