State and Territory Updates

New Jersey

January 18, 2023

Reminder: NJ Shared Responsibility Reporting Requirement Due March 31, 2023

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As a reminder, if an employer has at least one employee who resides primarily in New Jersey for at least 15 days in any month, the employer is subject to file Form(s) 1095 with the New Jersey Division of Taxation in the subsequent year annually. The current 2022 tax year’s filing is due on March 31, 2023. To meet NJ’s reporting requirements, employers can provide copies of Forms 1095-C (or B) prepared for the ACA employer mandate and individual mandate provisions.

For fully insured plans, if their insurers are filing their NJ residents’ Form(s) 1095-B, then the employers are not required to file the forms with the state. However, employers are encouraged to discuss and confirm with their insurers that the insurers are filing their forms in a timely manner.

For self-insured plans, employers are responsible for timely filing completed Forms 1095-C (or B) with the state.

The main objective of this state reporting is for the state to enforce its Individual Mandate requirement by verifying that each resident had health coverage in the prior year.

Affected employers should be aware of these developments.

New Jersey Shared Responsibility Requirement Site »


November 08, 2022

2023 Maximum Weekly Benefit Amount Announced

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The New Jersey Department of Labor and Workforce Development has announced the 2023 maximum weekly benefit amount that eligible employees will receive under temporary disability insurance is 85% of their average earnings up to a maximum of $1,025 per week (2022: $993 per week).

For the 2023 premium rates for temporary disability insurance (TDI) and family leave insurance (FLI), please refer to the October 25, 2022, edition of Compliance Corner.

2023 Rate information, Contributions and Due Dates »


October 25, 2022

Significant Decrease in 2023 Premium Rates for Temporary Disability Insurance (TDI) and Family Leave Insurance (FLI)

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On October 21, 2022, the NJ Department of Labor and Workforce Development (LWD) announced the 2023 TDI and FLI contribution rates. Below are the 2023 contribution rates for employees who work in NJ:

  2023 2022
TDI 0.00% 0.14%
FLI 0.06% 0.14%


As the above chart shows, there will be no employee contribution for TDI but only for FLI of 0.06% rate in 2023. Employers who participate in the state’s TDI program will be moved to a lesser contribution table and are expected to see a collective reduction of $20 million in their TDI contributions for 2023. Employers are not required to contribute to FLI.

TDI and FLI contribution rates have been decreasing over recent years due to low utilization of the TDI and FLI programs (fewer claims) compared to the collected funds.

TDI provides partial wage replacement to NJ employees who must stop working due to a physical or mental health condition or other disability unrelated to their work. FLI provides NJ employees with partial wage replacement when they take time off to bond with a newborn, newly adopted or placed foster child, or to provide care for seriously ill or injured family members. (The definition of family members is broad for the purpose of NJ FLI, and it can be found here.)

2023 Contribution Rates Announcement »
New Jersey TDI and FLI Programs Main Site »


February 01, 2022

Executive Order Strengthens COVID-19 Vaccination and Booster Requirements for Workers in Healthcare and Congregate Settings

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On January 19, 2022, Gov. Murphy signed Executive Order No. 283 requiring covered workers at healthcare facilities and high-risk congregate settings to be up to date with their COVID-19 vaccinations, including having received booster shots when they are eligible. The new requirement was imposed to strengthen protections against the spread of COVID-19 and the Omicron variant to vulnerable populations across the state.

Examples of covered health and high-risk congregate settings covered facilities under the Order can be found at the NJ state’s press release site here. The covered workers include both full and part-time employees, contractors, and individuals providing operational, custodial, or administrative support.

Unvaccinated healthcare facilities’ covered workers subject to the Biden Administration’s vaccine mandate for healthcare settings had until January 27, 2022, to obtain their first dose of the primary series of a COVID-19 vaccination, and will have until February 28, 2022, to submit proof that they have completed their primary series and any booster shots for which they are eligible. For unvaccinated healthcare facilities’ covered workers who are not subject to the Biden Administration’s vaccine mandate for healthcare settings and high-risk congregate care, they will have until February 16, 2022, to obtain their first dose of the primary series of a COVID-19 vaccination and submit proof that they are up to date with their vaccination by March 30, 2022.

All covered workers will be required to be vaccinated by the dates set forth in the Order noted above and will no longer be permitted to submit to testing as an alternative to vaccination, except for employees who request and receive an exemption because of a disability, medical condition or sincerely held religious belief. If an employee receives an exemption, they must submit to weekly or bi-weekly testing in accordance with the previous Executive Order signed by the Gov. last year.

Employers with healthcare facility covered workers and high-risk congregate settings in the state should be aware of these new updates.

Executive Order 283 »


December 07, 2021

Reminder: NJ Shared Responsibility Reporting Requirement Due March 31, 2022

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As a reminder, if an employer has at least one employee who resides primarily in New Jersey for at least 15 days in any month, the employer is subject to file Form(s) 1095 with the New Jersey Division of Taxation in the subsequent year annually. The current 2021 tax year’s filing is due on March 31, 2022. Employers are permitted to provide copies of Forms 1095-C (or B) that are prepared for the AIRS to meet NJ’s reporting requirements.

For fully insured plans, if their insurers are filing their NJ residents’ Form(s) 1095, then the employers are not required to file the forms with the state. Employers are encouraged to discuss and confirm with their insurers that the insurers are filing their forms timely.

For self-insured plans, employers are responsible for filing completed Forms 1095-C (or B) with the state, timely.

The main objective of this state reporting is for the state to enforce its Individual Mandate requirement by verifying that each resident had health coverage in the prior year.

Affected employers should be aware of these developments.

New Jersey Shared Responsibility Requirement Site »


November 09, 2021

2022 Temporary Disability Insurance and Family Leave Insurance Premium Rates and Maximum Benefit Amounts Announced

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The NJ Department of Labor and Workforce Development (LWD) recently announced that the 2022 Temporary Disability Insurance (TDI) employee contribution is 0.14% on the first $151,900 (wage cap) in covered wages earned during the calendar year. Accordingly, the maximum employee contribution for 2022 is $212.66/week. It is a significant rate decrease from the current rate of 0.47%. Employers are responsible for paying between $39.80 and $298.50 on the first $39,800 earned by each employee during this calendar year.

The 2022 employee contribution rate for Family Leave Insurance (FLI) is 0.14% on the first $151,900 (wage cap) in covered wages earned during the calendar year. The maximum employee contribution for 2022 FLI is $212.66 (the same as TDI). Employers are not required to contribute to the FLI program.

New Jersey employers should take note of the changes to these contributions and work with their payroll providers to institute the contributions.

Rate Information »
NJ TDI, Information for Workers, How the Program is Funded »
NJ TDI, Information for Employers, How the Program is Funded »
NJ FLI, How the Program is Funded »


September 14, 2021

Early Prescription Drug Refills and Waiver of 90-Day Supply Limits Due to Tropical Storm Ida

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On September 10, 2021 Commissioner Caride issued Bulletin No. 21-10 as a response to Tropical Storm Ida and the state of emergency declared by Gov. Murphy on September 1, 2021. The bulletin requires carriers to provide coverage of prescription drug refills even when the covered person has not yet reached the scheduled refill date. They must also permit coverage prescription drugs in excess of a 90-day supply. There must also be coverage through early refills and relaxed quantity limits with respect to lost or destroyed medications.

The Department of Banking and Insurance expects carriers to comply with and communicate the provisions of this bulletin to covered persons. Employers with New Jersey plans should be aware of this guidance.

