The state of New Jersey is requiring insurers and employers to report certain 2019 health coverage information to plan enrollees and the state in early 2020. Both small and large employers, including employers based in other states, may be affected. The rules are similar to the federal ACA rules and Forms 1095-B and 1095-C can be used to meet both requirements. And the good news is that employers whose health plans are insured do not have file any 1095s with the state as long as they make sure that their insurance carrier does so. Self-funded employers, however, will have a little more work to do.
Starting in 2019, New Jersey requires most residents to have minimum essential health coverage (MEC) or pay a state tax penalty. Coverage through Medicare, Medicaid, an individual medical insurance policy, or an employer-sponsored health plan, generally will satisfy the state’s MEC requirement. Individuals will indicate their coverage status when they file their 2019 state tax returns this spring. In order to verify the taxpayer’s information, the state also is requiring the insurance carrier, employer, or other entity that provided the coverage, to report MEC information.
The New Jersey Health Insurance Market Preservation Act (HIMPA) requires that the insurer or employer that provided MEC to a New Jersey resident in 2019 complete two reporting requirements:
Insurers and employers may be preparing 1095s for persons in multiple states as required under the federal ACA rules. To ensure privacy, however, insurers and employers are advised not to transmit 1095s for any out-of-state residents to the New Jersey system.
First, determine whether the employer provided MEC to any New Jersey residents in 2019. If so, determine whether the coverage was insured by a carrier or self-funded (self-insured) by the employer. Then take the appropriate steps:
If insured, confirm that the insurer (or multiemployer plan such as a union trust) will comply with the New Jersey reporting requirements by the due dates. The employer may share liability if the insurer or multiemployer plan does not file the required 1095s on time.
If self-funded, comply with the state reporting requirements by the due dates. The forms and instructions for completing them are the same as for self-funded employers under the federal ACA rules. (The state, however, does not require 1094s; only 1095s are filed with the state.) If participating in a self-funded multiemployer plan, the plan trustee may be handling the reporting but the employer should ensure it is completed on a timely basis to avoid liability.
The state of New Jersey provides detailed guidance to employers and other coverage providers. Reporting entities will want to pay particular attention to the instructions about transmitting forms electronically using the state’s MFT Secure Transport system.