reglab/statecodes huggingface dataset:
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.29dd - SHBC to cover preventive services.

52:14-17.29dd SHBC to cover preventive services.
9. a. The State Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital or medical expense benefits shall provide coverage, without requiring any cost sharing, for the following preventive services:
(1) evidence-based items or services that have in effect a rating of "A" or "B" in the current recommendations of the United States Preventive Services Task Force;
(2) immunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention;
(3) with respect to infants, children, and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration; and
(4) with respect to women, any additional preventive care and screenings not described in paragraph (1) as provided for in the comprehensive guidelines supported by the Health Resources and Services Administration.
b. (1) Except as provided in paragraph (2) of this subsection, nothing in this section shall:
(a) require a contract which has a network of providers to provide benefits for items or services described in subsection a. of this section that are delivered by an out-of-network provider; or
(b) preclude a contract which has a network of providers from imposing cost-sharing requirements for items or services described in subsection a. of this section that are delivered by an out-of-network provider.
(2) If a contract does not have in its network a provider who can provide an item or service described in subsection a. of this section, the contract shall cover the item or service when performed by an out-of-network provider, and shall not impose cost sharing with respect to that item or service.
c. (1) A contract shall provide coverage for an item or service described in subsection a. of this section for plan years that begin on or after the date that is one year after the date the recommendation or guideline is issued.
(2) (a) Except as provided in subparagraph (b) of this paragraph, a contract that is required to provide coverage for an item or service described in subsection a. of this section on the first day of a plan year shall provide coverage for that item or service through the last day of the plan year.
(b) The commissioner may remove a coverage requirement for an item or service during a plan year if the recommendation or guideline changes or is no longer described in subsection a. of this section.
L.2019, c.360, s.9.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.29ee - State Health Benefit Commission to cover adolescent depression screenings.

52:14-17.29ee State Health Benefit Commission to cover adolescent depression screenings.
9. The State Health Benefits Commission shall ensure that every contract purchased by the commission, on or after the effective date of this act, that provides hospital or medical expense benefits shall provide coverage for expenses incurred in screening adolescents between the ages of 12 and 18 for major depressive disorder, so long as screening for major depressive disorder in adolescents continues to receive a rating of "A" or "B" from the United States Preventative Services Task Force. Coverage shall not be denied solely on the basis that the screening is provided in conjunction with any other health care evaluation, treatment, or service.
The benefits shall be provided to the same extent as for any other condition under the contract, except that the contract shall not impose on covered persons receiving these services any form of cost sharing, including, but not limited to, copayments, deductibles, or coinsurance.
L.2021, c.73, s.9.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.29ff - State Health Benefits Program, opioid antidote coverage.

52:14-17.29ff State Health Benefits Program, opioid antidote coverage.
3. a. Notwithstanding any law or regulation to the contrary, the State Health Benefits Commission and the School Employees' Health Benefits Commission shall ensure that every contract under the State Health Benefits Program shall provide coverage for an opioid antidote to eligible members of the State Health Benefits Program and the School Employees' Health Benefits Program. The coverage shall be provided without the imposition of any prior authorization or other utilization management requirements, provided that the treatment is:
(1) prescribed or administered to the eligible member by a licensed medical practitioner who is authorized to prescribe or administer that treatment pursuant to State and federal law; or
(2) dispensed to the eligible member by a licensed pharmacist under a standing order to dispense an opioid antidote pursuant to section 1 of P.L.2017, c.88 (C.45:14-67.2).
b. The provisions of this section shall not be construed to limit the coverage of an opioid antidote only when administered by a medical practitioner.
c. Each commission shall develop and issue guidelines to ensure the safety and efficacy of benefits provided pursuant to this section.
d. As used in this section:
"Opioid antidote" means naloxone hydrochloride, or any other similarly acting drug approved by the United States Food and Drug Administration for self-administration for the treatment of an opioid overdose.
L.2021, c.157, s.3.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.29hh - SHBC, coverage for abortion, certain religious employers exemption.

52:14-17.29hh SHBC, coverage for abortion, certain religious employers exemption.
4. A contract providing hospital or medical expense benefits purchased by the State Health Benefits Commission may provide coverage for abortion. A contract providing hospital or medical expense benefits purchased by the commission shall not exclude a provider from its network or otherwise restrict services from the provider solely on the basis that the provider is a religious employer, as defined in section 3 of P.L.2021, c.375 (C.26:2S-39), that refuses to provide abortion services.
L.2021, c.375, s.4.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.29ii - Full-time firefighters to be screened for cancer.