Bulletin No. 21-10 »


April 27, 2021

Extension of COVID-19 Special Enrollment Period

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On April 12, 2021, Commissioner Caride released Bulletin No. 21-07, extending the special enrollment period (SEP) on the state exchange as a part of New Jersey’s ongoing response to the COVID-19 pandemic and following the passage of the American Rescue Plan Act of 2021. The SEP will now be in effect through November 30, 2021. As background, individuals may usually only elect coverage through the state exchange (Get Covered New Jersey) during open enrollment or special enrollment periods.

During this SEP, individuals who are not already enrolled in an individual health benefits plan can apply for coverage through the exchange or directly through carriers. The SEP will also allow individuals who are already enrolled in a health benefits plan to replace their coverage with coverage on the exchange. The coverage will be effective no later than the first of the next month after an individual’s enrollment.

Although this change affects the individual market, employers should keep this in mind as it would likely create a qualifying event that would allow for an employee to potentially drop employer coverage (for themselves or their dependents) to go on the New Jersey exchange.

Bulletin No. 21-07 »


February 02, 2021

COVID-19 Exchange Special Enrollment Period

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On January 29, 2021, Commissioner Caride released Bulletin No. 21-03, providing a special enrollment period (SEP) on the state exchange as a part of New Jersey’s ongoing response to the COVID-19 pandemic. The SEP will be in effect from February 1, 2021, through May 15, 2021. Individuals may only elect coverage through the state exchange (Get Covered New Jersey) during open enrollment or special enrollment periods.

During this SEP, individuals who are not already enrolled in an individual health benefits plan can apply for coverage through the exchange or directly through carriers. The SEP will also allow individuals who are already enrolled in a health benefits plan to replace their coverage with coverage on the exchange. The coverage will be effective no later than the first of the next month after an individual’s enrollment.

Although this change affects the individual market, employers should keep this in mind as it would likely create a qualifying event that would allow for an employee to potentially drop employer coverage (for themselves or their dependents) to go on the New Jersey exchange.

Bulletin No. 21-03 »


February 02, 2021

Coverage for COVID-19 Immunizations

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On January 7, 2021, Commissioner Caride issued Bulletin No. 21-01, which provides guidance to health insurers on preventive health services, including COVID-19 immunizations. The bulletin prohibits carriers – including those administering self-funded plans – from charging any cost sharing for qualifying coronavirus preventive services delivered in-network or out-of-network. Additionally, the Department of Banking and Insurance expects carriers to assess their readiness and take all steps to ensure that insureds have access to COVID-19 immunizations and their administration. When vaccines require multiple doses, carriers should communicate to insureds that they need to get both doses of the same vaccine. Carriers should also provide information to providers on how to submit claims for reimbursement of the immunizations.

Although this bulletin is directed towards insurance carriers, employers based in New Jersey should familiarize themselves with this guidance as individuals begin to access COVID-19 immunizations.

Bulletin No. 21-01 »


August 18, 2020

Insurers Required to Pay Annual Tax on Health Premiums

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On July 31, 2020, Gov. Murphy signed Assembly Bill No. 4389 into law. The bill imposes an annual 2.5% state tax on the premiums collected by most health insurers. As background, the ACA imposed a tax on health insurers (known as the HIT tax) that has been repealed and will no longer be levied in 2021. This NJ tax will essentially take the place of that federal tax.

Specifically, the tax would be levied on insurers and the funds would be passed on to a health insurance affordability fund that will be designed to subsidize premiums for low-income individuals and to bolster the state’s reinsurance pool. The bill also seeks to reduce racial disparities in coverage for the uninsured. To those ends, the bill also requires a report examining how the policy increases affordable healthcare options, reduces the uninsured rate and affects racial disparities in health insurance coverage.

While the law applies to insurers, it’s widely expected that insurers will pass this additional tax to consumers through health plan premiums. The tax is set to become effective in January 2021. We will continue to follow any developments with this law.

Assembly Bill, No. 4389 »


June 14, 2020

Guidance on COVID-19 and Worker Benefit

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On March 16, 2020, the Department of Labor & Workforce Development released guidance on how the state’s earned sick leave, temporary disability insurance (TDI), and family leave insurance laws apply in regards to the coronavirus emergency. The FAQs provide details on when employees may use their earned sick leave or family leave for purposes of COVID-19-related leave.

For example, if an individual or their loved one has tested positive for COVID-19, has symptoms, has been exposed to it through their work, or has been advised by a healthcare provider or public health authority to quarantine, they may use earned sick leave, but can only apply for TDI after exhausting unemployment benefits. Additionally, if employees have children that are home from school because the school is shut down for cleaning or decontamination or if the person’s business is ordered closed due to a public health reason, then they may be able to take leave under the earned sick leave law.

Employers should review this guidance in order to properly communicate with employees regarding the potential for leave or benefits under New Jersey law.

Worker Benefits, Protections and the Coronavirus (COVID-19): What NJ Workers Should Know »


June 09, 2020

Insurers Must Offer 60-Day Grace Period

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On May 28, 2020, Commissioner Caride released Bulletin No. 20-27, requiring insurers to provide a 60-day grace period for the payment of health and accident policies. The bulletin directs insurers to extend an emergency grace period for the payment of premiums to their policyholders pursuant to the governor’s emergency declaration. Policyholders may elect to begin the emergency grace period retroactively on April 1, 2020, or May 1, 2020, and during the 60-day period, coverage must remain in force and claims must be paid and not pended. Additionally, after the grace period ends, the policyholder must be given the option to repay the missed premiums over the remaining months of the policy (but for not less than six months).

Although this guidance is directed at insurers, employers with policies based on New Jersey would be able to avail themselves of this relief if needed.

Bulletin No. 20-27 »


May 27, 2020

Coronavirus Testing Requirements Updated

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On May 13, 2020, Department of Banking and Insurance Commissioner Caride issued Bulletin No. 20-24, updating the requirement for insurers to waive all cost-sharing payments for the screening and testing for COVID-19. This bulletin updates the guidance found in Bulletin No. 20-03 (discussed in the March 17, 2020, edition of Compliance Corner). This bulletin supplements the prior bulletin by expanding carrier required coverage without cost sharing or any SARS-COV-2 molecular test authorized by the New Jersey Department of Health Standing Order. Carriers must treat any such test authorized by the DOH Standing Order as medically appropriate for the individual. Additionally, carriers must not require a prescription or prior authorization, or employ any other medical management, for any SARS-COV-2 molecular test administered pursuant to the DOH standing order.   

Employers can notify their plan participants who may need to receive testing that the testing will be provided without cost sharing.

Bulletin No. 20-24 »


April 14, 2020

Employer Health Coverage Filings Due Date Extended

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In response to the COVID-19 pandemic, New Jersey recently announced that employers with employees in New Jersey now have until May 15 to file Forms 1095-C with the New Jersey Division of Taxation. As background, beginning in 2019, the New Jersey Health Insurance Market Preservation Act (HIMPA) requires third-party reporting to verify health coverage information supplied by individual payers of New Jersey’s income tax. Under HIMPA, employers and all other providers of MEC were originally required to file their employer mandate reporting forms with the Division of Taxation on or before March 31, 2020.

This announcement extends that due date to May 15, 2020. Employers with employees in New Jersey should ensure that they file those forms by the new due date.

Updated Guidance for Health Coverage Filings »


April 14, 2020

COVID-19 Guidance to Insurers in Small and Large Group Markets

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On April 10, 2020, Commissioner Caride released Bulletins 20-12 and 20-13, providing guidance on COVID-19 to insurers in the small employer market and large employer market, respectively. Among other things, the guidance requires insurers to allow for employees that are working fewer than full-time hours to remain eligible for coverage, to allow rehired employees to resume coverage absent a waiting period, to provide a 60-day grace period to any policyholder that has been financially or physically impacted by COVID-19, and to recognize time off for COVID-19 as time off due to a health factor (as it pertains to actively-at-work clauses).

