Changes for New Jersey Small Group (2-50) Employers and Individual Policyholders Renewing on or after Jan. 1, 2014
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1 Changes for New Jersey Small Group (2-50) Employers and Individual Policyholders Renewing on or after Jan. 1, 2014 As you know, many of the Affordable Care Act (ACA) provisions are being implemented on Jan. 1, 2014 and all New Jersey small group (2-50) and New Jersey Individual plans will change. In 2014, our products will include essential health benefits (EHB) and have different cost-sharing choices. Changes to New Jersey Small Group (2-50) Plans Under the authority of the New Jersey Administrative Code, section 11: , our current Oxford 1 New Jersey small group plan designs will be changing upon renewal, beginning with Jan. 1, 2014 effective dates through the end of We will be automatically renewing these plans into new Affordable Care Act (ACA) compliant plans. Employers may choose to renew into their proposed ACA compliant plan or, if they prefer, may also choose any of the other Oxford plans we offer in the New Jersey small group market. If no action is taken prior to renewal, your clients will be automatically renewed in the alternative plan described in their renewal packet and billed accordingly. In addition to EHB and ACA required changes, we are making other modifications that may affect your New Jersey small group (2-50) clients upon renewal: Oxford USA: Employees with Oxford USA out-of-area coverage will be transitioned to an alternate Oxford Health Insurance, Inc. option that will provide out-of-area coverage. Dental or Vision Rider: For groups that have the added dental or vision rider as part of their medical plan, these options will no longer be available upon renewal. Please note, we offer many stand-alone specialty benefit options, including dental and vision. We also offer pre-packaged specialty benefit options through Oxford Benefit Management (OBM). 2 HMO and POS Flex Plan Changes: All of our HMO and POS Flex plans on the Oxford Health Plans (NJ), Inc. license, with the exception of the Primary Advantage plans, are being withdrawn from the market. If your clients currently offer one of the impacted plans, they will be transitioned to an Oxford Health Insurance, Inc. licensed plan. Benefit coverage will remain largely the same; however, clients should review their Summary of Benefits and Coverage (SBC) for complete plan details. Limited Ambulatory Surgical Center Benefit: Upon renewal, all plans that include an out-of-network level of benefits will now have an annual dollar limit on the out-of-network benefit for Ambulatory Surgical Centers. Please note that some of our POS Flex plans already include this dollar limit. Per the above-mentioned Code, employers will receive a notice 90, 60 and 30 days prior to their renewal date informing them of these changes. With the exception of the 90 day notice for Jan. 1, 2014 renewals (which will be mailed separately), employers will receive this notice as an insert in their monthly bill. Groups will also receive their renewal package 60 days in advance of their renewal date. The renewal package will provide a high level comparison of their current plan design and the new, ACA compliant plan design, and updated rate information. We will share copies of the small group renewal letter and other renewal collateral with you in the next two weeks. Enclosed is a copy of the 90/60/30 day small group notice for your reference New Jersey Small Group (2-50) 90/60/30 EHB-Withdrawal Notice (bill insert)
2 Changes to New Jersey Individual Plans Under the authority of the New Jersey Administrative Code, section 11: , many of our existing Oxford New Jersey Individual plan designs are being withdrawn from the market and non-renewed, beginning with Jan. 1, 2014 effective dates through the end of We will be automatically renewing our New Jersey Individual plans into new ACA compliant plans. Individual policyholders may choose to renew into their proposed ACA compliant plan or, if they prefer, may also choose any of the other Oxford plans we offer in the New Jersey Individual market Policyholders enrolled in a Standard plan will be mapped to our most equivalent ACA compliant plan. Our Basic and Essential plan designs will no longer be available. Policyholders that are enrolled in these plans will be mapped to our most equivalent ACA compliant plan. If no action is taken prior to renewal, these policyholders will be automatically renewed in the alternative plan described in their renewal packet and billed accordingly. Per the above-mentioned Code, these policyholders will receive a notice 90, 60 and 30 days prior to their renewal date informing them of these changes. This notice contains a snapshot of our current Oxford New Jersey Individual plans with changes by product type that will become effective upon renewal. At a high level, this grid shows the 2014 changes to copayments, coinsurance, deductibles and maximum out-of-pocket costs. Policyholders can identify the plan in which they are currently enrolled by referring to