52:14-17.29ii Full-time firefighters to be screened for cancer.
1. a. A firefighter employed as a full-time paid employee of a fire department or unit of this State or a political subdivision of this State shall be provided a cancer screening examination conducted by a physician not less than three years after the start of the firefighter's employment as a firefighter and every three years thereafter during the course of the firefighter's employment. The examination shall include screening for, at a minimum and when applicable, the following cancers:
(1) colon;
(2) lung;
(3) bladder;
(4) oral;
(5) thyroid;
(6) skin;
(7) blood;
(8) breast;
(9) cervical
(10) testicular; and
(11) prostate.
b. Subsection a. of this section shall apply to a firefighter enrolled in the State Health Benefits Program as occupational coverage. For the purpose of this subsection, employment as a full-time paid employee of a fire department or unit of this State or a political subdivision of this State shall be a pre-existing condition.
c. Notwithstanding the provisions of any other law, rule, or regulation to the contrary, beginning January 1, 2023 and for each plan year thereafter, a public employer that does not participate in the State Health Benefits Program shall provide health care benefits coverage for its employees that offers cancer screening examinations consistent with the requirement of subsection a. of this section. A public employer that does not participate in the State Health Benefits Program shall be eligible for reimbursement from the State for its cost of providing benefits coverage for such examinations; provided, however, at no time shall the cost being reimbursed to the public employer by the State for the full examination required under subsection a. of this section exceed $1,250 per three-year period for each firefighter.
No co-payment, deductible, coinsurance, or out-of-pocket expense shall be required for such examinations.
A public employer shall maintain adequate records to facilitate the reimbursement authorized pursuant to this subsection.
For the purpose of this subsection, employment as a full-time paid employee of a fire department or unit of this State or a political subdivision of this State shall be a pre-existing condition. There shall be an appropriation from the State General Fund in each annual appropriations act of such funds as necessary for the purposes of this section.
L.2021, c.478; amended 2022, c.109.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.29jj - State Health Benefits Commission, contract, provide coverage for colorectal cancer screening.

52:14-17.29jj State Health Benefits Commission, contract, provide coverage for colorectal cancer screening.
9. a. The State Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act, that provides hospital or medical expense benefits shall provide benefits to any person covered thereunder for expenses incurred in conducting a colorectal cancer screening in accordance with United States Preventive Services Task Force recommendations. The method and frequency of screening to be utilized shall be in accordance with the most recent published recommendations of the United States Preventive Services Task Force and as determined medically necessary by the covered person's physician, in consultation with the covered person.
b. No deductible, coinsurance, copayment, or any other cost-sharing requirement shall be imposed for a colonoscopy performed following a positive result on a non-colonoscopy, colorectal cancer screening test recommended by the United States Preventive Services Task Force.
c. The benefits shall be provided to the same extent as for any other medical condition under the contract.
L.2023, c.8, s.9.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.29kk - State Health Benefits Commission, ensure, contract purchased, renewed, coverage, insulin for diabetes treatment.

52:14-17.29kk State Health Benefits Commission, ensure, contract purchased, renewed, coverage, insulin for diabetes treatment.
25. The State Health Benefits Commission shall ensure that every contract purchased or renewed by the commission on or after the effective date of P.L.2023, c.105 (C.17:48-6xx et al.), shall provide coverage for health care services to a person covered thereunder for insulin for the treatment of diabetes, if recommended or prescribed by a participating physician or participating nurse practitioner/clinical nurse specialist. Coverage for the purchase of a short-acting, intermediate-acting, rapid-acting, long-acting, and pre-mixed insulin product shall not be subject to any deductible, and no copayment or coinsurance for the purchase of insulin shall exceed $35 per 30-day supply, except a contract provided by the State Health Benefits Commission that qualifies as a high-deductible health plan shall provide coverage for the purchase of insulin at the lowest deductible and other cost-sharing requirement permitted for a high-deductible health plan under section 223(c)(2)(A) of the federal Internal Revenue Code (26 U.S.C. s.223 (c)(2)(A)). The provisions of this section shall apply to a plan that meets the requirements of a catastrophic plan, as defined in 45 C.F.R. s.156.155, to the maximum extent permitted by federal law.
Nothing in this section shall prevent the State Health Benefits Commission from reducing an enrollee's cost-sharing requirement by an amount greater than the amount specified in this section or prevent the commission from utilizing formulary management, including a mandatory generic policy, to promote the use of lower-cost alternative generic drugs that are the therapeutic equivalent of the brand-name drug, which could result in the member's copay being higher than set forth in this section.
L.2023, c.105, s.25.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.29ll - State Health Benefits Commission, ensure, contract purchased, renewed, coverage, epinephrine auto-injector device.