While this guidance is aimed at insurers, employers should familiarize themselves with the guidance to understand the flexibility that must be provided by insurers.

Bulletin 20-12 »
Bulletin 20-13 »


April 14, 2020

Extension of Transitional Health Insurance Plans

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On April 6, 2020, Commissioner Caride released Bulletin 20-10, extending the ability of health insurance carriers in the individual and small group market to continue transitional health insurance plans through December 31, 2021.

As background, on January 31, 2020, CMS provided guidance for a transition policy extension that allows insurers the option to renew non-grandfathered non-ACA-compliant plans, as long as the state allows for such an extension. Such transition policies are not required to be in compliance with certain ACA mandates including community rating, coverage of essential health benefits, prohibition on pre-existing condition exclusions and the annual out-of-pocket maximum limit. This bulletin applies this most recent federal extension to New Jersey and allows the issuer to renew these non-ACA-compliant plans.

Small employers that are interested in renewing their non-ACA-compliant plan should work with their advisors and insurers.

Bulletin No. 20-10 »


March 31, 2020

Use of Telehealth to Respond to COVID-19

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On March 22, 2020, Department of Banking and Insurance Commissioner Caride issued Bulletin No. 20-07, providing guidance to insurers regarding the use of telehealth to respond to the COVID-19 pandemic. Among other directives, the bulletin directs carriers to review their telehealth networks, cover telehealth without cost sharing and impose no more restrictive requirements on telehealth than are imposed on in-person treatment. Although this guidance is directed towards insurers, plan sponsors should familiarize themselves with how telehealth will be offered under plans offered in New Jersey.

Bulletin No. 20-07 »


March 31, 2020

Disruption Resulting from COVID-19

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On March 19, 2020, Department of Banking and Insurance Commissioner Caride issued Bulletin No. 20-04, encouraging insurers to take into consideration the difficulties residents have endured and will continue to endure until the spread of COVID-19 is controlled. Specifically, the bulletin encourages insurers to relax due dates for premium payments, extend grace periods, waive late fees and penalties, allow forbearances and payment plans, and to essentially work with policyholders to make sure insurance policies don’t lapse. As a result, employer plan sponsors that are facing economic hardship can discuss their options with insurers.

Bulletin No. 20-04 »


March 17, 2020

Insurance Commissioner Requires Coronavirus Testing Without Cost Sharing

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On March 10, 2020, Department of Banking and Insurance Commissioner Caride issued Bulletin No. 20-03, requiring insurers to waive all cost-sharing payments for the screening and testing for COVID-19. Insurers must also provide coverage for out-of-network testing in the same manner as it is provided in-network. Additionally, when a COVID-19 vaccine is formulated, insurers are encouraged to offer that vaccine without cost sharing. Employers can notify plan participants who may need to receive testing that the testing will be provided without cost sharing.

Bulletin No. 20-03 »


February 19, 2020

Additional 1095-C Filing Guidance for Employers with Employees Who Reside in NJ

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In connection with NJ’s individual mandate (which took effect in 2019), employers with employees who reside in NJ must file (or coordinate filing with their carrier) IRS Form 1095-C (or 1095-B, in some instances) with NJ. We have covered the filing requirements previously in the January 22, 2020, edition of Compliance Corner. NJ previously announced that employers must file electronically using the NJ Division of Revenue and Enterprise Services’ MFT SecureTransport service. This has caused angst among employers, since many employers may have only a handful of NJ-residing employees for whom they must report, and many employers may not be able to meet the appropriate formatting and technical requirements to file through the NJ SecureTransport service.

The additional guidance clarifies that there is a new manual process for employers that had fewer than 50 employees living in NJ during 2019. Under the manual process, the employer essentially keys in the Form 1095-C information for each NJ resident. The manual process, which uses the “Fillable Form NJ-1095” is outlined under the “Transmitting 1095 Returns” section at the below link. In addition to considering the new manual process, employers should reach out to their payroll provider or their IRS 1095-C filing vendor to see if the provider/vendor can assist with the NJ filings. While most provider/vendor contracts likely don’t address new state filings such as the NJ filing, it’s possible the provider/vendor would agree to add those services to the contract.

NFP Benefits Compliance will continue to monitor the NJ filing requirement issue, and report future developments here in Compliance Corner.

Guidance »


January 22, 2020

Updated Guidance for Employer Health Coverage Filings

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On December 13, 2019, the state of New Jersey published updated guidance relating to the New Jersey shared responsibility requirement (the requirement for New Jersey residents to carry minimum essential health insurance coverage or pay a tax penalty — a state individual mandate). Beginning in 2019, the New Jersey Health Insurance Market Preservation Act (HIMPA) requires third-party reporting to verify health coverage information supplied by individual payers of New Jersey’s income tax. Under HIMPA, employers and all other providers of MEC must file information with the Division of Taxation on or before March 31, 2020. Importantly, the state has no plans to offer filing extensions.

The updated guidance states that out-of-state employers who employ New Jersey residents have the same filing requirements as in-state businesses. The guidance includes important information on what forms are required and from whom. Specifically, employers must file the following:

  • Small fully insured employers are not required to file anything with NJ (the carrier will send 1095-B)
  • Small self-insured employers will file Forms 1095-B with NJ
  • Large fully insured employers will file Forms 1095-C with NJ
  • Large self-insured employers will file Forms 1095-C with NJ

Employers are required to submit forms electronically — there is no paper filing option available. Employers will need to file electronically to the state using the Division of Revenue and Enterprise Services’ MFT SecureTransport service. The guidance includes instructions on how to register for an account and use the service.

Employers with employees in New Jersey should review the updated guidance and determine their filing obligations. Employers should file by March 31, 2020.

Updated Guidance »


September 04, 2019

Updates to Family Leave Act Law Took Effect Recently

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Recently, New Jersey made some changes to the Family Leave Act (FLA) law. Beginning June 30, 2019, New Jersey FLA applies to all employers with 30 or more employees anywhere worldwide (previously it was 50 or more employees). The change was a result of a law passed previously this year (HB 3975, described in the March 9, 2019, edition of Compliance Corner). New Jersey also recently updated its fact sheet and FAQ, both of which reflect the applicability change from 50 to 30 employees.

Poster »
FAQ »
Fact Sheet »


May 29, 2019

Extended Transition for Grandmothered Plans

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On May 10, 2019, the New Jersey Department of Banking and Insurance published Bulletin 19-05. The purpose of the bulletin is to advise carriers of the department’s intent to continue to permit the renewal of coverage pursuant to the CCIIO’s latest transitional policy extension for non-grandfathered non-ACA-compliant plans (called “grandmothered plans”) in the individual and small group markets. As background, on March 25, 2019, CCIIO provided guidance for a transition policy extension that allows insurers the option to renew grandmothered plans as long as the state allows it. Such transition policies are not required to be in compliance with certain ACA mandates including community rating, coverage of essential health benefits, prohibition on pre-existing condition exclusions, and the annual out-of-pocket maximum limit.

According to the bulletin, NJ-issued policies may continue to be renewed on or before October 1, 2020, provided the policy will terminate by December 31, 2020. Insurers may renew early or issue coverage for periods less than one year if a policy terminates prior to December 31, 2020, and (in the case of a small group) if the employer wants coverage through the end of the calendar year. Employers with grandmothered plans should check with their adviser and carrier to determine if the carrier will continue to offer the plan via the extension.

Bulletin 19-05 »


April 16, 2019

Updated Employer Guidance For Individual Mandate

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NJ recently updated their guidance on the employer filing requirements related to the state’s individual health insurance mandate. As discussed in the January 23, 2019, edition of Compliance Corner, NJ residents are required to maintain health insurance as of January 1, 2019. The law requires that employers provide third-party reporting to verify the coverage information initially provided by individual taxpayers.

