New Jersey Response to COVID-19

 

The American Rescue Plan & Additional Financial Relief

The federal government recently passed a COVID-19 relief bill, the American Rescue Plan Act of 2021, which was signed into law by President Biden on March 11, 2021. The new law will reduce health insurance premiums by providing more financial help to eligible consumers who purchase a plan through Get Covered New Jersey. Get Covered New Jersey is working to implement the changes and update its system to ensure that New Jerseyans receive this relief as soon as possible.
 

More people than ever will qualify for financial help. If you did not qualify for financial help before because your income was too high, you may qualify under the federal changes. If you already receive financial help, you will likely be eligible for additional premium reductions. These new changes make coverage more affordable at many income levels.

During the COVID-19 pandemic, the State of New Jersey has remained focused on improving residents’ access to quality, affordable health insurance. The financial help available through this relief bill builds on the state’s efforts to provide access to health coverage for more New Jerseyans.
 

Here are more details on what you can expect:

  • Increases in financial help (Advance Premium Tax Credits or APTC) for all eligible consumers. The amount of financial help is based on household income just like before, but has increased at every income level. Families making less than 150% of the Federal Poverty Level (FPL) – or $19,140 a year for an individual or $39,300 for a family of four - will be eligible for near zero-dollar premiums under the new law.
     
  • New financial help for higher incomes. Previously, financial help was not available for households making more than $51,040 for an individual or $104,800 for a family of four. The new law ensures that no family spends more than 8.5% of their income on health insurance premiums. This means many individuals who previously did not qualify for financial help from the federal government may now see more affordable premiums.
     
  • Financial help for unemployed. Additional financial help may be available for anyone who has received unemployment benefits in 2021.

GetCoveredNJ will be working to ensure these new benefits are implemented in a timely manner. Check back to this page for updates. All enrolled consumers should be sure to read any notices sent by GetCoveredNJ.
 

 

American Rescue Plan Q&A
 

When will these new financial benefits start?

A: Get Covered New Jersey is working as quickly as possible so consumers can see these benefits in the near future. We will provide updates on our website in the coming weeks about when the benefits will be available. Current enrollees will be notified when the benefits are available and any action that needs to be taken to receive them.
 

Will I be able to change my health plan due to these changes?

A: Yes, you will be able to change your coverage based on any additional financial help you may receive.
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How do I know if I qualify for more financial help?

A: Financial help is still based on your individual household income. The amount you and/or your family make yearly will determine how much financial help you will receive.
 

If I need coverage now, should I wait until the new financial help is available?

A: There are low cost plans available now and you can enroll through the COVID-19 Special Enrollment Period. If you need coverage, you should check out your options. Consumers will be provided information about how to obtain the new financial help once it is available.

 

COVID-19 Special Enrollment Period Q&A

Get Covered New Jersey, the state’s official health insurance marketplace, has announced a COVID-19 Special Enrollment Period from February 1, 2021 to May 15, 2021 for all eligible  residents seeking health insurance at this critical time. Visit GetCovered.NJ.gov to shop and compare plans and see if you qualify for financial help.

 

Was the 2021 health insurance enrollment window extended beyond January 31?

A: Yes. The Open Enrollment Period ran from November 1, 2020 through January 31, 2021. Governor Murphy announced on January 29, 2021 an extension of the enrollment window for  New Jerseyans seeking coverage to May 15, 2021 through a COVID-19 Special Enrollment Period. Extending the enrollment timeframe for those who need insurance to May 15, 2021 helps to better protect New Jersey residents at this critical time.


Will I need to prove I was directly impacted by COVID-19 (positive coronavirus test or a job loss, for example) to enroll in a plan through Get Covered New Jersey during the COVID-19 Special Enrollment Period?

A: No. Residents do not need to be directly impacted by the coronavirus in order to enroll in a plan through the COVID-19 SEP, and no documentation will be required to demonstrate a direct impact of COVID-19. All eligible residents in need of health insurance can enroll through May 15, 2021.


If I am uninsured but also have a qualifying life event, should I enroll through the COVID-19 Special Enrollment Period or through a Special Enrollment Period that is specific to my circumstance?

A: It depends. No documentation specific to COVID-19 is required for eligible residents to enroll in a plan through the COVID-19 Special Enrollment Period. Coverage will take effect on the first day of the month following a plan selection through the COVID-19 SEP.

The coverage effective dates are as follows:

Enroll by February 28, coverage effective March 1;

Enroll by March 31, coverage effective April 1;

Enroll by April 30, coverage effective May 1;

Enroll by May 15, coverage effective June 1.
 