52:14-17.29ll State Health Benefits Commission, ensure, contract purchased, renewed, coverage, epinephrine auto-injector device.
26. The State Health Benefits Commission shall ensure that every contract purchased or renewed by the commission on or after the effective date of P.L.2023, c.105 (C.17:48-6xx et al.), shall provide coverage for at least one epinephrine auto-injector device, if recommended or prescribed by a participating physician or participating nurse practitioner/clinical nurse specialist. Coverage for the purchase of an epinephrine auto-injector device shall not be subject to any deductible, and no copayment or coinsurance for the purchase of an epinephrine auto-injector device shall exceed $25 per 30-day supply, except a contract provided by the State Health Benefits Commission that qualifies as a high-deductible health plan shall provide coverage for the purchase of an epinephrine auto-injector device at the lowest deductible and other cost-sharing requirement permitted for a high-deductible health plan under section 223(c)(2)(A) of the federal Internal Revenue Code (26 U.S.C. s.223 (c)(2)(A)). The provisions of this section shall apply to a plan that meets the requirements of a catastrophic plan, as defined in 45 C.F.R. s.156.155, to the maximum extent permitted by federal law.
Nothing in this section shall prevent the State Health Benefits Commission from reducing a covered person's cost-sharing requirement by an amount greater than the amount specified in this section or prevent the commission from utilizing formulary management, including a mandatory generic policy, to promote the use of lower-cost alternative generic drugs that are the therapeutic equivalent of the brand-name drug, which could result in the member's copay being higher than set forth in this section.
L.2023, c.105, s.26.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.29mm - State Health Benefits Commission, ensure, contract purchased, renewed, coverage, prescription asthma inhaler.

52:14-17.29mm State Health Benefits Commission, ensure, contract purchased, renewed, coverage, prescription asthma inhaler.
27. The State Health Benefits Commission shall ensure that every contract purchased or renewed by the commission on or after the effective date of P.L.2023, c.105 (C.17:48-6xx et al.), shall provide benefits to a person covered thereunder for expenses incurred for a prescription asthma inhaler, if recommended or prescribed by a participating physician or participating nurse practitioner/clinical nurse specialist. Coverage for the purchase of a covered prescription asthma inhaler shall not be subject to any deductible, and no copayment or coinsurance for the purchase of a covered prescription asthma inhaler shall exceed $50 per 30-day supply, except a contract provided by the State Health Benefits Commission that qualifies as a high-deductible health plan shall provide coverage for the purchase of a covered prescription asthma inhaler at the lowest deductible and other cost-sharing requirement permitted for a high-deductible health plan under section 223(c)(2)(A) of the Internal Revenue Code (26 U.S.C. s.223). The provisions of this section shall apply to a plan that meets the requirements of a catastrophic plan, as defined in 45 C.F.R. s.156.155, to the maximum extent permitted by federal law.
Nothing in this section shall prevent the State Health Benefits Commission from reducing a covered person's cost-sharing requirement by an amount greater than the amount specified in this section or prevent the commission from utilizing formulary management, including a mandatory generic policy, to promote the use of lower-cost alternative generic drugs that are the therapeutic equivalent of the brand-name drug, which could result in the member's copay being higher than set forth in this section.
L.2023, c.105, s.27.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.30a - Findings, declarations relative to health care costs.

52:14-17.30a Findings, declarations relative to health care costs.
1. The Legislature finds and declares that:
a. The cost of health care in this country has been increasing at a pace that will make our current system of health care delivery unsustainable on its present trajectory.
b. As health care costs continue to rise more quickly than the average annual income, those costs displace other priorities for individuals, such as saving for retirement or their children's education, and even discourage people from obtaining recommended health care. The litany of research in this area has demonstrated that all necessary action must be taken to reduce costs wherever possible.
c. One way to reduce costs is to increase the oversight that a self-insured employer, such as the State, exercises over health care programs, as occurs when hiring a third-party medical claims reviewer to examine claims processing.
d. Hiring a third-party medical claims reviewer to provide regular, frequent, and ongoing review and oversight of the claims process, which process includes, but is not limited to, the receipt, management, adjudication, and payment of claims, serves the best interests of the State, participating employers, and the thousands of employees and their dependents covered under the State Health Benefits Program and the School Employees' Health Benefits Program. A third-party medical claims reviewer would act in the best interests of the State, participating employers, and program participants, work toward identifying and eliminating systemic errors, recover overpayments, and ensure that only the required and appropriate amounts due and owing on claims are paid as a result of proper adjudication.
e. For the purpose of facilitating greater efficiency and transparency in the adjudication of health benefits claims to State employees, their eligible family members, and participating local government and education employees and their eligible family members, the State of New Jersey deems it fitting and crucial to procure a third-party medical claims reviewer expeditiously, with a goal for implementation in the plan year beginning in January of 2020.
L.2019, c.143, s.1.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.32a1 - Funding of health care benefits for retired State employees under C.52:14-17.25 et seq.