This third-party verification requires employers to provide NJ taxpayers and the state with the same 1094 and 1095 health-care coverage information sent to the IRS. The employer filing requirements vary depending upon whether the employer is fully-insured, self-insured or a participating employer in a multi-employer plan. The size of the company also impacts the reporting requirements. Generally though, employers that filed Form 1094-C/Form 1095-C federally in 2018, may use those forms for purposes of NJ reporting. Similarly, filers of Form 1094-B/Form 1095-B should use those forms. Out of state employers that withhold and remit NJ gross income tax for residents have the same filing requirements.

Employers must verify health coverage through the same electronic system used for filing W-2 forms. The guidance clarifies that should the federal government discontinue or substantially alter Forms 1094-B, 1094-C, 1095-B, or 1095-C, NJ will issue similar forms to continue the third-party verification requirements.

The deadline for employers to file 2019 coverage verification information is February 15, 2020.

NJ Health Insurance Mandate Website »


April 02, 2019

Pre-Tax Transportation Benefits

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On March 1, 2019, Gov. Murphy signed S1567 into law, requiring employers with more than twenty employees to offer pre-tax transportation fringe benefits to their employees who are not otherwise covered by a collective bargaining agreement.

Under the bill, an employee may set aside a certain portion of pre-taxed wages to be made available for specified transportation services and this will also reduce the employee’s federal taxable income. This pre-tax fringe transportation benefit includes services such as transit passes, commuter highway vehicle travel, and costs of parking at park-and-ride lots. This bill does not apply to employees of the federal government who are eligible for a transit benefit equal to or greater than the pre-tax transportation fringe benefit required by the state.

Please note that this law does not require employers to offer a qualified parking or bicycle benefit, but employers are permitted to do so.

The Commissioner of Labor and Workforce Development will enforce this new measure and is authorized to issue citations to employers that do not offer this pre-tax transportation fringe benefit. Employers that do not comply will be liable for a civil penalty of not less than $100 and not more than $250 for the first violation.

The NJ DOL intends to adopt rules and regulations to address the administration of and enforcement of this pre-tax benefit. The Act takes effect immediately, but shall remain inoperative for 365 days following the date of enactment (March 1, 2020) or upon the effective date of rules and regulations adopted.

S1567 »

Governor’s Statement »


March 05, 2019

Family Leave Act Expanded

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On Feb. 19, 2019, Gov. Murphy signed assembly bill No. 3975, expanding family leave under the New Jersey Family Leave Act (NJFLA), making corresponding changes under the NJ Family Leave Insurance (NJ FLI), the NJ Temporary Disability Benefits Law (NJTDBL), the NJ Temporary Disability Insurance (TDI), and also adding eligibility of family leave to the NJ Security and Financial Empowerment Act (SAFE).

Effective June 30, 2019, the NJFLA will require employers with at least thirty employees to provide up to twelve weeks of unpaid family leave in a 24-month period for the birth or adoption of a child or to care for a family member with a serious health condition. Previously, the NJFLA applied only to employers with 50 or more employees and allowed qualifying employees to take up to six weeks of leave in a 12-month period.

The bill also increased the amount of weekly benefits for family leave insurance and pregnancy leave to 85 percent of the claimant’s average weekly wage (an increase from 66 percent) up to a maximum of $860 per week (or 70 percent of the NJ’s average weekly wage). This increased benefit is paid exclusively through increases in payroll taxes and will not increase the employer contribution rates.

Certain provisions take effect immediately, including a change to the definition of “child” to allow a parent of a foster child to take unpaid and paid family leave, as well as an employee who becomes a parent pursuant to a surrogacy or a valid written gestational carrier agreement. It also expands the definition of “family member” to include parent-in-law, sibling, grandparent, domestic partner, or any other blood relative, and “any other individual that the employee shows to have a close association with the employee which is the equivalent of a family relationship.”

The NJ SAFE law provides qualifying employees with up to 20 days of unpaid leave in a 12-month period and was amended to allow employees to take paid family temporary disability leave in the event that they become victims of domestic or sexual violence and need medical care, counseling or to attend court or other legal proceedings. An employee may also use this leave to assist a family member who is a victim of domestic or sexual violence.

The bill also makes significant changes to permitted intermittent leave, provides anti-retaliation measures to ensure employers do not discriminate or retaliate against employees that take advantage of the benefits, and updates the employer notice requirement to require an NJ FLI notice be placed at all worksites.

Employers with employees in NJ should review this bill to ensure that their employee handbook and policies reflect the changes required by the law as well as to ensure they are compliant with the notice and posting requirements. They must also confirm that the changes to the payroll tax deductions are properly implemented.

HB 3975 »


January 23, 2019

Updated NJ Health Insurance Mandate Information

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Beginning Jan. 1, 2019, NJ requires its residents to maintain health insurance throughout 2019 and beyond (unless an exemption applies). NJ recently updated its website to detail the requirement of employers to verify the information provided by individual taxpayers.

As background, Gov. Murphy signed the Health Insurance Market Preservation Act on May 30, 2018, requiring every NJ resident to have health coverage or pay a penalty (shared responsibility payment). This state mandate mirrors the former federal individual mandate imposed by the ACA and intends to require NJ residents to purchase health care so that the NJ health insurance market will remain stable and provide more affordable rates of coverage. We initially discussed the individual mandate shortly after it became law in Compliance Corner.

Beginning in 2020, the NJ legislature will require employers with at least 50 employees to provide 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,” that they currently provide to taxpayers and the IRS to the NJ Div. of Taxation. Copies of the forms must be submitted on or before Feb. 15 following the close of each calendar year. This NJ reporting requirement mirrors the current ACA reporting requirements, but if the federal government discontinues the use of Forms 1094-C or Forms 1095-B and 1095-C at some point in the future, then NJ will deploy similar forms for the ongoing filing requirement.

Similar to the federal requirement, NJ does not require dependent information, including adult children who are covered by their parents’ plans. However, 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 NJ.

NJ employers should review the NJ website for the reporting requirements and make note of the Feb. 15 deadline to provide the Forms 1094-C and 1095-C starting in 2020. Please also note that this reporting requirement also applies to out-of-state employers that withhold and remit NJ gross income tax for NJ residents.

For more information, employers can visit the NJ Health Insurance Mandate website.

The NJ Health Insurance Market Preservation Act »


November 28, 2018

New Jersey Outlines New Out-Of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act

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On Nov. 20, 2018, Commissioner Caride released Bulletin No. 18-14 to provide guidance for the additional obligations under the Out-Of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act (the Act). As background, the Act became effective Aug. 30, 2018, with the purpose to enhance consumer protections from surprise bills for out-of-network health care services, including transparency, new consumer disclosures, and cost-containment for out-of-network services. This Act creates and modifies processes for carriers regarding out-of-network policy disputes for inadvertent and/or involuntary out-of-network services provided in New Jersey or to NJ residents.

In addition, it addresses out-of-network billing and adds new disclosure and transparency requirements. While most of the notice relates to insurance carriers that cover NJ residents, portions of the notice apply to self-funded health benefit plans that elect to be subject to the claims processing and binding arbitration provisions of the Act.

Claims Processing and Arbitration. The Act creates an arbitration process to resolve out-of-network billing disputes for inadvertent and/or involuntary out-of-network services. Specifically, when carriers (including self-funded plans that elect to participate) and out-of-network providers cannot agree upon reimbursement for such services, an arbitrator will decide and will be binding upon both parties. The intended result is that the out-of-network health providers will bill the covered person for the cost-sharing liability for inadvertent and/or involuntary out-of-network services only once upon acceptance of the allowed charge/amount, whether it is initially agreed upon, determined through negotiations or decided through the arbitration process. NJ providers and self-funded health benefit plans that opt-in must apply the new arbitration process applies for claims with a date of service on or after Aug. 30, 2019.

