N.J. Admin. Code § 17:9-9.1

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

Section 17:9-9.1 - Employee Dental Plans

(a) The Employee Dental Plans were established under the provisions of 52:14-17.29(F) and were extended to local participating employers as of January 1, 2005. The Employee Dental Plans are available to full-time employees and their eligible dependents. Newly eligible employees may enroll by completing an application during the first 60 days of employment. The Employee Dental Plans offer a choice between two types of dental plans: a Dental Expense Plan and a Dental Plan Organization (DPO). The Dental Expense Plan is a PPO that allows the employee to select any licensed dentist for dental care. The Dental Plan Organizations (DPOs) are companies that contract with a network of providers for dental services. The employee must use providers participating with the DPO selected.

(b) The Plans are voluntary. A separate election will be required for enrollment and for a change in, or a voluntary termination of, coverage in the Employee Dental Plans.

(c) The rules are the same as those of the SHBP as administered by the Commission in accordance with the provisions of N.J.S.A. 52:14- 17.25 et seq., with the following exceptions:

1. Coverage may be continued during an approved leave of absence without pay of not more than three months (six biweekly pay periods) provided the employee pays the entire premium in advance (employer and employee shares of the premium for employees and dependents);

2. All employees enrolled for coverage are required to participate in the Plan for a minimum 12-month period while eligibility for coverage exists unless the minimum enrollment requirement is waived by the Commission;

3. An employer who participates in the Employee Dental Plans is not eligible to request a premium delay of 30 or 60 days for payment of the premium charges pursuant to 17:9-5.2(a);

4. If an employer elects to participate in the Employee Dental Plans, the employee's share of the cost for the Plans may be determined by a formula different from that used to determine the employee's share of the cost of health coverage. The employee may pay a share of the cost of dental coverage for the employee and for the employee's covered dependents as required by a collective negotiations agreement. The employer may establish by ordinance or resolution, rules for the employee's share of the cost for those employees not covered under a collective negotiations agreement;

5. An employer who does not participate in the SHBP or School Employees' Health Benefits Program is ineligible for participation in the Employee Dental Plans; and

6. An employer who elects to participate in the Employee Dental Plans must remain in the Plans for a minimum of 12 months before terminating coverage unless the employer terminates participation in the SHBP or School Employees' Health Benefits Program.

N.J. Admin. Code § 17:9-9.1

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