GPAHU Pulse – February 2021

GPAHU - Monthly State and Legislative Updates

Here’s something to talk about when discussing plan design options and employer contribution strategy with group clients in the New Year.

Telehealth now constitutes 6 percent of outpatient visits, compared with less than 1 percent before the pandemic, according to recent research by the Urban Institute,

  • One-third of adults had a telehealth visit in the first six months of the coronavirus outbreak.
  • Adults who were more likely to use telehealth than their respective counterparts include those in fair or poor health, adults with multiple chronic conditions, and Black and Hispanic/Latino adults.
  • Those who were more likely to want a telehealth visit but did not receive one were more likely to have an unmet need for care because of the pandemic.
  • Fewer than 10 percent of adults did not see a provider because they did not want a telehealth visit or the provider did not offer telehealth visits.

Source: The Urban Institute, January 12, 2021.

The Big Three

Each month GPAHU identifies three top public policy or legal developments that could impact our members and clients.  Here are this month’s big three!

Pennsylvania Announces New Exchange Special Enrollment Period

Pennsylvania state officials recently announced that the new state-based health insurance exchange, “Pennie,” will reopen from February 15 through May 15 to help Pennsylvanians who are uninsured or who lost coverage due to job do the COVID-19 pandemic access coverage. Pennsylvanians can use Pennie to access individual health insurance coverage during this new open enrollment period—no qualifying event required. Certified brokers may help their clients obtain individual coverage and premium tax credits through Pennie. 

The new Pennie open enrollment period parallels the federal Centers for Medicare and Medicaid Services’ announcement that the federal health insurance marketplace,, will reopen for new applicants and existing application updates between February 15-May 15, 2021. In our area, this order applies to Delaware, which uses directly for its marketplace.  New Jersey’s state-based exchange, Get Covered New Jersey, also responded to COVID-19 with a special enrollment period.  New Jersey’s exchange is already accepting new applications and will continue to do so through May 15, 2021.

President Biden’s Healthcare Executive Order

On Thursday, January 28, 2021, President Biden signed the Strengthening Medicaid and the Affordable Care Act (ACA) Executive Order. It repeals two Trump Administration healthcare-related Executive Orders–13765 and 13813 and directs all federal departments and agencies to review existing policies and suspend, revise, or rescind any that do not help improve healthcare access and affordability, and support Medicaid and the ACA as soon as possible.

This order could eventually change existing health insurance coverage options for individual and group purchasers. Former President Trump’s Executive Order 13765 directed all federal agencies to relax any possible ACA requirements, which led the IRS to allow health insurance issuers a safe harbor for distribution of Form 1095-B. Executive Order 13813 instructed federal agencies to develop new health coverage options, which ultimately led to individual coverage health reimbursement arrangements, excepted benefit health reimbursement arrangements, an additional association health plan option, and revisions to federal policies concerning short-term limited-duration insurance policies. As per President Biden, all of these health coverage options are now under review, with the potential of activity in the near-term future to revise or rescind related actions.

Change To New Jersey Employer Requirements Affects Businesses Nationwide That Provide Health Insurance to State Residents

New Jersey regulators recently announced a change to their employer reporting policies that affect all businesses in every state that offer Garden State residents coverage.  New Jersey has its own employer reporting requirements to help enforce the state’s mandate that all residents maintain health insurance coverage, and the rules just got a lot more complicated for any company with New Jersey employees. In the past, the state just asked applicable large employers and companies that offered self-funded coverage to provide them with the federal Form 1095 information they gave to the IRS and New Jersey-based employees. Now the state is asking all employers nationwide, regardless of size, to provide them with coverage details about each New Jersey-based enrollee. The information that the state requires for every covered employee or dependent who is a full or part-time New Jersey resident includes:

  • Employer group contact information;
  • Each state resident’s full name;
  • Their social security number or other tax identification number;
  • Date of birth if the tax identification number is not available; and
  • Each month the individual was enrolled in group coverage in 2020. 

In practice, what this means is every business in the country with New Jersey-based residents on their group health plan must ensure that the state gets all of this data for each individual.  The data can come from either federal 1095-B statements for those individuals, federal form 1095-Cs with just parts one and three filled out, or the New Jersey Form 1095, which is very similar to IRS Form 1095-B. Applicable state residents also need to get a copy of their form, even if the carrier does not typically send one except on request due to relaxed federal standards. 

A fully-insured group health plan can ask their health insurance carrier to do the New Jersey-specific filing for them. Still, ultimately the employer retains the filing penalty liability, which is $50 per covered state resident, with a cap of $50,000. Last year, few health insurance carriers did the New Jersey-specific filing for their employee groups, particularly those located out of state, so any group, including small groups, may need a reporting solution.  Self-funded groups and level-funded groups with plan participants from New Jersey also need to report in themselves or find vendors to do so on their behalf.

If a group has a reporting vendor, it is critical to make sure that they will both complete the New Jersey specific group reporting and submit just the New Jersey-based data to the state. Otherwise, there are privacy violation concerns. There are two other solutions for groups available. Those with less than 100 forms to file can use the NJ Form 1095 and manually file each one themselves. If an employer needs to file 100 or more forms and already has an account with the state’s MFT/Axway system (which is the same system an employer would use if they directly file Forms W-2), they can use that login to file directly. There are data standards attached to this method that an employer needs to meet, and the employer will need to get the appropriate information from their carrier. It’s important to only submit data for New Jersey-based enrollees to avoid a HIPAA violation.  

Check This Out!

If you want to expand your health policy knowledge beyond this newsletter, here is a resource to check out!

The Department of Labor has an online compliance tool available that employers and clients can use to test if different laws apply to them and help them determine what to do about it if they do!

You May Also Like…

PA-NABIP Pulse June 2024

PA-NABIP Pulse June 2024 The Facts of the Month Here is something to mention when discussing health trends in the...

PA-NABIP Pulse May 2024

The Facts of the Month Here is something to mention when discussing coverage trends in the month ahead. While the...

PA-NABIP Pulse April 2024

The Facts of the Month Here is something to mention when discussing coverage trends in the month ahead. Twenty-three...