Out of Network Billing. The Act prohibits providers from balance-billing for inadvertent and/or involuntary out-of-network services for any amount above the financial responsibility that they would have incurred if the same service(s) had been provided by an in-network health care provider. The Act also prohibits most opportunities for an out-of-network provider to, either directly or indirectly, knowingly waive, rebate, give, pay or offer any thereof as an inducement to seek services from such out-of-network provider.

Disclosure and Transparency. Carriers must provide clear and understandable descriptions of the benefits for services rendered by out-of-network health care providers that are covered under the plan, including emergency or urgent services, for inadvertent out-of-network services and, where applicable, voluntary out-of-network treatment. The bulletin provides a template summary of the transparency disclosures required by the Act.

For self-funded plans that choose to opt-in to the claims processing and arbitration provisions, they are not bound to the transparency disclosures and other sections of the Act.

Bulletin No. 18-14 »
Template Summary of Transparency Disclosure Requirements »


November 13, 2018

New Jersey Issues FAQ for Sick and Safe Leave Law

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On Oct. 29, 2018, the NJ Earned Sick Leave Law went into effect. On that same day, NJ’s Dept. of Labor and Workforce Development (DOL) released an FAQ and published a model employee notice in English and 12 other languages.

As we discussed in previous Compliance Corner articles (the Oct. 3 Paid Sick Leave proposal update and the May 1 Paid Sick Leave Law update), Gov. Murphy signed the NJ Paid Sick Leave Act into law on April 12, 2018, making NJ the 10th state to require employers to provide paid time off to full- and part-time workers. Under the law, employers must allow eligible employees to accrue up to 40 hours of paid sick leave.

The FAQ provides answers to more than 100 questions, including details regarding the employees that are covered by the law, the rights to earn sick leave, the proper use of sick leave, how an employee’s earned sick leave is paid, how an employee can file a complaint against an employer, and the required notice to employees.

The DOL also published a model employee notice to assist employers with the law’s requirement to give employees notice of their right to earned sick leave. Specifically, employers are to provide notice of employee rights within 30 days of the notice being published (Nov. 29, 2018), at the time of a new employee’s hiring (going forward), and upon first request by an employee. The model notice is available in English and 12 other languages: Arabic, Chinese (simplified and traditional), Guajarati, Haitian Creole, Hindi, Italian, Korean, Polish, Portuguese, Spanish and Tagalog. The employer must also provide notice of the law in a conspicuous place or places to all employees of each employer’s workplaces. This poster must be displayed in English, Spanish or any other language that a majority of employees consider their primary language as long as the agency has created a notice in that language.

Employers must keep or maintain records that the notice was provided to an employee and proof that it was received. The FAQ clarifies that an employer may satisfy this requirement by sending employees an email and can satisfy the posting obligation by displaying the notice on internet or intranet sites exclusively used by employees (if all employees have access). Saved signed copies or email receipts is a good way to document that individual notice occurred.

The NJ DOL is accepting written comments to the proposed rules through Dec. 14, 2018.

The employer should review its record retention policies to ensure compliance with the law.

NJ Earned Sick Leave Webpage »
NJ Press Release »
Frequently Asked Questions »
Model Notice »


November 13, 2018

New Jersey Reiterates State Law Regarding AHPs

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On Oct. 29, 2018, Ins. Commissioner Caride issued bulletin No. 18-13 regarding association health plans.

As background, on June 21, 2018, the DOL issued final regulations regarding AHPs and expanded the definition of an “employer” for associations that could sponsor group health coverage. The regulations permit an association to form for the sole purpose of offering an AHP (or MEWA) to its members, provided the association maintains a commonality of interest. Essentially, the DOL made it easier for association-sponsored plans to offer group health coverage and be treated as a single “employer” for ERISA purposes to allow treatment similar to large-group coverage.

This bulletin points out that the DOL’s final regulations explicitly state that traditional oversight and regulatory authority over AHPs/MEWAs remains with the states and does not modify or limit existing state authority under ERISA. Any state law regulating insurance may apply to the AHP, to the extent that it isn’t inconsistent with ERISA. NJ law also extends to policies issued outside of NJ.

The intended purpose of the bulletin is to advise carriers, brokers and other interested parties that the recent federal rulemaking related to association health plans (AHPs) does not modify or preempt NJ’s existing regulatory authority and oversight regarding MEWAs, and any AHP operating, expanding or otherwise marketed in NJ. Ultimately, a MEWA or AHP, whether insured, partially-insured or self-funded whether organized in NJ or another jurisdiction may not market (that is, sell, solicit or negotiate) its plan in NJ unless it complies with all applicable NJ laws and regulations.

Bulletin 18-13 »


October 03, 2018

New Jersey Issues Proposed Rules for Paid Sick Leave

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On Sept. 26, 2018, the New Jersey Department of Labor and Workforce Development (NJDLWD) issued proposed rules to assist employers in compliance of the NJ Paid Sick Leave Act (Act), which goes into effect on Oct. 29, 2018. The proposed rules provide additional clarity with respect to the Act’s requirements, including the calculating and recording of earned sick time, employer notice requirements, and potential penalties for noncompliance.

As we discussed in a previous Compliance Corner article, the Act was originally signed on May 2, 2018, and requires employers, regardless of size, to provide earned sick leave to each employee working in NJ and outlines the way that sick leave is to be accrued, advanced, used, paid, paid out and carried over. In NJ, the earned sick leave may be used to cover:

  • An employee’s own medical needs or the medical needs of a covered family member
  • Certain needs resulting from the employee, or a family member of the employee, being a victim of domestic or sexual violence
  • An employee’s inability to work because of a closure of the employee’s workplace, or the school or place of care of a child of the employee, due to a public health emergency
  • Time needed by an employee to attend a child’s school-related conference, meeting or event as requested or required by the school

Eligible employees must accrue paid leave at a rate of at least one benefit hour per 30 hours worked.

Some notable provisions within the proposed rules include the following:

General Definitions

  • The definition of “benefit year” may be any period of twelve consecutive months as established by the employer. Though a subsequent change to the “benefit year” is permissible, the employer must provide written notice to the NJDLWD at least 30 calendar days prior to the proposed change. The notice must include the reason for the proposed change, and a list of current employees with corresponding contact information and a history of accrual, use, payment, payout, and carry-over of earned sick leave for each employee for the preceding two benefit years. If the proposed change is identified as preventing the accrual or use of earned sick leave by an employee, then the Commissioner can impose a benefit year on the employer and deny the proposed change, subject to an appeal process.
  • The definition of “family member” is expansive and includes a child, grandchild, sibling, spouse, domestic partner, civil union partner, parent, or grandparent of an employee, or a spouse, domestic partner, or civil union partner of the employee, or any other individual related by blood to the employee or whose close association with the employee is the equivalent of a family relationship.
    • A “close association” includes any person with whom the employee has a significant personal bond that is, or is like, a family relationship, regardless of biological or legal relationship.