their policy or contract. With the exception of the 90 day notice for Jan. 1, 2014 renewals (which will be mailed separately), policyholders will receive this notice as an insert in their monthly bill. In addition, these policyholders will receive a renewal letter with rates for their proposed ACA compliant plan 60 days in advance of their renewal. We will share copies of the New Jersey Individual renewal letter and other renewal collateral with you in the next two weeks. Enclosed is a copy of the 90/60/30 day individual policyholder notice for your reference New Jersey Individual 90/60/30 EHB-Withdrawal Notice (bill insert) For the latest information on health reform, visit our Resource Center at uhc.com/reform. For specific questions, please contact your Oxford Sales Representative. Thank you for your continued support. 1 Oxford HMO products are underwritten by Oxford Health Plans (NJ), Inc. Oxford insurance products are underwritten by Oxford Health Insurance, Inc. 2 Oxford Benefit Management (OBM) packages are not available in all states and state-specific requirements may cause limitations or variations to the plans. Packaged Savings is not available for this product. Components are subject to change. UnitedHealthcare Life and Disability products are provided by UnitedHealthcare Insurance Company or its affiliates. UnitedHealthcare Dental plans are provided by or through UnitedHealthcare Insurance Company or its affiliates. UnitedHealthcare Vision plans are provided by UnitedHealthcare Insurance Company or its affiliates. UnitedHealthcare Vision benefits and administrative services are provided by or through Spectera, Inc. UnitedHealthcare Insurance Company is located in Hartford, CT. NJ (9/30/13)
3 IMPORTANT NOTICE FOR NEW JERSEY SMALL GROUP EMPLOYERS WITH RENEWAL DATES EFFECTIVE 1/1/14 THROUGH 12/1/14 Under the authority of the New Jersey Administrative Code, section 11: , our current Oxford 1 New Jersey small group plan designs will be changing on your 2014 renewal date, beginning with 1/1/14 effective dates. We will be renewing your group coverage into a new Affordable Care Act (ACA) compliant plan. You may also choose any of the other Oxford plans we offer in the New Jersey small group market. Your renewal package, which arrives 60 days prior to your effective date, will outline changes being made to benefits and member cost shares. Please make sure to review your renewal package in order to fully understand your replacement coverage. You should also review your Summary of Benefits and Coverage (SBC) 2, which is available online 60 days prior to your renewal. The directions on how to do so will be included in your renewal package. Your renewal package will also contain other resource materials on how the ACA, including the addition of Essential Health Benefits (EHB), may impact your benefits and pricing. Our goal is to provide information that will help guide you in making your renewal choice for the coming year. Please note that if no action is taken prior to renewal, you will be automatically renewed in the alternative plan described in your renewal packet and billed accordingly. In addition to EHB and ACA required changes, we are making other modifications that may affect your New Jersey small group plan upon renewal: Oxford USA: Employees with Oxford USA out-of-area coverage will be transitioned to an alternate Oxford Health Insurance, Inc. option that will provide out-of-area coverage. Dental or Vision Rider: For groups that have the added dental or vision rider as part of their medical plan, these options will no longer be available upon renewal. Please note, we offer many stand-alone specialty benefit options, including dental and vision. We also offer pre-packaged specialty benefit options through Oxford Benefit Management (OBM). 3 HMO and POS Flex Plan Changes: All of our HMO and POS Flex plans on the Oxford Health Plans (NJ), Inc. license, with the exception of the Primary Advantage plans, are being withdrawn from the market. If you currently offer your employees one of the impacted plans, we will be transitioning your plan to an Oxford Health Insurance, Inc. licensed plan. Your benefit coverage will largely remain the same. Please refer to your SBC for details. Limited Ambulatory Surgical Center Benefit: Upon renewal, all plans that include an out-of-network level of benefits will now have an annual dollar limit on the out-of-network benefit for Ambulatory Surgical Centers. Please note that some of our POS Flex plans already include this dollar limit. This is a year of health care changes and we have developed tools to help you navigate these changes and help determine which plan(s) best meet your business needs. We encourage you to reach out to your broker or General Agent with questions or contact our Client Services Team at or by at groupservices@oxfordhealth.com. Thank you for allowing UnitedHealthcare to serve your health benefit plan needs. Note: Per the above-mentioned regulation, you will receive this notice 90 days prior to your renewal date and, again, 60 days and 30 days prior to your renewal date.