52:14-17.32a1 Funding of health care benefits for retired State employees under C.52:14-17.25 et seq.
48. Effective July 1, 2007, health care benefits for retired State employees and their dependents for which the State is required to pay the premiums or periodic charges under the "New Jersey State Health Benefits Program Act," P.L.1961, c.49 (C.52:14-17.25 et seq.), shall be funded and paid by the State through a separate fund established in the Department of the Treasury. Beginning with the valuation period ending June 30, 2007, the Director of the Division of Pensions and Benefits shall annually compute a contribution to fund these health care benefits which shall be the amount necessary to pay the anticipated premiums or periodic charges for the benefits for the following valuation period and to provide that the balance in the fund as of the end of the following valuation period shall be increased by 3/5 of 1% of the salary of the active members for the valuation period. If the assets in the fund are insufficient to pay the premiums or periodic charges for the benefits, they shall be paid directly by the State. Nothing herein above shall alter health care benefits for qualified retirees and their dependents or relieve the State from its acknowledged obligation to fund the benefits.
L.2007, c.103, s.48.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.32b - Cessation of active full-time employment; payment of premiums

52:14-17.32b. Cessation of active full-time employment; payment of premiums
The cessation of active full-time employment shall be deemed to occur on the last day of the coverage period for which premiums have been paid and such premiums will be required if the employee receives payment for any service rendered in the coverage period.
L.1970, c. 231, s. 8, eff. Oct. 22, 1970.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.32c - Coverage for employee paid on 10-month basis pursuant to annual contract

52:14-17.32c. Coverage for employee paid on 10-month basis pursuant to annual contract
For purposes of State and local employer coverage, an employee paid on a 10-month basis, pursuant to an annual contract, and who terminates his service with the employer at the end of the contract year, having served during all of the months of the year as prescribed by his contract, shall be entitled to coverage comparable to that of an employee paid on a 12-month basis. Coverage for these employees and their dependents will continue during the 2 months of the year in which they are not paid provided that proper payment is made for dependent coverage as may be required by the State or participating employer.
L.1970, c. 231, s. 9, eff. Oct. 22, 1970.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.32d - Leave of absence for illness without pay; continuance of coverage; payment of premium

52:14-17.32d. Leave of absence for illness without pay; continuance of coverage; payment of premium
Notwithstanding any other regulation or statutory authority pertaining to the continuation of coverage for those on an approved leave of absence, the coverage of any eligible State employee and of his dependents, if any, during any period of authorized leave of absence for illness without pay, shall be continued for a period of as much as 3 months or the equivalent number of payroll periods for those not reported on a monthly basis; such period shall commence following the last payroll period or month for which the employee receives a salary payment. The premium for the coverage extended for such period of leave of absence shall be paid for by the State.
L.1974, c. 192, s. 1, eff. Dec. 27, 1974.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.32e - Termination of coverage; continuance upon payment of premium by employee

52:14-17.32e. Termination of coverage; continuance upon payment of premium by employee
The coverage of an eligible State employee and of his dependents, if any, during any period of authorized leave of absence without pay shall terminate on the last day of the coverage period for which premiums have been paid; provided, however, the coverage of the employee and the employee's dependents may be continued by such employee, if the employee shall pay in advance the total premium required for the employee's coverage and the coverage of the employee's dependents during such period of authorized leave of absence without pay; provided, further, that no period of such continued coverage shall exceed a total of 9 months, or the equivalent number of payroll periods for those not reported on a monthly basis, during which the employee receives no pay.
L.1974, c. 192, s. 2, eff. Dec. 27, 1974. Amended by L.1978, c. 179, s. 1, eff. Dec. 28, 1978.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.32f - Retired teachers' eligibility, limitation.