Use and Documentation of Paid Sick Leave

  • Current employees must begin accruing earned sick leave as of Oct. 29, 2018 and employees hired on and after Oct. 29, 2018 must begin accruing earned sick time immediately upon employment. Though the law goes into effect Oct. 29, 2018, an employer isn’t required to allow employees to use their earned sick leave until Feb. 26, 2019 (120 days after the Act’s effective date of Oct. 29, 2018).
  • When an employee is terminated, laid off, furloughed or otherwise separated from employment, but is reinstated or rehired in NJ by the same employer (or successor employer) within six months of separation, any unused earned sick leave accrued by the employee before the separation must be returned to the employee upon rehire and reinstatement.
  • For exempt employees, an employer isn’t required to maintain records documenting the hours, but instead has the option of either recording the actual hours worked by that employee for the purpose of calculating earned sick leave accrual or presuming, solely for the purpose of calculating earned sick leave accrual, that the employee works 40 hours per week.
  • All requests by employees to use earned sick leave shall be treated by the employer as presumptively valid. If the employee’s need to use earned sick leave is foreseeable, then the employer may require advance notice, but such notice cannot exceed seven calendar days prior to the first date of leave. If the employee’s need to use earned sick leave is not foreseeable (that is, not reasonably anticipated), then the employer may require an employee to provide notice as soon as practicable, but in order to require such notice, the employer must have already notified the employee of this notice requirement.
  • An employer may also prohibit an employee from using earned sick leave on certain dates as long as such dates are limited to verifiable high-volume periods or special events that would disrupt employer operations. The rules include examples of a high-volume period, such as holiday travel for the airline industry, or the day or week in which a new product first becomes available for the manufacturers of retail products.
  • The proposed rules also provide guidance for an employee that has two or more different jobs with the same employer or where employees are paid overtime, on commission, with tips or on a piecework basis.

Notice Requirements

  • Employers must post a notice regarding employee rights and responsibilities under the Act in places accessible to all employees. The notice requirement is satisfied if the employer posts the information on the employer’s internet or intranet site or sends the notice through email.

Violations and Administrative Penalties

  • A violation of the Act is considered a violation of a “state wage, benefit and tax law” that empowers the NJDLWD Commissioner to direct a suspension or permanent revocation of one or more licenses held by an employer.
  • An employer that knowingly and willfully violates the Act would be subject to a fine of not less than $100 and no more than $1,000 and/or not less than ten days and no more than 90 days of imprisonment for the first offense. Upon a second offense, the fine would be no less than $500. Separately, if the NJDLWD Commissioner finds that an employer has violated the Act, they would be able to assess and collect administrative penalties in the amount of $250 for the first violation and between $250 and $500 for a second violation. Each week during which an employee has not been provided the amount of sick leave required by the Act constitutes a separate offense.

NJ employers should review their earned sick leave policy to make sure that they’re compliant before the Act becomes effective on Oct. 29, 2018. Employers that already offer paid time off (including personal days, vacation days and sick days) will be compliant under the law, provided the accrual rate is at least as generous as described under the law, all eligible employees are provided leave and employees can use their earned sick time for the same permissible purposes provided in the Act.

A public hearing regarding the proposed rules is scheduled on Nov. 13, 2018, and the NJDLWD is also accepting written comments until Dec. 14, 2018.

Proposed Rules »


July 24, 2018

New Jersey Passes Act to Increase Out-of-Network Cost Transparency

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On June 1, Gov. Murphy signed S485, creating the Out-Of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act. This Act imposes new disclosure obligations for “surprise” out-of-network services and caps the pricing for such health care services. The bill also creates an arbitration system to quickly resolve billing disputes — and imposes significant penalties for noncompliance. Though the act primarily affects health care facilities, health care professionals and health insurance carriers, it also impacts self-insured health benefit plans (those subject to ERISA).

The bill generally requires health care facilities to disclose to patients whether the facility is in-network or out-of-network in respect to the patient’s plan, advise patients that, if in-network, the patient won’t incur any out-of-pocket costs outside of typical costs (e.g. copayment, deductible, etc.) unless the patient knowingly, voluntarily and specifically selects an out-of-network provider to provide services. For “emergency or urgent” services administered out-of-network, the act generally limits the amount a provider can charge to the deductible, copayment or coinsurance amount applicable to in-network services.

The Act incudes an “opt-in” procedure for self-insured health benefit plans (those governed by ERISA). For those plans that want to be subject to the act, they can do so by filing an annual notice with the state and amending their plan document to reflect that the benefits of the statute apply to the plan’s members. If the plan opts in, the participants wouldn’t be balance billed for out-of-network charges for emergency care in excess of the deductible, copayment or coinsurance amount applicable to in-network services, and the plan can take advantage of the act’s binding arbitration agreements. Self-insured health plans that don’t want to opt in don’t need to do anything.

The act goes into effect on or near Aug. 30, 2018 (90 days after enactment). Self-insured plans in New Jersey must determine whether to opt in to be subject to the act by the end of August 2018. Additional regulatory guidance will be forthcoming.

S485 »


June 12, 2018

New Jersey Enacts Individual Health Insurance Mandate

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On May 30, 2018, Gov. Murphy signed into law A 3380, the Health Insurance Market Preservation Act, which requires all New Jersey residents to have health coverage or pay a penalty. New Jersey's mandate mirrors the former federal requirement under the ACA and refers back to the ACA for key terms, including definitions, minimum essential coverage (MEC) and penalty amounts based on individual or family income. The annual penalty is 2.5 percent of the household's income or a per-person charge, whichever is higher. Interestingly enough, the Act provides that should Congress repeal the federal premium tax credits under the ACA or stop funding to the program, then the state mandate will not be enforced.

The New Jersey law is scheduled to take effect Jan. 1, 2019, making New Jersey the second state to enact such a state-wide individual health insurance mandate. The proceeds from the annual penalty are slated to fund a reinsurance program to help insurers cover the cost of the most expensive patients.

Because this is an individual mandate, employers don't need to take any action, but they should be mindful of potential tax implications for employees residing in New Jersey.

A3380 »


June 12, 2018

New Jersey Extends Transition for Non-ACA Compliance Plans

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On May 30, 2018, the New Jersey Department of Banking and Insurance published Bulletin No. 18-10, which relates to the extension of renewal for non-ACA-compliant plans (also known as “grandmothered plans”). As background, on April 9, 2018, CMS issued guidance allowing extension of grandmothered plans (i.e., non-ACA-compliant plans that have been continued since 2014), subject to state and carrier approval. Bulletin No. 18-10 is New Jersey's approval for such an extension for the full period outlined by the CMS.

Similar to the extension approval for 2018, the bulletin directs carriers to the CMS guidance, meaning New Jersey will accept approvals for extensions based on the CMS bulletin's requirements. The CMS guidance allows an extension of non-ACA-compliant policies to policy years beginning on or before Oct. 1, 2019, provided that all such policies end by Dec. 31, 2019.

New Jersey employers with non-ACA-compliant plans should work with their carriers in extending their policies, as carriers may have their own restrictions (or prohibitions) on extending such plans.

Bulletin No. 18-10 »
CMS Guidance »


May 30, 2018

Local Paid Leave Laws Still in Effect

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Building upon our previous Compliance Corner articles, we wanted to remind employers that New Jersey cities, towns and counties may continue to enforce paid sick leave requirements upon private employers until Oct. 29, 2018, when the New Jersey Paid Sick Leave law goes into effect. The following counties have their own paid leave laws:

  • Bloomfield
  • East Orange
  • Elizabeth
  • Irvington
  • Jersey City
  • Monclair
  • Morristown
  • New Brunswick
  • Newark
  • Passaic
  • Paterson
  • Plainfield
  • Trenton

Employers should be mindful of the city requirements and continue to comply until the state’s paid sick and safe leave law becomes effective Oct. 29, 2018. Once in effect, the New Jersey Earned Sick Leave law preempts any such ordinance, resolution, law, rule or regulation adopted by a city, town or county.

New Jersey Earned Sick Leave »


May 01, 2018

Paid Sick Leave Law

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On April 12, 2018, the New Jersey legislature passed S2171, known as the New Jersey Paid Sick Leave Act, which is a mandatory paid sick leave law applicable to all employers. Gov. Phil Murphy has announced his intention to sign the bill into law on May 2, 2018 to be effective 180 days after its execution.

