FAQs for Providers with Patients Previously Covered by Freelancers Consumer Oriented and Operated Plan, d/b/a Health Republic Insurance of New Jersey (Health Republic)
| 1. | What happened to Health Republic? | |
| Health Republic, like all insurance companies, must meet financial requirements to ensure that it has enough money to pay all of its financial obligations, most importantly its financial promises to policyholders and their medical providers. When a company fails to meet these requirements and is found to be in a hazardous financial condition, the Department of Banking and Insurance (Department) takes action to protect consumers and providers. Here, the Department asked the Court to issue an Order of Rehabilitation. The Court granted this request and issued an Order of Rehabilitation on October 19, 2016. That Order allowed the Department to take control of the company. The Department carefully reviewed Health Republic’s financial condition after taking control and determined that it was not possible to restore the company to a solvent position. The Department then sought an Order of Liquidation, which was entered on February 3, 2017. | ||
| 2. | What will happen to claims that Health Republic has not already paid? Can I bill my patients? | |
| The New Jersey Life and Health Guaranty Association (Association) will pay provider claims for covered services subject to a 20% reduction. This reduction is required by law. Providers must not bill patients for the 20% reduction or for any other amounts unpaid by Health Republic for covered services. However, providers can submit a Proof of Loss to Health Republic in Liquidation for the 20% reduction and any other amounts they feel Health Republic owes them. Once Health Republic has marshalled its assets and adjudicated the Proof of Loss forms, Health Republic will make one or more distributions to all parties filing Proofs of Loss in accordance with the statutory claim classes in N.J.S.A. 17B:32-71. | ||
| 3. | How will the 20% reduction be calculated? | |
| The 20% reduction will be applied to the allowed amount, member cost sharing will then be calculated based on the reduced allowed amount and the difference between the reduced allowed amount and member cost sharing will be paid by the Association through QualCare. | ||
Here is an example. Assume a billed amount of $1,200, an allowed amount of $1,000, member coinsurance of 20%, the deductible has been satisfied and copayment does not apply.
| Billed Amount | Allowed Amount | 20% Reduction | Member Coinsurance | Association Payment |
| 1,200 | 1,000 | 800 | 160 | 640 |
Questions about the New Jersey Life and Health Insurance Guaranty Association should be directed to:
NJLHIGA
521 Newman Springs Road, Suite 22
Lincroft, NJ 07738
732-345-5200
Other questions can be directed to the Department at 800-446-7467.