Coverage effective dates may vary for SEPs specific to a life-changing event, allowing for an earlier effective date. Additionally, some SEPs specific to a life change require verification documentation.
 

If I have a life changing event such as pregnancy, having a baby, or adoption, which SEP should I enroll through?

Certain events, such as having a baby and adopting a child are qualifying life events that provide for SEP enrollment back to the date of the event. Additionally, pregnancy is a new NJ-specific qualifying life event that allows for SEP enrollment back to the month of the confirmed pregnancy. If you need retroactive coverage related to these events, you may apply through the SEP specific to your life event. (Note: Pregnancy, adoption and birth do not require verification documentation).
 

More information may be found on the When Can I Buy Insurance page. If you have questions, trained certified assisters are available at Find Local Assistance.
 

I have health insurance, but am losing my job-based coverage soon and therefore will qualify for a Special Enrollment Period (loss of Minimum Essential Coverage). Which SEP should I enroll through?

A: Loss of Minimum Essential Coverage requires documentation to verify the loss of coverage and allows 60 days from the event to enroll in a plan. Coverage can start the first of the month after you apply and enroll. If you know you are losing coverage within the next 60 days, you can submit an application on GetCovered.NJ.gov before you lose your coverage to ensure you can stay covered throughout the year. For example, if you know you’ll lose coverage on February 28, and you apply and enroll in plan on February 10, your new coverage will start March 1.
 

If you lose coverage and become uninsured, you can enroll through the COVID-19 Special Enrollment Period without providing documentation. Your coverage will begin on the first day of the month following your plan selection.
 

I already have health insurance through Get Covered New Jersey. Can I switch plans through the COVID-19 Special Enrollment Period?

A: Yes. Special Enrollment Periods are available throughout the year for residents who have a major life change, called a qualifying life event (QLE), which allow for enrollment outside of the open enrollment period. Certain QLEs also allow for enrollees to change their existing plan. They include: birth, adoption, marriage, death, dependent aging off coverage, moving, income loss that changes eligibility for Marketplace coverage (for example, newly qualifies you for financial help). Remember to update your application with any income or household changes as it may impact your financial help. Additionally, changes to current coverage unrelated to a specific life event can be made through the COVID-19 Special Enrollment Period.

 

I enrolled during the Open Enrollment Period, but the health insurance company I selected a plan from made an error. Should I re-enroll through the COVID-19 Special Enrollment Period?

A: Errors made by a health insurance carrier or by the program qualify you for an Exceptional Circumstance Special Enrollment Period. Documentation of the error will be required (see standard form here). Your coverage may be retroactively updated back to the date of the error, if applicable.
 

How long will the COVID-19 Special Enrollment Period last?

A: The COVID-19 SEP will allow eligible residents in need of coverage to enroll in a plan through May 15, 2021.
 

How do I enroll?

To enroll, visit GetCovered.NJ.gov. Select “2021 COVID-19 Enrollment Period” when submitting your application.

Trained navigators and brokers can help you enroll by phone, virtually, and may have in-person availability. Information may be found on our website under Find Local Assistance. You may also call our Consumer Assistance Center: 1-833-677-1010.

If you are eligible for NJ FamilyCare, the state’s publicly funded low or no cost health insurance program (Medicaid or Children’s Health Insurance Program), you can enroll any time of year.
 

Is the COVID-19 Special Enrollment Period also available for enrollment in plans that are sold directly through a health insurance company?

A: Yes. The state established a COVID-19 Special Enrollment Period for enrollment in plans available through Get Covered New Jersey and directly from insurance carriers in the individual market. All available plans may be viewed by using our Shop and Compare tool.
 

Is Coronavirus care covered under plans available through Get Covered New Jersey?

Yes. Health insurance companies are required to waive cost-sharing, including lab fees, co-payments, coinsurance, and deductibles for any visit to test for coronavirus at a doctor’s office, urgent care center, or emergency room, and for a coronavirus vaccine. Additionally, if the primary purpose of an office visit is the delivery of the COVID-19 immunization, then insurance companies may not impose cost-sharing requirements for the office visit.
 

Can you qualify for the COVID-19 Special Enrollment Period even if you are not sick?

Yes. All eligible New Jerseyans in need of coverage may qualify for this COVID-19 Special Enrollment Period.

Additional information about Special Enrollment Periods may be found on our When Can I Buy Insurance page.
 

Coronavirus Resources

For more information on the coronavirus, including testing and vaccine locations, visit the New Jersey COVID-19 Information Hub at https://covid19.nj.gov/ For vaccine information, you may also call the state’s COVID-19 Vaccine Call Center at 855-568-0545.