Under the new law, employers, regardless of size, must establish a “benefit year” and allow eligible employees to accrue up to 40 hours of paid sick leave at a rate of one benefit hour per 30 hours worked. Eligible employees include those perform work within NJ, but doesn’t include certain employees performing service in the construction industry that is under contract pursuant to a collective bargaining agreement, any per diem health care employees or public employees who are provided with full paid sick leave pursuant to another state law.

Employers that already offer paid time off (including, but not limited to, personal days, vacation days and/or sick days) will be compliant under the law, provided the accrual rate is at least as generous as described under the law, all eligible employees are provided leave and employees can use their earned sick time for the same permissible purposes (described below).

Unless the employer has already accrued sick time prior to the effective date of the law, sick leave will begin to accrue on the date that the law takes effect for employees hired and working before such date. Newly hired employees begin to accrue sick leave immediately upon starting a new job and may use earned sick time on the 120th day after the employee begins working.

Employees may use earned sick time for any the following reasons:

  • Diagnosis, care, treatment of, or recovery from a mental or physical illness, injury or other adverse health conditions, or for preventative medical care of the employee
  • Caring for a family member during diagnosis, care, treatment of, or recovery from a mental or physical illness, injury or other adverse health conditions, or for preventative medical care of the employee’s family member
  • Absence(s) necessary due to the employee or employee’s family member being a victim of domestic or sexual violence, if the sick leave is used for any of the following:
    • Medical attention needed to recover from physical or psychological injury or disability caused by domestic or sexual violence
    • Services from a designated domestic violence agency or other victim services organization
    • Psychological or other counseling
    • Relocation
    • Other legal services, including obtaining a restraining order or preparing for, or participating in, any civil or criminal legal proceeding related to the domestic violence or sexual violence
  • Time needed after the closure of the employee’s workplace or the school/place of care for the employee’s child by order of a public official or other public health emergency, or if a public health authority issues a determination that the presence of the employee or their family member would jeopardize the health of others
  • Attending a school-related function of the employee’s child requested or required by the school responsible for the child’s education, or attending a meeting concerning the care provided to the child in connection with the child’s health conditions or disability

Employers may require an employee to provide advance notice to use sick leave (if foreseeable), but not more than seven calendar days. Notice should include the date the leave is set to begin and the expected duration. If unforeseeable, employees must give notice as soon as practicable. If the sick leave is of three or more consecutive days, an employer may require that employees provide reasonable documentation that their leave time is for a permitted purpose under the law. Any information concerning the health or domestic or sexual violence of an employee or their family member will be confidential and shall not be disclosed, except to the affected employee or with written permission of the employee.

The law includes recordkeeping and notification requirements. Specifically, employers must keep employee records of hours worked and sick leave taken for a period of five years, and those records must be made available for review upon request by the NJ Department of Labor. The department will develop a notice that the employer must post in the workplace. The employer must also give a copy of this notice to employees within 30 days of the notice being drafted and provided to new hires as well as upon any employee’s request.

With regard to penalties, the law provides for a private right of action by an aggrieved employee and includes (but is not limited to) liquidated damages equal to the actual damages sustained by an aggrieved employee (i.e., wages multiplied by two).

The law expressly prohibits towns and cities from enacting ordinances regarding earned sick leave and preempts the previous municipal ordinances in existence prior to the law. When the law is signed, New Jersey will become the tenth state to require some form of paid leave.

Because it’s anticipated that this law will be signed, New Jersey employers should review their sick leave and paid time off policies to ensure compliance with the new law. Employers with specific questions should work with outside counsel, particularly since the law relates to employer leave policies, which can involve issues outside the employee benefits realm.

New Jersey Paid Sick Leave Act »


January 23, 2018

Updated Coverage Requirements for Contraceptives

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On Dec. 15, 2017, Gov. Christie signed A2297 into law, creating Chapter 241. Under the new law, plans must include prescription contraceptives intended to last for: a three-month period for the first dispensing of contraceptives to plan participants, or a six-month period for any subsequent dispensings of the same contraceptives (regardless of whether plan participants are plan enrollees when contraceptives were first dispensed). Plans can provide coverage for a supply of contraceptives that is less than a six-month period if a six-month period extends beyond the contract terms.

Importantly, there is an exemption for religious employers. Specifically, employers that qualify as tax-exempt religious organizations (such as churches and other entities that are controlled, operated or supported by churches) are not required to provide contraceptive coverage if contraceptive use conflicts with an employer’s bona fide religious beliefs and practices.

The new law is effective for policies and contracts delivered, issued or renewed on or after March 15, 2018.

Chapter 241 »


September 19, 2017

New Law Prohibits Discrimination Based on Gender Identity

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On July 21, 2017, Gov. Christie signed A4568 into law, creating Chapter 176. The new law prohibits plans from containing any provision that discriminates against plan participants or prospective plan participants on the basis of gender identity or expression or on the basis that plan participants or prospective plan participants are transgender persons. For purposes of the new law, discrimination includes denying, canceling, limiting or refusing to issue or renew contracts and requiring additional or discretionary payments or premiums. Discrimination also includes designating gender identity or expression (or designation of someone as a transgender person) as a pre-existing condition in order to deny or limit coverage. Finally, discrimination includes denying or limiting coverage, or denying claims for services, relating to an individual’s gender identity or expression or for a transgender person, including gender transition (if services are covered under plans when services aren’t related to gender transition), hormone therapy, hysterectomy, mastectomy and vocal training.

For purposes of the law, “gender expression” means a plan participant’s gender-related appearance and behavior, whether or not that appearance or behavior is stereotypically associated with the sex assigned to that person at birth. “Gender transition” means the process of plan participants changing their outward appearance, including sex characteristics, to agree with their actual gender identity. “Transgender persons” are plan participants who identify themselves as a gender different from their gender at birth.

The new law applies to health plans delivered, issued, executed or renewed in New Jersey on or after Nov. 1, 2017. The new law does not bring new employer compliance obligations, but employers should be aware of the new requirements and should work with outside counsel if they have questions on any health plan issues relating to gender identity and coverage of items or services relating to transgender persons.

Chapter 176 »


June 13, 2017

Coverage for Diagnosis and Treatment of Infertility

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On May 1, 2017, Gov. Christie signed into law SB 1398, creating Chapter 48. The new law expands the availability of insurance coverage for infertility-related health benefits to certain women who are currently denied coverage for those benefits. Current NJ law requires coverage for medically necessary expenses incurred in the diagnosis and treatment of infertility, but the definition of “infertility” requires the female to have unprotected intercourse (and therefore excludes certain females, such as lesbians, women without partners or women with partners who have protected intercourse). To include those individuals, the new bill restructures the definition of “infertility” to mean diseases or conditions that result in abnormal function of the reproductive system, infertility based on the determination of a NJ-licensed physician, or that a plan participant meets one of the following conditions:

  1. Male plan participants who are unable to impregnate females,
  2. Female plan participants who are under age 35 and have male partners who can’t conceive after 12 months of unprotected sexual intercourse,
  3. Female plan participants who are 35 years of age or older and have male partners who can’t conceive after six months of unprotected sexual intercourse,
  4. Female plan participants who are under age 35 and don’t have male partners and can’t conceive after 12 failed attempts of medically supervised intrauterine insemination,
  5. Female plan participants who are over age 35 and don’t have male partners and can’t conceive after six failed attempts of medically supervised intrauterine insemination,
  6. Plan participants’ partners who can’t conceive because of involuntary medical sterility,
  7. Plan participants who are unable to carry a pregnancy to live birth, or
  8. Plan participants who previously have been determined to be infertile.