4 1 Oxford HMO products are underwritten by Oxford Health Plans (NJ), Inc. Oxford insurance products are underwritten by Oxford Health Insurance, Inc. 2 Please Note: As of Sept. 23, 2012, the Affordable Care Act (ACA) requires all health plan issuers (i.e., UnitedHealthcare and Oxford) and group health plans to provide new and renewing groups and members a Summary of Benefits and Coverage (SBC) for their health benefit plan. This notification provides information regarding when and how SBCs will be made available to you and when you need to provide it to your members. All assumed renewal plan SBCs are made available through IDEA and the employer portal of oxfordhealth.com within 60 days of your renewal date. The information related to when you must provide the SBCs to your members is found directly on IDEA and the employer portal. A paper copy is available upon request by calling Client Services. 3 Oxford Benefit Management (OBM) packages are not available in all states and state-specific requirements may cause limitations or variations to the plans. Packaged Savings is not available for this product. Components are subject to change. UnitedHealthcare Life and Disability products are provided by UnitedHealthcare Insurance Company or its affiliates. UnitedHealthcare Dental plans are provided by or through UnitedHealthcare Insurance Company or its affiliates. UnitedHealthcare Vision plans are provided by UnitedHealthcare Insurance Company or its affiliates. UnitedHealthcare Vision benefits and administrative services are provided by or through Spectera, Inc. UnitedHealthcare Insurance Company is located in Hartford, CT. NJ NJSG EHB Withdrawal Day Notice 90/60/30 (bill stuffer)
5 IMPORTANT NOTICE FOR NEW JERSEY INDIVIDUAL POLICYHOLDERS WITH 2014 RENEWAL DATES EFFECTIVE 1/1/14 THROUGH 12/1/14 Beginning Jan. 1, 2014, many of our existing plan designs are being withdrawn from the market and non-renewed under the authority of New Jersey Administrative Code, section. 11: Your current Oxford 1 New Jersey Individual plan will no longer be available effective upon your 2014 renewal date. We will automatically renew your medical coverage into a new Affordable Care Act (ACA) compliant plan. In addition to the changes required by the ACA, we are also making some changes to our current product portfolio that may affect you. For your reference, on the reverse side of this sheet, we have included a snapshot of our current Oxford New Jersey Individual plans, showing the changes by product type that will become effective upon renewal. At a high level, this chart shows the 2014 changes to copayments, coinsurance, deductibles and maximum out-of-pocket costs, along with the new plan names for To identify the plan in which you are currently enrolled, please refer to your policy or contract. Your renewal letter, which will arrive 60 days prior to your plan s effective date, will include rates for your new ACA compliant plan. At that time, you will also receive a Summary of Benefits and Coverage (SBC) 2 for your new ACA compliant plan. The SBC will provide details of the coverage offered under the plan we have selected for your renewal. You can choose to renew into this proposed ACA compliant plan or, if you prefer, you may also choose any of the other Oxford plans we offer in the New Jersey individual market. For questions about alternative plan options, please contact your broker or agent or call our Customer Service Department at Please note that if no action is taken prior to your renewal date, you will be automatically renewed into the plan described in your renewal letter and billed accordingly. IMPORTANT NOTICE: As required under ACA, all individual polices must be issued and renewed on a calendar year basis starting January 1, If your policy is not currently a January renewal, your contract year for 2014 will be shortened so that your next renewal will be January 1, Your premium will also be adjusted on your new renewal date. This is a year of health care benefits changes and it is our goal to help you navigate these changes and help determine which plan(s) best meet your business needs. If you have questions, please contact your broker or general agent or call our Customer Service Department at Thank you for allowing UnitedHealthcare to serve your health benefit plan needs. Note: Per the above-mentioned regulation, you will receive this notice 90 days prior to your renewal date and, again, 60 days and 30 days prior to your renewal date. 1 Oxford HMO products are underwritten by Oxford Health Plans (NJ), Inc. Oxford insurance products are underwritten by Oxford Health Insurance, Inc. 2 As of Sept. 23, 2012, the Affordable Care Act (ACA) requires all health plan issuers (i.e., UnitedHealthcare and Oxford) to provide individual plan members with a Summary of Benefits and Coverage (SBC) for their health benefit plan. This notification will be mailed to all assumed renewing individual plan holders 60 days prior to their effective date. NJ NJ Individual Basic & Essential/Standard Withdrawal Notice 90/60/30 (bill stuffer)
6 2014 New Jersey Individual Plan Changes by Product Type Current Plan 50% coinsurance;$5,000 deductible 50% coinsurance;$10,000 deductible 50% coinsurance;$1,000 deductible New Jersey Indemnity Plan C New Jersey Indemnity Plan D 80% coinsurance; $1,000 deductible New Jersey Individual HMO Plan (Liberty Network) $30 copayment New Jersey Individual Plan HMO (Freedom Network) $15 copayment New Jersey Individual HMO Plan (Liberty Network) $15 copayment New Jersey Individual Plan HMO (Freedom Network) $15 copayment New Jersey Individual PPO Plan C $2,500 in-network deductible/$5,000 out-of-network deductible New Jersey Individual PPO Plan C $15 copayment; $1,000 deductible (Age Banded) New Jersey Individual PPO Plan C $2,500 deductible New Jersey Individual PPO Plan D $1,000 deductible (Age Banded) New Jersey Basic and Essential Plan EPO Limited benefit plans New Jersey HCR Updated Enhanced Basic and Essential Limited benefit plans New 2014 Proposed Plan EPO Plan C EPO Plan D 80% coinsurance; $1,500 deductible EPO Plan C EPO Plan D 80% coinsurance; $1,500 deductible EPO Plan C EPO Plan D 80% coinsurance; $1,500 deductible
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