N.J. Admin. Code § 17:9-2.4

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

Section 17:9-2.4 - Coverage changes; exceptions

(a) An employee may change the employee's enrollment and the enrollment of the employee's dependents to any type of coverage if such changes result from a change in the family, dependency, or employment status of the employee or the employee's dependents. Such changes will be permitted under the following conditions:

1. Marriage and civil unions. Any employee who marries or enters into a civil union may enroll the employee and eligible dependents, if any, for any appropriate type of coverage by applying for coverage within 60 days after such marriage or civil union. In the event that the spouse or partner is already enrolled in the SHBP or SEHBP as an employee, the provisions of 17:9-3.5, regarding the prohibition of multiple coverage shall apply to such spouse's or partner's enrollment. A copy of the marriage certificate or certificate of civil union must be submitted with the completed application to add the spouse/partner.

2.Divorce; separation; termination of domestic partnership or end of civil union. Any employee who has been enrolled or has been covered as a dependent of an enrolled employee and is subsequently divorced or ends a civil union pursuant to N.J.S.A. 2A:34 or terminates a domestic partnership pursuant to 26:8A-10 may enroll and delete from coverage or cover any eligible dependents by completing and forwarding a new enrollment form within 60 calendar days after the divorce or termination of the domestic partnership or civil union of such employee or dependent of an employee who was covered previously under the spouse's/partner's contract. A change of enrollment of this nature may also be made in the case of separation.

3.Death of spouse, civil union partner, eligible domestic partner or dependent child. Any employee who is enrolled as the dependent of their spouse/partner who dies may thereupon enroll as an employee, and may enroll any eligible dependents, for any appropriate coverage by completing and forwarding a new enrollment form within 60 days following the death.

4.Return from military leave. Any employee, upon return from any period of military leave without pay, may enroll the employee and any eligible dependents for any appropriate coverage by completing and forwarding an enrollment form within 60 days after the date of the employee's return to active full-time employment. In the event a dependent of an employee is discharged from military service, the employee may enroll such dependent for any appropriate coverage within the time specified above.

5. When last covered child reaches age 26, marries, or enters into a civil union prior to that time. On December 31 of the year in which the child reaches age 26, the child shall be removed from coverage by the SHBP and the level of coverage of the employee or retiree shall be adjusted accordingly, unless the child is otherwise eligible for continued coverage as an overage child with disabilities. Any employee who shall have enrolled one or more children as dependents may enroll for any coverage at the time the last such child reaches age 26, marries prior to that time, enters into a domestic partnership or civil union or becomes otherwise ineligible, by completing and forwarding a new enrollment form.

6. When last covered child obtains other group health coverage through employment, marriage, or upon entering into a civil union or domestic partnership prior to attaining age 26. Any employee who shall have enrolled one or more children will be removed from dependent coverage at the time the last such child obtains other health benefits through employment or marriage, or upon entering into a civil union or domestic partnership prior to attaining age 26, or becomes otherwise ineligible. A subscriber may complete and forward a new enrollment form to change coverage level.

7. An employee, spouse, eligible domestic or civil union partner, or dependent ceases to be covered by other group health coverage. If the employee, spouse, domestic or civil union partner, or other dependent has other group health coverage, and then becomes ineligible for that employment, divorce, termination of domestic or civil union partnership, death, or reduction in hours worked, the employee may enroll in any plan or for any coverage in the SHBP, provided that the employee submits a new enrollment application accompanied by proof of the prior coverage, within 60 days of the qualifying event.

8. Birth, adoption, or guardianship of children. When an employee acquires qualified dependents through birth, placement for adoption, adoption, legal guardianship of children, or the assumption of direct support of children, the employee may enroll the employee and any eligible dependents for any appropriate type of coverage by completing and forwarding a new enrollment form within the period beginning 60 days prior to and ending 60 days after the birth, placement for adoption, the adoption, the guardianship, or the assumption of direct support of children. Such application regarding placement for adoption, adoption, assumption of direct support of children, and guardianship shall be accompanied by legal documentation evidencing the relationship.

9. COBRA enrollment. When an employee or dependent enrolls in the COBRA group, the employee or dependent may, within 60 days of the qualifying event, select any plan. In order for an employee or dependent to enroll in health benefit, dental, or prescription coverage through COBRA, the subscriber must have been eligible for that coverage in the active group.

i. A Chapter 375 dependent who thereafter becomes ineligible for group medical and prescription coverage under Chapter 375 is not eligible for group medical and prescription coverage under COBRA.

ii. Chapter 375 dependents are permitted to continue vision and/or dental coverage under COBRA at the time they enroll in group medical and prescription coverage under Chapter 375, because Chapter 375 does not provide vision or dental coverage.

10.Upon return to employment from an approved leave of absence. Within 60 days after the return to employment from an approved leave of absence, the employee may elect to change coverage to add any eligible dependent(s) who had been removed from this group coverage while the employee was on such leave. If the employee elected not to continue his or her benefits while on leave or missed the open enrollment period, the employee may elect to enroll in any plan or coverage level as appropriate.

11.Deference to local employer contracts. When a local employer's contract limits coverage choices of an employee for a specified period of time after the employee's hire date, the employee may increase coverage levels provided an enrollment application is submitted within 60 days following the attainment of additional benefits provided in the contract.

(b) An employee may change the employee's enrollment and the enrollment of the employee's eligible dependents to any type of coverage under conditions other than those specified in (a) above, only during the annual enrollment period, or during a special SHBP open enrollment period.

(c) An employee who wishes to change the employee's enrollment and the enrollment of the employee's eligible dependents for any of the reasons included in (a) above, but who has failed to complete and forward the required enrollment form within the time limits therein prescribed, may effect such change of enrollment only during the annual enrollment period or during a special SHBP open enrollment period. For provisions governing coverages and charges for 10-month employees, see 17:9-5.8(c).

N.J. Admin. Code § 17:9-2.4

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