It’s also important to note that coverage for medically necessary diagnosis and treatment of infertility does not include infertility resulting from voluntary sterilization procedures.

Also, tax-exempt religious employers (including churches or groups that are controlled, operated or supervised by churches) may exclude coverage for artificial insemination, embryo transfer, intracytoplasmic sperm injection, in vitro fertilization and zygote intrafallopian transfer, if such coverage is contrary to the religious employer’s religious belief.

The new requirements are effective for insured group health plans issued or renewed on or after July 31, 2017. NJ employers with fully insured plans should work with carriers on any questions relating to the new infertility coverage requirements.

Chapter 48 »


May 16, 2017

Coverage for Treatment of Substance Use Disorders

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On May 8, 2017, the New Jersey (NJ) Department of Insurance published Bulletin No. 17-05. The bulletin relates to a recently enacted NJ law (Chapter 28), which requires carriers to administer benefits for the treatment of substance use disorder in a specific way and relies on the American Psychiatric Association’s definition of “substance use disorder” (including substance use withdrawal). Substance abuse disorder can be applied to the following classes of drugs: alcohol, cannabis, hallucinogens (including phencyclidine), inhalants, opioids, sedatives, hypnotics, anxiolytics, stimulants and tobacco. Under the new law, carriers are required to provide unlimited inpatient and outpatient benefits for the treatment of substance use disorder at network facilities (meaning with network providers). Except for the case of an in-plan exception, a person covered under a PPO or POS plan who voluntarily uses on out-of-network provider will not be entitled to the protections of the new law with respect to those out-of-network services. Carriers must provide benefits for the first 180 days per plan year of inpatient and outpatient treatment of substance use disorder without prior authorization or other prospective utilization management requirements when determined medically necessary by the person’s physician, psychologist or psychiatrist. Carriers are also required to provide benefits for the first 28 days of an inpatient stay during each plan year without retrospective or concurrent review (where deemed medically necessary). The bulletin contains examples to help explain how that might work across two different plan years.

The bulletin also contains more detail on what constitutes “medical necessity,” and concurrent review with respect to inpatient care. It also outlines that in the case of an emergency admission to an out-of-network hospital, the covered person must comply with the emergency admission requirements stated in their plan.

On prescription drugs, the bulletin (and the new NJ law) describes coverage for prescription drugs as they relate to substance use disorder. Specifically, benefits for outpatient prescription drugs for the first 180 days may not be subject to any prior authorization or prospective utilization management. In addition, the cost-sharing for covered prescription drugs is generally the applicable cost-sharing required by the covered person’s plan. There are specific rules when it comes to opioid drugs, where cost-sharing for the initial maximum five-day supply may be determined in two ways. The first method allows cost-sharing proportional to the amount prescribed, whereas the second method allows the cost-sharing for the full 30-day supply to be charged but prohibits cost-sharing if/when the balance of the same drug is prescribed. The bulletin contains three examples on how that might play out.

Finally, the bulletin contains a helpful summary chart (on page 10) that outlines the various changes under the new NJ law. The bulletin applies to plans issued or renewed on or after May 16, 2017. Employers don’t have to make any compliance changes in connection with the bulletin, but should be aware of the bulletin as a resource for employees with substance use disorder treatment questions.

Bulletin No. 17-05 »


March 21, 2017

Coverage for Treatment of Substance Use Disorders

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On March 6, 2017, the New Jersey Department of Insurance published Bulletin No. 17-01, which relates to coverage for treatment of substance use disorders. The bulletin relates to a recently-enacted New Jersey law (P.L. 2017, Chapter 28), which provides that the benefits for the first 28 days of an inpatient stay during each plan year must be provided without any prior authorization or retrospective or concurrent review and that medical necessity must be determined by the covered person’s physician. The benefits for inpatient care on the 29th day and thereafter must be subject to concurrent review.

Importantly, the law states that if a carrier determines that continued inpatient care in a facility is no longer medically necessary, the carrier must within 24 hours provide written notice to the covered person and the covered person’s physician of its decision and the right to file an expedited internal appeal of the determination. According to the bulletin, in order to comply with the intent of the notice requirement, carriers must provide that notice within 24 hours to the covered person, the covered person’s physician as well as to the facility providing the services. The notice is meant to enable appropriate handling of a covered person’s treatment and appeal rights.

The bulletin contains no new employer obligations. But employers will want to be aware of the substance use disorder treatment process, including rights to appeal, should any covered employee (or their dependents) have any questions.

Bulletin No. 17-01 »


March 21, 2017

Extension of Renewal for Non-PPACA-Compliant Plans

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On March 10, 2017, the New Jersey Department of Insurance published Bulletin No. 17-02, which relates to the extension of renewal for non-PPACA-compliant plans (also known as ‘grandmothered plans’). As background, on Feb. 23, 2017, CMS issued guidance allowing extension of grandmothered plans (i.e., non-PPACA-compliant plans that have been continued since 2014), subject to state and carrier approval. Bulletin No. 17-02 is New Jersey’s approval for such an extension.

The bulletin directs carriers to the CMS guidance, meaning New Jersey will accept approvals for extensions based on the CMS bulletin’s requirements. The CMS guidance allows an extension of non-PPACA-compliant policies to policy years beginning on or before Oct. 1, 2018, provided that all such policies end by Dec. 31, 2018.

New Jersey employers with non-PPACA-compliant plans should work with their carriers in extending their policies, as carriers may have their own restrictions (or prohibitions) on extending such plans.

Bulletin No. 17-02 »


May 19, 2015

NJ State Updates - 2015 Jan 19 No.01

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On May 4, 2015, Commissioner of Insurance Kobylowski issued Bulletin No. 15-04. The bulletin addresses an amendment to New Jersey’s minimum standards for health benefit plans to facilitate “bronze” plan designs consistent with federal requirements.

As background, PPACA requires health benefit plans issued in the individual and small employer markets to satisfy specific actuarial value (AV) standards. The AV calculator proposed by the federal government for 2016 generally produces higher AVs than the AVs calculated using the current (2015) calculator. The 2015 to 2016 calculator change has caused New Jersey health carriers to claim that the “bronze” plans, or plans that must fall within the 58 to 62 percent AV requirement under the new Federal 2016 AV calculator, will be particularly challenging given the $2,500 individual network deductible limit as set forth in New Jersey law.

The New Jersey Department of Insurance has taken action to ensure the continued availability of reasonable and understandable bronze plans for consumers on the federal insurance exchange. The Department will permit New Jersey health carriers to use an individual network deductible up to $3,000 for bronze plans offered in the individual and small employer markets. Therefore, New Jersey employers in the small market will, therefore, see bronze plans with individual deductibles up to $3,000.

Bulletin 15-04 »


February 10, 2015

NJ State Updates - 2015 Jan 10 No.01

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On Jan. 9, 2015, Gov. Christie signed Senate Bill 562, creating Public Law 2014 Chapter 88, which will require health insurance carriers to encrypt certain information. The law applies to any insurance company, hospital service corporation, health service organization, or health maintenance organization authorized to issue health benefits plans in New Jersey. These entities must protect individually identifiable health information via encryption. They will be prohibited from maintaining computerized records that contain personal information unless it is encrypted. "Personal information" means an individual's first name or first initial and last name linked with one or more of the following data elements: (1) Social Security number (2) driver's license number or state identification card number (3) address or (4) identifiable health information. The law applies only to end user computer systems (e.g. computer systems, laptops and other devices used by end users to access the data) and computerized records transmitted across public networks.

While the law does not impact employers directly, group health plan sponsors will likely notice additional measures taken by carriers and insurers subject to these requirements in order to protect individually identifiable health information and comply with the state law.

The law becomes effective Aug. 1, 2015.

Public Law 2014 Chapter 88 »