N.J. Admin. Code § 17:9-7.3

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

Section 17:9-7.3 - Continuation of coverage

(a) The coverage of an employee, and an employee's dependents, may be continued if:

1. The employee has an award pending or received an award of periodic benefits under Workers' Compensation and the employee is not otherwise covered as an employee or retiree under the SHBP. The employee may continue coverage and the coverage of the employee's dependents, provided that the employee shall pay to the employer in advance that portion, if any, of the charges due from the employee to continue the coverage;

2. The employee is on an approved leave of absence without pay. The coverage of such employee and such employee's dependents may be continued by such employee, provided that the employee shall pay in advance the total charge required for the employee's coverage and coverage of the employee's dependents during such period of authorized leave of absence without pay; provided that no period of continued coverage, as provided above, shall exceed a total of 20 biweekly payroll periods, or nine months, during which the employee receives no pay. After the 20 biweekly payroll periods, or nine months, the employee may continue coverage through COBRA for the remaining balance of the COBRA continuation period; or

3. The employee is on an approved State or Federal Family Leave.

i. The State Family Leave Act (34:11B-1 et seq.) entitles an employee to continue 12 weeks of SHBP coverage in any 24-month period at the expense of their employer. This includes all health care benefits, including Prescription Drug, Dental and Vision Care benefits if the employer provides them. State Family Leave includes leave from employment to provide care for the birth or adoption of a child, or the serious illness of a child, parent, spouse or partner. It does not provide for a leave due to the personal illness of the employee.

ii. The Federal Family Leave Act (Family and Medical Leave Act of 1993, 29 U.S.C. §§ 2601 et seq.) has benefits similar to the State Family Leave Act with the exception that the Federal act also requires that leave be permitted for the employee's own serious illness of up to 12 weeks in any 12-month period.

iii. In cases where the employee on an approved Family Leave has a deduction, the employer must make arrangements with the employee to receive direct payment for the required employee contribution. If the SHBP does not receive full payment from the employer, then the employee's benefit coverage will be terminated under the termination provisions of the SHBP program.

iv. The time an employee spends on Federal or State family leave shall not count as part of the COBRA eligibility period should an employee receive approval from their employer to extend the leave.

N.J. Admin. Code § 17:9-7.3

Amended by R.2003 d.437, effective 11/3/2003.
See: 35 N.J.R. 2587(a), 35 N.J.R. 5149(a).
Rewrote the section.
Amended by R.2009 d.150, effective 5/4/2009.
See: 41 N.J.R. 101(a), 41 N.J.R. 2037(a).
In (a)1, substituted "SHBP" for "State Health Benefits Program"; and in (a)3i, substituted a comma for "or" preceding "spouse" and inserted "or partner".