N.J. Admin. Code § 17:9-2.11

Current through Register Vol. 56, No. 23, December 2, 2024

Section 17:9-2.11 - Out-of-network PPO and high deductible health plan; eligible charges at enrollment (local employees)

(a) For purposes of local coverage, all eligible charges incurred by an eligible employee or the employee's covered dependents, from January 1 of a calendar year to the effective date of coverage for the employee's participating employer, will be considered toward satisfying the out-of-network deductibles and coinsurance required under the plan.

(b) For purposes of retiring members with local coverage, all eligible charges incurred by eligible retirees and their covered dependents from January 1 of a calendar year to the effective date of coverage will be considered toward satisfying the out-of-network deductibles and coinsurance required under the plan.

(c) The charges considered are to be eligible charges under the plan. No charges will be used to satisfy the deductibles and coinsurance for which the employee has been reimbursed by any source.

N.J. Admin. Code § 17:9-2.11

Amended by 48 N.J.R. 2387(a), effective 11/7/2016