Grandmothering Extended Into 2019 for Pre-ACA Plans

May 31, 2018

Applies to: Pre-ACA Small Group plans with 4th quarter 2018 renewals

Horizon Blue Cross Blue Shield of New Jersey is pleased to advise that groups with health plans that preceded the Affordable Care Act (“pre-ACA plans”) and that renew between December 31, 2018, will be permitted to renew within those pre-ACA plans. With the fourth quarter representing our highest volume of renewing membership, our decision to grandmother pre-ACA plans will facilitate a smooth renewal process.

If a group opts to leave its pre-ACA plan, it will need to move to an ACA-compliant policy with stand-alone pediatric dental (SAPD) coverage. Popular ACA-compliant options include our OMNIA SM Health Plans.

Horizon BCBSNJ will communicate to you and your impacted groups the important details and dates regarding the renewal process. Below is an outline of the communications.

Broker Communications

  • October, November and December pre-ACA and ACA renewals will be available to the Broker of Record via the FTP secure site. An email notification will be sent once a renewal is available.
  • Renewals will be released according to the following schedule:
  • October renewals – no later than July 31
  • November renewals – no later than August 31
  • December renewals – no later than September 30

Group Communications

  • October ACA renewals: Renewals will include recommended ACA plans to which each group can be mapped.
  • October, November and December pre-ACA renewals: Renewals will include a pre-ACA renewal indicating that they may renew as is, as well as a suggested ACA plan to which each group can be mapped. A CMS Model Notice will also be included.
  • Renewals will be released according to the following schedule:
  • October renewals – no later than July 31
  • November renewals – no later than August 31
  • December renewals – no later than September 30

Please note:

  • If a group does not actively select an ACA plan, it will automatically renew as is with its existing pre-ACA product.
  • For all groups that select an ACA plan, please submit the ACA conversion via Broker Online Services.

Pre-ACA to ACA Plan Conversions

It is important to familiarize yourself with the process and paperwork requirements for groups that are converting from a pre-ACA plan to an ACA plan. All groups are required to send in, with the conversion form, new certification paperwork including applicable tax documentation, as noted below, and waivers. This applies to all pre-ACA to ACA conversions regardless of whether they previously sent in their certification to Horizon BCBSNJ and were advised by Horizon BCBSNJ Small Group Certification they could renew as is. Conversion paperwork should be sent to our Conversions department at Conversion@HorizonBlue.com , not to Horizon BCBSNJ’s Certification department

Mandatory Tax Documentation for Groups with two to five or 45+ Eligible Employees
Group Structure Form Additional Documentation
Single Owner/Sole Proprietor Schedule C Q3 2018 WR-30 for employees
Partnership
(must be 100% ownership)
K-1(s) Q3 2018 WR-30 for employees
Corporate Entities (C- and S-corps) Schedule G for 2017 Q3 2018 WR-30 for employees
All Groups   NJ State WR-30: Most recent completed quarter for all employees¹

WR-30 = Quarterly Wage Report

¹Effective October 1, 2018 and after, third quarter WR-30s will be required for fourth quarter 2018 conversions.

Groups of six to 44 eligible employees do not need to submit tax documents, but rather the Certification with Conversion form and waivers.

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Published on: June 5, 2018, 06:46 AM ET
Last updated on: June 6, 2018, 05:41 AM ET