52:14-17.32f Retired teachers' eligibility, limitation.
3. A qualified retiree from the Teachers' Pension and Annuity Fund (N.J.S.18A:66-1 et seq.) and dependents of a qualified retiree, but not including survivors, are eligible to participate in the State Health Benefits Program until June 30, 2008, and beginning July 1, 2008, in the School Employees' Health Benefits Program, regardless of whether the retiree's employer participated in the program.
A qualified retiree is a retiree who:
a. Retired on a benefit based on 25 or more years of service credit;
b. Retired on a disability pension based on fewer years of service credit; or
c. Elected deferred retirement based on 25 or more years of service credit and who receives a retirement allowance.
The program shall reimburse a qualified retiree who participates in the program for the premium charges under Part B of the federal Medicare program for the retiree and the retiree's spouse. A qualified retiree who retired under subsections a. and b. of this section prior to the effective date of this 1987 amendatory and supplementary act is eligible for the coverage if the retiree applies to the program for it within one year after the effective date, and a qualified retiree as defined under subsection c. of this section whose retirement allowance commenced prior to the effective date of this 1992 amendatory act is eligible for the coverage if the retiree applies to the program for it within one year after the effective date.
The premium or periodic charges for benefits provided to a qualified retiree and the dependents of the retiree, and the cost for reimbursement of Medicare premiums shall be paid by the State. An employee who becomes a member of the Teachers' Pension and Annuity Fund on or after the effective date of P.L.2010, c.2 shall pay as a qualified retiree 1.5 percent of the retiree's monthly retirement allowance, including any future cost-of-living adjustments, through the withholding of the contribution, for health benefits coverage provided under P.L.2007, c.103 (C.52:14-17.46.1 et seq.) and the State shall pay the remainder of the premium or periodic charges for benefits provided to a qualified retiree and the dependents of the retiree, and the cost for reimbursement of Medicare premiums.
L.1987, c.384, s.3; amended 1992, c.126, s.1; 1994, c.62, s.12; 2007, c.103, s.42; 2010, c.2, s.2.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.32f2 - Applicability of C.52:14-17.32f; coverage.

52:14-17.32f2 Applicability of C.52:14-17.32f; coverage.
1. The provisions of section 3 of P.L.1987, c.384 (C.52:14-17.32f) shall apply to any employee of a board of education who is a member of a pension fund created prior to January 5, 1996 under the provisions of article 2 of chapter 66 of Title 18A of the New Jersey Statutes (N.J.S.18A:66-94 et seq.) and who retires on a benefit based upon 25 or more years of service credit in the pension fund, or retires on a disability pension based upon fewer years of service credit in that pension fund, or elected deferred retirement based upon 25 or more years of service credit and receives a retirement allowance from that pension fund, except that the costs of the premium or periodic charges for the benefits and reimbursement of medicare premiums provided to a retiree and the dependents of the retiree under this section shall be paid by the State. An employee who becomes a member of the pension fund on or after the effective date of P.L.2010, c.2 shall pay in retirement 1.5 percent of the retiree's monthly retirement allowance, including any future cost-of-living adjustments, through the withholding of the contribution, for health benefits coverage provided under P.L.2007, c.103 (C.52:14-17.46.1 et seq.) and the State shall pay the remainder of the premium or periodic charges for benefits provided to a qualified retiree and the dependents of the retiree, and the cost for reimbursement of Medicare premiums.
An employee who retired prior to the effective date of this act is eligible for the coverage if the employee applies to the program for it within one year after the effective date.
L.1995, c.357, s.1; amended 2010, c.2, s.4.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.32g - Benefits program continued.

52:14-17.32g Benefits program continued.
1. Notwithstanding any other provisions of P.L.1961, c.49 (C.52:14-17.25 et seq.) to the contrary, the health care benefits of any employee of an employer with at least three years of service under a permanent appointment with that employer and any dependent of the employee may be continued and the premiums for the coverage may be paid by the employer during any approved leave of absence of the employee with or without pay, for a period of up to two years.
For the purposes of this section "employer" means a local board of education, regional board of education, county college, educational services commission, jointure commission, county special services school district, county vocational-technical school district, or any board or commission under the authority of the Commissioner of Education, or State Board of Education, as the case may be.
L.1989, c.127, s.1; 2007, c.103, s.47.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.32h - Enrollment in State Health Benefits Program by former employee of local board of education

52:14-17.32h. Enrollment in State Health Benefits Program by former employee of local board of education
4. On or after July 1, 1993, a former employee of a local board of education who:
a. retires from employment with the board,
b. is receiving a retirement benefit from a State- or locally-administered retirement system,
c. is eligible for the federal Medicare program, and
d. is participating in the health benefits plan of the board may enroll in the State Health Benefits Program upon enrollment in the federal Medicare program. The laws and regulations governing the program, except as provided in this section, are applicable to enrollments in the program under this section.
A former employee of a local board of education who shall have retired from employment with the board prior to July 1, 1993 and who meets the requirements for enrollment in the State Health Benefits Program prescribed in this section may enroll in the program on or after July 1, 1993 and on or before June 30, 1994.
L.1993,c.8,s.4.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.32i - Health benefits, certain; law enforcement retirants, certain

