NJ Governor Phil Murphy wants money, if residents don't maintain individual health insurance. Effective January 1, 2019, the governor signed a new law reestablishing the recently repealed "shared responsibly tax". It forces individuals to pay 2.5 percent of a household's income or a per-person charge - whichever is higher. A "hardship exception" for individuals who cannot afford coverage would be decided by one person i.e. the state treasurer Elizabeth Mucio.
At the same time, NJ is one of the worst states for offering individual alternatives to fill the gaps in the out-of-pocket cost for health insurance. NJ also does not allow individuals to secure short term major medical in-between open enrollment periods.
The maximum out-of-pocket cost for health insurance will be raised, based on the inflation-adjusted out-of-pocket limits from $7,350 per individual and $14,700 per family to $7,900 per individual and $15,800 per family in 2019. Meanwhile, according to the Kaiser Family Foundation (KFF), more than a quarter of U.S. adults struggle to pay their medical bills. This includes folks who have insurance, whether independently or through an employer. In fact, medical debt is the No. 1 source of personal bankruptcy filings in the U.S.. In 2014, an estimated 40% of Americans racked up debt resulting from a medical issue. The amount of money owed on average is $13,279 based on a 2007 study. Moreover, according to a recent GoBankingRates survey, 69% of Americans have less than $1,000 in savings, while 34% have no money in the bank whatsoever.
The options are slim to none if you do not have coverage or you lapse your insurance for non-payment of premium. We have been giving individuals with no coverage a way to offset medical expenses based on four services. Access to doc 24/7, broach certified doctors who can prescribe medication, accident plans that pay up to $15,000 per individual based on billed charges, Preferred Provider access to any type of medical expenses allowing you to pay wholesale verses retail rates, life with living benefits of critical, chronic, and Long Term Care protection. Term and Permanent life insurance can advance pay the death benefits for major medical conditions that shorten one's life span.
Everyone should beware of the law when you can enroll and the options available to them. Most people are not aware that each family member can enroll in a different health plan, based on their needs. Some still do not realize that children can be covered for low or no cost through the state children health program. I also find that most people do not know the rules that allow them to qualify for substantial subsidies on individual insurance. They are also unfamiliar with the ways they could take advantage of tax savings for no covered out-of-pocket medical, vision, and dental expenses.
There are numerous other rules and requirements that individual and employers should know as well. Everyone needs to have a trained advisor. Everyone needs to know that a Navigator or the Marketplace representatives are not licensed, cannot discuss insurance plans, and typically just go by what their computer tells them. There is a tremendous amount that you need to be advised on when protecting your family and more changes are coming.
Recent executive orders from the White House will allow for association plans to be marketed. These plans will not offer all the essential services required by the Affordable Care Act. Therefore, you will have to read the contracts to find out what is not included. Buyers beware!

The new law applies to any business entity in NJ that hires employees regardless of its size. The law is broad-based in coverage and will surely hurt employers with high turnover positions. NJ will be following nine other states that are the only ones to implement this benefit. This adds to the already high burden on employers in NJ. The Paid Sick Leave law excludes employers in the construction industry employed by union, per diem healthcare employees, and public employers who must give paid sick leave to their employees. Furthermore, this law supersedes all existing and any future municipal ordinances in the state that deal with paid sick leave. Tax payers will pick up the costs for the municipalities and employers will have to pass on the cost to their customers.
The law allows employees to accrue sick leave time with a cap of 40 hours per benefit year at a rate of 1 hour for every 30 hours worked. Employer can frontload said hours at the beginning of the company's designated benefits year. Although, I do not think there will be many takers. Additionally, employers who have existing PTO, personal days, vacation days, and sick day policies may utilize them to meet the requirements set by the state paid sick leave law. All existing policies have to meet the state law requirements.
Employer can subtract part-time and seasonal workers that work less than 120 days for the company. However, once this waiting period is met, employees can use paid sick time for these reasons:

• The diagnosis, treatment, and recovery from a mental or physical illness (preventive medical care included)
• Caring for a covered family member during the diagnosis, treatment, and recovery from mental or physical illness (preventative medical care included)
• Recovering from domestic or sexual violence (either an employee or an employee's family member)
• The closing of an employee's workplace due to a public health emergency
• The closing of a school of an employee's child due to a public health emergency
• Attending school conferences or meetings to discuss a child's health condition or disability

Employers will face penalties for not following the new law effective October 29 of this year. Plus, there is also an anti-retaliation provision in the law that makes it illegal to retaliate against workers who use their earned time off. An employer who takes retaliatory actions against an employee using their paid sick time could face additional penalties and lawsuits. Employees will be able to sue their employer, if the latter violated the law and can seek damages, as well as, liquidation damages.
Questions remain. For instance, does a NJ employer have to offer the same benefits to out-of-state employees working for the NJ employer? Can they instead avoid the policy with an independent contractor designation? Even temporary help service firms are affected as the paid sick leave will accrue by the total time worked on assignment. Employers are instructed to seek assistance from HR compliance experts to help prepare for the law and ensure compliance when it goes into effect.

Rates have been filed across the country and the outlook is not great. Not only will individuals have to sign up for coverage within 45 days, but the choice will also be limited. Across the nation, 42.41% of counties will only have one insurance carrier to pick a plan with and 1.27% of counties are projected to have no carriers at all. Premium rates for larger networks of providers or offering out-of-state or out-of-network coverage will increase upwards of 59%. Meanwhile, the maximum out-of-pocket cost for individuals and groups will be raised to $7,350 for self-only coverage and $14,700 for family coverage. Still, upwards of three-quarters of individuals will be insulated from rate hikes by staying with the high out-of-pocket benchmark plans using the subsidies offered through the Affordable Care Act. Individuals earning less than 250% of the Federal Poverty Level will also be shielded from higher out of pocket costs unless of course, President Trumps stops the cost sharing subsidies. As of this date, it looks like individuals earning over 400% of the Federal Poverty Level will pay an average increase of 22% with Horizon of New Jersey on their popular Omnia Silver plan. AmeriHealth is asking for as much as a 59% increase on some plans. Eastern PA residents seem to be spared with Keystone Health Plan East looking for a 4.6% increase on individuals but 10.18% on small group plans. In New York, the average increase is 14.6% for individuals and 9.3% for small groups plans. Looking at these price increases, it is strange that Eastern PA, with only one insurance carrier, is offering coverage with the lowest rate increase while NJ, with 3 carriers, and NY, with 15, cannot say the same. Still, these rate increases on top of last year's increase will make insurance unfordable to many paying the full cost for coverage. 1 Stop Benefits Inc. will continue to stay on top of all the changes in the insurance world, and seek out ways to find high quality, low-cost care for everyone. We strongly suggest you contact us right away and as about our enhanced supplements to fill the gaps in any health plan. Some of these low-cost cash benefits will not be available to new clients as of the new open enrollment. NJ residents should view this Flyer because you only have up to November 15 to purchase.