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Final Rule on Nondiscrimination in Health Programs and Activities
Rules already in place for nondiscrimination due to gender, age, color, etc. One of the additions includes, that individuals be treated consistent with their gender identity, which may be different from their sex assigned at birth.
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Form 1095-B and Health Coverage Information
Members will receive Form 1095-B because either they bought their coverage directly from Horizon Blue Cross Blue Shield of New Jersey and not through Healthcare.gov* OR they have Horizon BCBSNJ coverage through their fully-insured employer.
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Changes to Maximum Out-of-Pocket (MOOP) Limits in 2016
Beginning 1/1/16 for Small Group and upon renewal for Large Group that is subject to the mandate, the Individual MOOP applies to each and every member who is enrolled under a Family, Two Adults or Parent and Child contract under a group health plan.
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2014 ACA provisions affecting SEH plan eligibility and UW rules
ACA affect several of the eligibility and underwriting rules that apply to SEH benefits plans issued on or after 1/1/14. Some affects are: majority employees do not need to reside in NJ anymore; late entrants must wait until anniversary to enroll...
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Broker News: Health Care Reform for November 2013
Horizon Special Edition newsletter, contains news on: Horizon expands away from home care program; accessing new portals; Horizon reaction to DOBi statement regarding Obama extension of canceled plans; and more...
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Federally Facilitated Marketplace (FFM) Agent/Broker training
Horizon release regarding training. The ACA requires licensed agents and brokers to register and/or become certified to help clients select and enroll in coverage through the new Health Insurance Marketplaces, also known as public exchanges.
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Health Care Reform 301 - FAQ
Attached is the FAQ handout from Horizon's Health Care Reform: 301 webinar
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Broker News: Health Care Reform
Horizon Special Edition newsletter, contains news on: How ACA will affect small group market and premiums; Public Exchanges; Employer Reporting Requirements; and more...
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New rules issued for the Summary of Benefits and Coverage
HHS recently released final rules on SBCs along with some changes. The new rules applu to coverage issued during 2014 (or plan year 2014 for group health plans). Horizon created a Q&A to help assist you with the changes.
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Employer-Coverage Mandate postponed until 2015
Affecting employers with 50+ employees, the White House announced a 1 year delay for the employer penalty in ACA. This transitional period, employers are encouraged to voluntarily adhere to regulations, but penalties will not begin until 2015.
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Update on Summary of Benefits and Coverage (SBC)
The Department of Labor recently released revised templates and additional FAQs related to the SBC. Regulators are extending the safe harbors and enforcement relief provided last year. Penalties will not be imposed on plans/issuers working to comply.
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Reinsurance Assessment Fee UPDATE - How payments are made
HHS has clarified that for self-funded groups, this fee must be paid by the plan (employer) itself. It cannot be collected by the carrier. This is different from fully insured groups, where the carrier can include the fee in the premium collection.
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03.13.2013
SBCs: Creating & Distributing for the Individual Market
To comply with PPACA, brokers who solicit individual customers need to give SBC’s to these prospects at the certain points including: When Shopping, upon application of coverage, coverage is changes or remains same at renewal and more...
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03.05.2013
Affordable Care Act (ACA) requires Reinsurance Assessment Fee
Under ACA, states may establish a reinsurance program by 1/1/14. The program is funded by a fee charged to carriers, which will be charged down to clients. SEH clients are not subject yet until DOBi approves a rate change.
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02.20.2013
ACA imposes Insurer Fee on premiums
ACA, in order to subsidize premiums for low income individuals and families, will impose an insurer fee beginning 2014. Horizon will increase premiums accordingly to accomodate the tax. SEH clients are safe until DOBi approves new rates.
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