52:14-17.32i. Health benefits, certain; law enforcement retirants, certain
1. a. A qualified retiree from the Police and Firemen's Retirement System of New Jersey (C.43:16A-1 et seq.), hereinafter referred to as PFRS, the Consolidated Police and Firemen's Pension Fund (C.43:16-1 et seq.), hereinafter referred to as CPFPF, or the Public Employees' Retirement System of New Jersey (C.43:15A-1 et seq.), hereinafter referred to as PERS, and dependents, as defined in section 2 of P.L.1961, c.49 (C.52:14-17.26), of a qualified retiree, are eligible to participate in the program, in accordance with the law and rules governing the program, except as otherwise provided by this act, regardless of whether the retiree's employer participated in the program.
A qualified retiree is a retiree who:
(1) retired on a benefit based on 25 or more years of service credit in PFRS or CPFPF, or in PERS as a law enforcement officer as defined in section 1 of P.L.1955, c.257 (C.43:15A-97) or in a position eligible for participation in PFRS as provided in section 9 of P.L.1989, c.204 (C.43:16A-1.2); or
(2) retired on a disability retirement under PFRS or CPFPF, or under PERS as a law enforcement officer or in a position eligible for participation in PFRS, based on fewer years of service credit; and
(3) was eligible to receive health benefits coverage at the expense of the employer of the person immediately preceding retirement.
b. The State shall pay the amount of the premium or periodic charges for the coverage for the qualified retiree and dependents, but not including survivors, equal to 80 percent of the premium or periodic charges for the category of coverage elected by the qualified retiree under the State managed care plan or a health maintenance organization participating in the program which provides services in the 21 counties in the State, whichever provides the lower premium or periodic charge. The qualified retiree shall pay the difference between the premium or periodic charge for the coverage and the amount paid by the State.
c. The State Health Benefits Commission shall annually certify to the State the cost for providing health benefits coverage to qualified retirees and their dependents under this section. The State shall annually remit to the commission the amount certified at a time specified by the State Treasurer.
d. The provisions of this section shall not apply to (1) a retired State employee whose premium or periodic charges for benefits under the program are paid by the State pursuant to section 8 of P.L.1961, c.49 (C.52:14-17.32) or section 6 of P.L.1996, c.8 (C.52:14-17.28b); and (2) a retiree of an employer other than the State which pays the premium or periodic charges for health care benefits for eligible retirees pursuant to section 7 of P.L.1964, c.125 (C.52:14-17.38) or N.J.S.40A:10-23 on the effective date of P.L.1997, c.330 (C.52:14-17.32i et al.).
L.1997,c.330,s.1.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.32j - Eligibility for benefits

52:14-17.32j. Eligibility for benefits
2. A qualified retiree shall be eligible for the benefits provided by P.L.1997, c.330 (C.52:14-17.32i et al.) at the time of retirement, or at the time the qualified retiree becomes eligible for Medicare. A qualified retiree receiving health benefits coverage from an employer after retirement shall be ineligible for the benefits under this act.
L.1997,c.330,s.2.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.32k - Existing retiree health care benefits remain intact

52:14-17.32k. Existing retiree health care benefits remain intact
3. No provision of this act shall be deemed to replace, supersede or modify retiree health care benefits provided by an employer by negotiated agreement, ordinance or resolution.
L.1997,c.330,s.3.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.32l - Enrollment of certain retirees in SHBP.

52:14-17.32l Enrollment of certain retirees in SHBP.
15. After the effective date of P.L.2003, c.128, a former employee of a county, county college or municipality who:
a. retires from employment with the county, county college or municipality pursuant to the provisions of section 2 of P.L.2003, c.128 in accordance with the action taken pursuant to section 4 or 11 of P.L.2003, c.128,
b. is receiving a retirement benefit from a State- or locally-administered retirement system, may enroll in the State Health Benefits Program upon retirement, but not later than 60 days following retirement. The laws and regulations governing the program, except as provided in this section, are applicable to enrollments in the program under this section.
L.2003,c.128,s.15.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.32m - Enrollment of certain PFRS retirees in SHBP.

