31 July 2018 By

Below is a rather long, but interesting and informative article about new legislation that will help protect your employees from out-of-network billing for services that were received at in-network facilities.  Good examples of this is emergency rooms, anesthesiologists, radiology and lab services who are usually not participating with any carrier, or at least may not be participating with your particular carrier.  It is precisely this mismatch of participation status that leads to the so-called surprise bills. 

The interpretation, implementation and administration of the law is complicated and while it may not actually alleviate claims issues from arising, it’s a big step in the right direction because the intent of the law is clear and its patient protections will potentially improve the outcomes and reduce costs.

I will keep you apprised of any further developments.  Please let me know if you have any questions.

Barry E. Fields
Vice President, Employee Benefits

JGS I N S U R A N C E
Cell: 908-406-7000 | Fax: 732-834-0233
101 Crawfords Corner Road, Suite 1300, Holmdel, NJ 07733


If services are either out-of-network “inadvertently” or are “emergent,” the provider is barred from billing the patient in excess of their deductible, copayment or coinsurance obligation.

On June 1, Assembly Bill 2039 became law, ushering in bold patient protections and blockbuster realignment of claims-handling processes. Effective Aug. 30, extinction of “surprise” out-of-network claims is its goal. Patient protections now secured, the true “surprise” awaits providers and carriers scrambling to meet disclosure requirements and the uncertain fiscal impact upon plans who must comply.

A new claims order

Protection under the act hinges upon two classifications of medical charges.

The first category addresses out-of-network services that are “knowingly, voluntarily and specifically” selected. In these circumstances, aside from brief disclosure obligations of the provider (discussed later), no further protections apply.

The second category really shakes things up. Major patient protection provisions are created. Claims practices between providers and payers are significantly modified. Namely, if services are either out-of-network “inadvertently” or are “emergent,” the provider is barred from billing the patient in excess of their deductible, copayment or coinsurance obligation. This is the hallmark achievement of the act, sparing patients from so called “surprise medical billing.”
03 July 2018 By

The Department of Labor (DOL) released a final rule that gives businesses more freedom to join together as a single group to purchase health insurance in the large group market. These benefit arrangements are called Association Health Plans (AHPs).  According to the DOL, this will provide employers with more affordable health insurance options.  However, in exchange for lower premiums, AHPs may cover fewer benefits.
 
Prior to this executive order, the criteria that must be satisfied for a group of employers to sponsor an AHP were very narrow.  The final rules make it easier for employers to join together to purchase health insurance.  However, just because the legislation reduces the requirements for creating an AHP doesn’t mean that insurance carriers will be any more receptive to covering these groups than in the past.
 
What many employers do not realize is there are currently a few existing Association Health Plans available in the New Jersey market.  These programs utilize the largest networks of participating providers and are viable alternatives to the traditional carriers.
 
As always, please let me know if you have any questions or would like additional information.


Barry E. Fields
Vice President, Employee Benefits

JGS I N S U R A N C E
Cell: 908-406-7000 | Fax: 732-834-0233
101 Crawfords Corner Road, Suite 1300, Holmdel, NJ 07733

06 June 2018 By

Governor Phil Murphy signed into law a bill that requires New Jersey residents to have health coverage or pay a penalty.  

 
The law, which will take effect on January 1, 2019, will require every New Jersey resident to obtain health insurance with minimum essential coverage or pay a fee, essentially adopting the rules of the federal Affordable Care Act (ACA). Under the Individual Mandate at the federal level, most Americans were required to obtain health insurance or pay a fine.  However, beginning in January 2019 there is no fee associated with the Individual Mandate due to the federal repeal. The main purpose of this new law is to

23 May 2018 By

New Jersey is the latest state to mandate a comprehensive equal pay law, called the Diane B. Allen Equal Pay Act.  What makes this law different and more robust than laws in other states is that the New Jersey equal pay law will soon extend legal protections beyond gender and provide relief to all classes of employees protected under the state's antidiscrimination law.

New Jersey's existing wage and hour law already prohibits employers from discriminating in any way in the rate or method of payment of wages to any employee because of his or her sex.

The new law, which will take effect on July 1, expands this protection and amends the New Jersey Law Against Discrimination to make discrimination in wages on the basis of any protected class an unlawful employment practice. With the new law soon taking effect, you need to carefully analyze your existing pay practices to ensure compliance.

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