Additional Resources

New Jersey Department of Health: https://www.nj.gov/health/

Centers for Disease Control and Prevention: https://www.cdc.gov/

Special Enrollment Period (SEP)

 

A time outside the yearly Open Enrollment Period when you can sign up for health insurance. You qualify for a Special Enrollment Period if you’ve had certain life events, including losing health coverage, moving, getting married, having a baby, or adopting a child.  If you qualify for an SEP, you usually have up to 60 days following the event to enroll in a plan. If you miss that window, you have to wait until the next Open Enrollment Period to apply.
 

There are 4 basic examples of qualifying life events.

  • Loss of health coverage
    • Losing existing health coverage, including job-based, individual, and student plans
    • Losing eligibility for Medicare, Medicaid, or CHIP
    • Turning 26 and losing coverage through a parent’s plan
  • Changes in household
    • Getting married or divorced
    • Having a baby or adopting a child
    • Death in the family
  • Changes in residence
    • Moving to a different ZIP code or county
    • A student moving to or from the place they attend school
    • A seasonal worker moving to or from the place they both live and work
    • Moving to or from a shelter or other transitional housing
  • Other qualifying events
    • Changes in your income that affect the coverage you qualify for
    • Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
    • Becoming a U.S. citizen
    • Leaving incarceration (jail or prison)
    • AmeriCorps members starting or ending their service

 

 



What documents can I submit?

Documents must show that you lost qualifying health coverage in the past 60 days or will lose coverage in the next 60 days. These documents must include your name and the date of coverage loss. Documents you can submit:
 

  • A letter from an insurance company, on official letterhead or stationery, including:
    • A letter or premium bill from your former insurance company that shows you or your dependent’s cancellation/termination from health coverage.
    • A decertification letter from your insurance company stating when coverage will no longer be offered.
  • A letter from an employer, on official letterhead or stationery, that confirms one of these about you or your spouse or dependent family member:
    • That your employer dropped or will drop your coverage or benefits.
    • That your employer stopped or will stop contributing to your cost of coverage.
    • That your employer changed or will change coverage or benefits, and your coverage will no longer be considered qualifying health coverage.
  • A letter about COBRA coverage, like a letter from an employer or health insurance company that confirms these:
    • Your employer’s offer of COBRA coverage along with the date this coverage would start.
    • Your COBRA coverage ended or will end, or your employer stopped or will stop contributing to the cost of coverage and when.
  • A health care program document, on official letterhead or stationery, including:
    • A letter from a government health program, like TRICARE, Veterans Affairs (VA), Peace Corps, or Medicare, showing when coverage ended or will end.
    • A letter from your state Medicaid or CHIP agency showing that your eligibility for Medicaid or CHIP was denied and when it was denied or that your Medicaid or CHIP coverage ended or will end.
    • A dated copy of your military discharge document (DD214).
  • A letter if you lost student health coverage, which shows when the coverage ended or will end. This should be on official letterhead or stationery.

 

 

 

 

You can also submit any of the documents in the list below. However, these documents may include only some of the information we need to confirm, so you’ll most likely need to submit more than one of these documents:

  • Pay stubs, if you lost employer-sponsored coverage. You can submit:
    • 2 pay stubs from the past 1-3 months, one that shows a deduction for health coverage and another which shows that the deduction ended in the past 60 days.
    • If a reduction in work hours caused you to lose coverage, you can submit one previous pay stub that shows that you worked 30 or more hours and a deduction for health coverage, and a pay stub from the past 60 days that shows that you worked less than 30 hours and no deduction for health coverage.
  • Document showing you lost coverage because of divorce, legal separation, custody agreements, or annulment within 60 days of submitting your application, including:
    • Divorce or annulment papers that show the date responsibility ends for providing health coverage or proof that you stopped getting health coverage because of your relationship to your former spouse.
    • Legal separation papers that show the date responsibility ends for providing health coverage.
    • Other confirmation that you lost or will lose coverage because of divorce, legal separation, or annulment that shows the date that health coverage ends.
  • Document showing you lost coverage due to death of a family member, including:
    • A death certificate or public notice of death and proof that you were getting health coverage because of your relationship to the deceased person, like a letter from an insurance company or employer that shows the names of the people on the health plan.
    • Other confirmation that shows you lost or will lose coverage because of the death of a spouse or other family member.

 


What if I don't have any of these documents?

You can submit a letter explaining the coverage you had, why and when you lost it or will lose it, and the reason you can't provide documents.

Christopher S. Kudryk
Insurance Specialist
chris@kbenefits.com
732-333-1976

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