52:14-17.32m Enrollment of certain PFRS retirees in SHBP.
13. After the effective date of P.L.2003, c.130, a former employee of an employer participating in the Police and Firemen's Retirement System, P.L.1944, c.255 (C.43:16A-1 et seq.) who retires from employment with the employer pursuant to the provisions of section 2 of P.L.2003, c.130 in accordance with the action taken pursuant to section 4 of P.L.2003, c.130 and the former employee's dependents, may enroll in the State Health Benefits Program upon retirement, but not later than 60 days following retirement. The laws and regulations governing the program, except as provided in this section, are applicable to enrollment in the program under this section.
L.2003,c.130,s.13.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.32o - Payment of premium, periodic changes; deferral of certain benefits.

52:14-17.32o Payment of premium, periodic changes; deferral of certain benefits.
2. Notwithstanding the provisions of P.L.1961, c.49 (C.52:14-17.26 et seq.) to the contrary, from funds appropriated therefor, the State shall pay the premium or periodic charges for the benefits provided to a retired State employee and any dependents under the program, but not including survivors, if the employee: (a) submitted an application for retirement with the Judicial Retirement System pursuant to section 1 of P.L.2019, c.287 (C.43:6A-11.1); (b) subsequently served in the position of county prosecutor or of Administrative Director of the Courts; (c) was covered by the program at the time of terminating full-time employment as a judge with the State, and (d) was eligible for health care benefits coverage in retirement under the program paid in full or in part by the State at the time of terminating full-time employment as a judge with the State.
The health care benefits coverage in retirement under the program to which the former State employee is entitled shall be deferred. The former State employee shall notify the program of the date on which employment as a county prosecutor or as the Administrative Director of the Courts is terminated and the deferred retirement is to commence pursuant to section 1 of P.L.2019, c.287 (C.43:6A-11.1). The former State employee and the employee's dependents shall be enrolled in the program as soon as feasible after that termination date and shall be entitled to such health care benefits coverage and payments for such coverage as the former State employee was eligible on the date terminating full-time employment as a judge with the State.
L.2019, c.287, s.2; amended 2021, c.329, s.2.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.33 - Annual appropriations; limitation upon obligation of state; remission of premiums

52:14-17.33. Annual appropriations; limitation upon obligation of state; remission of premiums
The Legislature shall annually make appropriations to cover the expense of procuring the benefits contracts and for the other purposes of this act. No obligation of the State shall be incurred under this act except within the limits of available appropriations. Premiums or periodic charges for such contracts payable to carriers from appropriated funds and from the health benefits fund shall be remitted to said carriers at intervals not less frequent than monthly.
L.1961, c. 49, p. 516, s. 9.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.34 - Extension of New Jersey State Health Benefits Program, certain.

52:14-17.34 Extension of New Jersey State Health Benefits Program, certain.
3. In order that the New Jersey State Health Benefits Program Act may be extended to include other public employees, participation by counties, municipalities, public agencies or organizations as defined in section 71 of P.L.1954, c.84 (C.43:15A-71), including the New Jersey Turnpike Authority, the Interstate Environmental Commission, the Delaware River Basin Commission, New Jersey Housing and Mortgage Finance Agency, New Jersey Educational Facilities Authority, New Jersey Meadowlands Commission and the Compensation Rating and Inspection Bureau, hereinafter defined as employers, is hereby authorized, provided, however, that no such employer shall enroll for coverage under the State Health Benefits Program pursuant to P.L.1961, c.49 (C.52:14-17.25 et seq.) employees as defined in section 32 of P.L.2007, c.103 (C.52:14-17.46.2).
L.1964, c.125, s.3; amended 1972, c.75, s.8; 2000, c.6, s.18; 2007, c.103, s.28.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.34a - "Independent state authority."

52:14-17.34a "Independent state authority."
43. As used in this section, "independent State authority" means a public authority, board, commission, corporation, or other agency or instrumentality of the State allocated, in but not of, a principal department of State government pursuant to Article V, Section IV, paragraph 1 of the New Jersey Constitution, or which is not subject to supervision or control by the department in which it is allocated, and a regional authority, but shall not include a college or university.
Notwithstanding the provisions of any other law to the contrary, public employees of an independent State authority who are not subject to the provisions of section 40 of P.L.2011, c.78 (C.52:14-17.28d) shall contribute, through the withholding of the contribution from the pay, salary, or other compensation or from the monthly retirement allowance, toward the cost of health care benefits coverage for the employee and any dependent provided by the authority during active service and in retirement in an amount that shall be determined as closely as possible in accordance with sections 39 and 40 of P.L.2011, c.78 (C.52:14-17.28c and C.52:14-17.28d).
Once those employees are subjected to the contribution requirements set forth in this section, the public employers and public employees shall be bound by this act, P.L.2011, c.78, to apply the contribution levels set forth in section 39 of this act until all affected employees are contributing the full amount of the contribution, as determined by the implementation schedule set forth in subsection a. of section 40 of this act. Notwithstanding the expiration date set forth in section 83 of this act, P.L.2011, c.78, or the expiration date of any successor agreements, the parties shall be bound to apply the requirements of this paragraph until they have reached the full implementation of the schedule set forth in subsection a. of section 40 of this act.
L.2011, c.78, s.43.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.35 - Definitions.

