Carrier News

Our Partner EMPLOVA PEO Has Earned ESAC Accreditation   ESAC accreditation is the gold standard for PEO best practices and financial reliability. It ensures a PEO is meeting the highest standards for financial stability, ethical business conduct and adherence to operational standards and regulatory requirement. Less than 5% of PEO’s have been able to attain… Read More

UHC/Oxford Montefiore Health Systems Out-of-Network Communications for Employees As previously communicated Montefiore’s hospitals and physicians are now out-of-network for UHC/Oxford plans. However, consistent with state regulations, members enrolled in fully insured commercial plans will continue to have in-network access to Montefiore’s hospitals until March 1, 2021. To help members with their transition UHC/Oxford has prepared employee communications providing alternative… Read More

Montefiore Health Systems Out-of-Network for UHC/Oxford Effective January 1, 2020 UHC/Oxford has advised that they were unable to reach an agreement with Montefiore Health System despite months of negotiations. As a result, Montefiore’s hospitals and physicians are now out-of-network for UHC/Oxford plans, effective January 1, 2021. Consistent with state regulations, members enrolled in fully insured commercial plans will continue… Read More

Horizon January 1st Effective Date: Deadline Extension See below from Horizon.  NJDOBI has extended the deadline for January 1st effective dates due to heavy call volumes received in the past 2 weeks for both ON and OFF Exchange. Please follow the process below for January 1st exception requests (including renewals) up to the deadline of… Read More

Below are links to our 2021 Small Group Insurance Carrier Requirements Quick Reference Charts for New York and New Jersey. 2021 New York Small Group Insurance Carrier Requirements 2021 New Jersey Small Group Insurance Carrier Requirements Below are links to our Quick Reference In-Network Hospital Charts outlining the hospital systems that are included in each… Read More

See Below 2021 Updates and Information from Members Health Plan Please note the following 2 key changes effective 1/1/20: Husband/Wife groups are no longer eligible Pharmacy changing to Aetna   January 2021 Plan Changes and Updates Pharmacy Program transitioning to Aetna effective 1/1/21 New ID Cards being Mailed to All current Members beginning the week… Read More

Waiver of minimum participation and minimum employer contribution requirements on the new 7/1/20 Horizon OMNIA Health Plans has been extended to 12/31/20. Below is the original Brief Notes announcing these new plans with updated waiver highlighted in yellow. HORIZON BRIEF NOTES Applies to: Small Employer & Mid-size markets New OMNIA Health Plans for Small Employers… Read More

Horizon Blue Cross Blue Shield of New Jersey and Professional Group Plans cordially invite you to attend: The 2020 Broker Sales Conference via Webinar Thursday, October 29 at 1:30 PM   Click Here to register. About the Broker Sales Conference Horizon Blue Cross Blue Shield of New Jersey welcomes you to join us for an informative… Read More

Medicare Estimation is a process for determining the secondary payment when Medicare Part B is the primary payer. Medicare Estimation reduces the payment by the amount the primary Medicare Part B would have paid, by assuming the eligible member was enrolled in Medicare Part B. As previously communicated, July 1, 2020 Oxford began strictly enforcing… Read More

See below Flu Season Reminder Brief Notes from Horizon BCBSNJ Applies to: Fully insured and self-insured health plans (excluding Medicare Advantage) Staying Healthy During Flu Season Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) reminds members that getting a flu shot is the most effective way to prevent the flu. We encourage all… Read More