NJ Health Insurance Mandate
Republished as seen on: https://nj.gov/treasury/njhealthinsurancemandate/employers.shtml
Starting with Tax Year 2019, the New Jersey Legislature requires third-party reporting to verify health coverage information provided by individual taxpayers. That means employers must provide New Jersey taxpayers and the State with the same 1094 and 1095 health-care coverage information they sent to the IRS in Tax Year 2018. Employers will file health coverage forms through New Jersey’s system for filing of W-2 forms. Companies must file 2019 coverage information electronically by February 15, 2020. We will post instructions on this website in mid-2019.
The State expects Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns, and Form 1095-C, Employer-Provided Health Insurance Offer and Coverage, from employers who filed these forms federally in 2018. Filers of Form 1094-B, Transmittal of Health Coverage Information Returns, and Form 1095-B, Health Coverage, should use those forms for New Jersey filings.
If the federal government discontinues or substantially alters Forms 1094-B, 1094-C, 1095-B, or 1095-C, New Jersey will deploy similar forms and require that they be sent to the State and to New Jersey taxpayers. Check this website periodically for reporting updates.
Out-of-State Employers of New Jersey Residents: Out-of-State employers that withhold and remit New Jersey Gross Income Tax for New Jersey residents have the same filing requirements as businesses located in New Jersey.
Guidance on Forms Sent to New Jersey: Requirements for these filings vary depending on whether an employer is fully insured, self-insured, or a participant in a multiemployer plan. The size of a company also affects reporting requirements, as detailed below:
Single-Company, Applicable Large Employers (ALEs). ALEs generally are companies with 50 or more employees: Health coverage provider (the insurer) files 1095-B for each covered member of the plan. Employer files 1095-C (Parts I and II) for each person who was a full-time employee of the employer for at least one month of the calendar year.
Single-Company, Not an Applicable Large Employer (Non-ALE). Non-ALEs generally are companies with fewer than 50 employees:Health coverage provider files 1094-B. Employer does not file a 1095-C.
Any Fully Insured Employer Participating in a Multiemployer Plan:Plan sponsor (generally a board of trustees) files 1095-B for enrolled individuals. Employer files Parts I and II of 1095-C for each employee.
Single-Company, Applicable Large Employers (ALEs). ALEs generally are companies with 50 or more employees: Employer files 1095-C for each person who was a full-time employee of the employer for at least one month of the calendar year. Employer fills out Parts I and II of 1095-C for part-time employees. ALE members that offer employer-sponsored, self-insured health coverage to non-employees who enroll may use Forms 1094-B and 1095-B, rather than Form 1095-C, Part III, to report coverage for those individuals and other family members. For this purpose, a non-employee includes a non-employee director, an individual who was a retired employee during the entire year, or a non-employee COBRA beneficiary. This also applies to a former employee who terminated employment during a previous year.
Single Company, not an Applicable Large Employer (Non-ALE). Non-ALEs generally are companies with fewer than 50 employees:Employer files a 1095-B for each covered employee.
Any Self-Insured Employer Participating in a Multiemployer Plan:Plan sponsor (generally a board of trustees) files 1095-B for each covered employee. Employer files Parts I and II of 1095-C for each covered employee.
Information About Adult Children Under Age 26
Under the federal Affordable Care Act, adult children up to age 26 may be covered by their parents’ health plan.
NJHIMPA does not require Forms 1095-B or 1095-C be provided separately to children covered by their parents’ health plans. This applies regardless of their residency, beyond the requirement under 26 U.S.C. s.6055, as that section was in effect and interpreted on December 15, 2017.It is recommended that employers advise employees to provide a copy of any Form 1095-B or 1095-C containing coverage information to their children residing in New Jersey.
Association Health Plan News Update
On June 19, 2018, the U.S. Department of Labor expanded access to affordable health coverage options for America’s small businesses and their employees through Association Health Plans.
Association Health Plans work by allowing small businesses, including self-employed workers, to band together by geography or industry to obtain healthcare coverage as if they were a single large employer.
Association Health Plans will also be able to strengthen negotiating power with providers from larger risk pools and greater economies of scale.
The Final Rule’s effects:
- Fifteen million Americans who work for a small business or operate a sole proprietorship, and their families, lack health coverage
- Four million Americans, including 400,000 who otherwise would lack insurance, will join an AHP by 2023 according to Congressional Budget Office estimates
- Association Health Plans (AHPs), under the Department of Labor’s rule, are group health plans that employer groups and associations offer to provide health coverage for employees.
- AHPs allow small employers to band together to purchase the types of coverage that are available to
large employers, which can be less expensive and better tailored to the needs of their employees.
- The rule allows more employer groups and associations to form AHPs, based on common geography or industry.
- An AHP could offer coverage to some or all employers in a state, city, county, or a multi-state metro area, or it could offer coverage to businesses in a trade or industry group nationwide.
- For the first time, working owners without other employees (including sole-proprietors) and their families will be permitted to join AHPs, creating a new path for these hardworking Americans to access affordable, quality health coverage.
- Consumer protections and healthcare anti-discrimination protections apply to large businesses and will also apply to AHPs organized under this rule.
- AHPs may not charge higher premiums or deny coverage to people because of pre-existing conditions, or cancel coverage because an employee becomes ill.
- AHPs will not be able to charge different premiums to employees based on their health status.
- Additionally, AHPs under this rule will not be able to charge employers different rates based on the health status of their employees.
- The new rule does not affect previously existing AHPs, which were allowed under prior guidance.
- Such plans can continue to operate as before, or elect to follow the new requirements if they want to expand within a geographic area, regardless of industry, or to cover the self-employed.
- New plans can also form and elect to follow either the old guidance or the new rules.
- The final rule does not diminish state oversight, which remains in place.
- States will share enforcement authority with the federal government.
Important dates for AHP expansion under the Final Rule:
- All associations (new or existing) may establish a fully-insured AHP on September 1, 2018
- Existing associations that sponsored an AHP on or before the date the Final Rule was published may establish a self-funded AHP on January 1, 2019
- All other associations (new or existing) may establish a self-funded AHP on April 1, 2019