52:14-17.35 Definitions.
4. As used in this act and in the act to which this act is a supplement:
(a) The term "employer" means a county, municipality, public agency or organization as defined in section 71 of P.L.1954, c.84 (C.43:15A-71), including the New Jersey Turnpike Authority, the Interstate Environmental Commission, the Delaware River Basin Commission, New Jersey Housing and Mortgage Finance Agency, New Jersey Educational Facilities Authority, New Jersey Meadowlands Commission and the Compensation Rating and Inspection Bureau. The term "employer" shall include a subsidiary corporation or other corporation established by the Delaware River Port Authority pursuant to subdivision (m) of Article I of the compact creating the authority (R.S.32:3-2), as defined in section 3 of P.L.1997, c.150 (C.34:1B-146), except that only persons who are employees of the South Jersey Port Corporation on the effective date of P.L.1997, c.150 (C.34:1B-144 et al.) and are re-employed by the subsidiary or other corporation within 365 days of the effective date are eligible to participate in the program.
(b) The term "State Treasury" means the State agency responsible for the administration of the New Jersey State Health Benefits Program Act which is to be located in the Division of Pensions and Benefits in the Department of the Treasury.
L.1964, c.125, s.4; amended 1972, c.75, s.9; 1997, c.150, s.26; 2000, c.6, s.19; 2007, c.103, s.29.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.36 - Participation in health benefits program; rules, regulations.

52:14-17.36 Participation in health benefits program; rules, regulations.
5. a. The commission established by section 3 of chapter 49 of the laws of 1961, is hereby authorized to prescribe rules and regulations satisfactory to the carrier or carriers under which employers may participate in the health benefits program provided by that act. All provisions of that act will, except as expressly stated herein, be construed as to participating employers and to their employees and to dependents of such employees the same as for the State, employees of the State and dependents of such employees.
b. All changes in the provision of health care benefits through the program that are included in collective negotiations agreements between the State and its employees entered into on or after the effective date of P.L.2010, c.2 shall be made applicable by the commission to participating employers and their employees at the same time and in the same manner as to State employees. This subsection shall be applicable to the State Health Benefits Program and to the School Employees' Health Benefits Program to the extent not inconsistent with the provisions of sections 31 through 41 of P.L.2007, c.103 (C.52:14-17.46.1 et seq.).
L.1964, c.125, s.5; amended 2010, c.2, s.8.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.36a - Certain majority representative of State employees, participation in SHBP permitted.

52:14-17.36a Certain majority representative of State employees, participation in SHBP permitted.
1. a. Notwithstanding any provision of P.L.1961, c.49 (C.52:14-17.25 et seq.) or any other law to the contrary, an affiliate of a majority representative of State employees for collective negotiation purposes, as recognized by the Public Employment Relations Commission established pursuant to P.L.1941, c.100 (C.34:13A-1 et seq.), which affiliate represents State employees, may participate in the State Health Benefits Program pursuant to P.L.1961, c.49 (C.52:14-17.25 et seq.). All provisions of P.L.1961, c.49 (C.52:14-17.25 et seq.) shall be construed as to such participating employers and their elected officers and full-time employees, and their dependents, in the same manner as for participating local government employers, their employees and the dependents of such employees.
As used in this section, the phrase "an affiliate of a majority representative of State employees" means a local union affiliate that has some employees who are engaged in the day-to-day representation of State employees, and shall not mean a local union affiliate's parent or international union.
b. The Division of Pensions and Benefits shall certify to each such affiliate of a majority representative electing participation under the program the premium rates and periodic charges as determined for local government employees applicable to the coverage provided to the affiliate's elected officers and full-time employees and their dependents. The participating affiliate shall remit to the division the premiums and periodic charges in advance of their due dates, subject to the rules and regulations of the State Health Benefits Commission.
c. The State Health Benefits Commission shall adopt rules and regulations within 90 days of the effective date of this act, P.L.2005, c.135 (C.52:14-17.36a et seq.), to implement this section and such rules and regulations shall permit an affiliate of a majority representative electing participation under the program to begin participation on or after the 120th day following the effective date of this act.
L.2005,c.135,s.1.