The State of New Jersey
NJ Department of Banking and Insurance
search  


Home > Health Insurance Programs > FAQs - Health Republic Insurance of New Jersey - Providers
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)
What’s happening?  What does it mean for you?  What do you need to do?
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.

Claims will continue to be processed by QualCare.  Any claims that have not yet been submitted should be sent to QualCare.  Claims that have been submitted to QualCare but have not yet been paid need not be resubmitted in order to have those claims paid by the Association.
 
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
   
4.  How do I file a Proof of Loss?           
  All parties having an interest in the liquidation of HRINJ (previous members, subscribers, policyholders, providers that have previously submitted claims, vendors and others) will be mailed Proof of Loss forms directly from the insolvency office for Health Republic on or before March 1, 2017.  If you do not receive a Proof of Loss form, you may contact the insolvency office for Health Republic on or after March 1, 2017, at: 800-982-8347 or insolvencyoffice@njliq.org.  All Proofs of Loss must be filed in writing pursuant to the directions on the form and must be postmarked no later than August 2, 2017, to be considered.
   
5.  Who can I contact to get more information?
  Questions regarding claim status and processing should be directed to QualCare as it will continue to process provider claims in the liquidation. Questions regarding the Proof of Loss process and other liquidation matters should be directed to Health Republic in Liquidation at 800-982-8347.

Questions about the New Jersey Life and Health Insurance Guaranty Association should be directed to:

NJLHIGA
11 Wharf Avenue, Suite One
Red Bank, NJ 07701
732-345-5200

Other questions can be directed to the Department at 800-446-7467. 

 
OPRA
OPRA is a state law that was enacted to give the public greater access to government records maintained by public agencies in New Jersey.
line
Adobe Acrobat
You will need to download the latest version of Adobe Acrobat Reader in order to correctly view and print PDF (Portable Document Format) files from this web site.
state seal
Copyright © 2011, State of New Jersey
New Jersey Department of Banking and Insurance