reglab/statecodes huggingface dataset:
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 8 - SUPPLEMENTAL ANNUITY COLLECTIVE TRUST PROGRAM › Subchapter 3 - RETIREMENT, TERMINATION AND TRANSFERS › Section 17:8-3.6 - Termination; transfer to suspense

Current through Register Vol. 56, No. 14, July 15, 2024
If a participant's account in his or her basic retirement
				  system is terminated and later placed in suspense, the value of his or her
				  account in the Supplemental Annuity Collective Trust shall be determined as of
				  the close of the month in which his or her account in the basic retirement
				  system was terminated and he or she shall no longer participate in earnings or
				  losses.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 8 - SUPPLEMENTAL ANNUITY COLLECTIVE TRUST PROGRAM › Subchapter 3 - RETIREMENT, TERMINATION AND TRANSFERS › Section 17:8-3.7 - Separate pension accounts; transfer to trust

Current through Register Vol. 56, No. 14, July 15, 2024
Participants' contributions received by the various pension
				  systems are directly deposited to the Trust as received. Contributions are
				  separately recorded and accounted for by pension system and Supplemental
				  Annuity type (regular supplemental annuity contributions and tax-sheltered
				  supplemental annuity contributions).
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 8 - SUPPLEMENTAL ANNUITY COLLECTIVE TRUST PROGRAM › Subchapter 3 - RETIREMENT, TERMINATION AND TRANSFERS › Section 17:8-3.8 - Payment of pension loan balance upon retirement; order of use of funds from different account types

Current through Register Vol. 56, No. 14, July 15, 2024
(a) If a
				participant elects to use funds available in his or her variable accumulation
				account to satisfy all or any portion of a pension loan, funds shall be used
				from the various Supplemental Annuity Collective Trust account types in a
				consecutive order to minimize Federal income tax liability for the participant.
				The order of use shall be as follows from first to last:
1. Regular account contributions;
2. Regular account earnings;
3. Tax-sheltered account; and
4. QVEC account.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 8 - SUPPLEMENTAL ANNUITY COLLECTIVE TRUST PROGRAM › Subchapter 3 - RETIREMENT, TERMINATION AND TRANSFERS › Section 17:8-3.9 - Transfers to alternate investment providers

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Employees of
				the Department of Education, the Commission on Higher Education or the
				governing body of any public institution of higher education may transfer all
				or a portion of the tax-sheltered plan to a tax-deferred annuity with an
				insurer or mutual fund company authorized to provide investment contracts under
				the provisions of
				52:18A-113.2 et seq.
(b) Accounts shall be valued in accordance
				with the provisions of
				17:8-1.5(g), not
				including the participant's contributions, if any, during the current calendar
				quarter.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 8 - SUPPLEMENTAL ANNUITY COLLECTIVE TRUST PROGRAM › Subchapter 4 - QUALIFIED VOLUNTARY EMPLOYEE CONTRIBUTIONS › Section 17:8-4.1 - Qualified voluntary employee contribution account

Current through Register Vol. 56, No. 14, July 15, 2024
(a) An account
				shall be maintained in order to properly account for the receipt and
				accumulation of the contributions made pursuant to this subchapter.
(b) An individual account shall be maintained
				for each participant.
(c) At the
				retirement of a participant, the number of equity units in the participant's
				account as of the date of retirement shall be transferred, determined, and
				payable as an annuity, all in accordance with the provisions of
				17:8-1.6.
(d) Investment income and gains and losses on
				the contributions made under this subchapter shall be credited or charged in
				accordance with the provisions of
				17:8-1.7, and computation of
				dollar values of the equity units shall be made in accordance with
				17:8-1.8.
(e) Contributions made under this subchapter
				shall be commingled for investment purposes with voluntary contributions
				otherwise made under the Trust.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 8 - SUPPLEMENTAL ANNUITY COLLECTIVE TRUST PROGRAM › Subchapter 4 - QUALIFIED VOLUNTARY EMPLOYEE CONTRIBUTIONS › Section 17:8-4.2 - Participant contribution

Current through Register Vol. 56, No. 14, July 15, 2024
Due to the Income Tax Reform Act of 1986, qualified
				  voluntary employee contributions were discontinued as of January 1, 1987. The
				  balance of a participant's account continues to be maintained and participates
				  in the gains and losses of the fund until the participant qualifies for
				  distribution.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 8 - SUPPLEMENTAL ANNUITY COLLECTIVE TRUST PROGRAM › Subchapter 4 - QUALIFIED VOLUNTARY EMPLOYEE CONTRIBUTIONS › Section 17:8-4.4 - Tax information

Current through Register Vol. 56, No. 14, July 15, 2024
For tax reporting purposes, any amount attributable to the
				  participant's qualified voluntary employee contributions shall be reported
				  separately from other amounts distributed from the Trust.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 1 - ADMINISTRATION › Section 17:9-1.1 - Commission meetings

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The State
				Health Benefits Commission shall meet, as necessary, at the call of the
				Chairperson or the Secretary provided that the required public notice has been
				given, pursuant to the provisions of the Open Public Meetings Act,
				10:4-13.
(b) Any three members of the Commission, at
				least two of whom are ex-officio members, shall constitute a quorum for the
				purpose of conducting the business of the Commission. Each member shall be
				entitled to one vote and a majority of all votes of the entire Commission shall
				be necessary for a motion to carry.
(c) If a member is unable to attend a
				meeting, the member, if a member who is authorized by statute to appoint a
				designee, shall designate, in writing, an alternate. The person so designated
				shall be permitted to vote on business brought before the Commission.
(d) All Commission members and alternates
				shall complete all mandatory training required by either the implementing
				regulations of the Federal Health Insurance Portability and Accountability Act
				of 1996 (HIPAA) or the State Ethics Commission prior to hearing any appeals
				before the Commission.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 1 - ADMINISTRATION › Section 17:9-1.2 - Records

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Secretary of the Commission shall
				maintain minutes of the Commission meetings in compliance with the Senator
				Byron M. Baer Open Public Meetings Act (OPMA),
10:4-6
et seq. Public
				session minutes are public records subject to access under the Open Public
				Records Act (OPRA),
47:1-1
et
				seq., and the requirements of the Federal Health Insurance Portability and
				Accountability Act (HIPAA),
42 U.S.C. §§ 3210d
et
				seq. Minutes of closed sessions pertaining to the claims of any individual
				shall be redacted of all personal identifying information unless the individual
				member waives his or her privacy interest and consents in writing to disclosure
				in accord with HIPAA. Minutes of executive sessions shall be subject to
				disclosure pursuant to the OPMA after the Commission determines the need for
				confidentiality no longer exists. Records of the Commission subject to public
				access under OPRA may be inspected during regular business hours at the office
				of the Division under supervision of a representative of the State Health
				Benefits Program or other representatives of the office. All requests for
				records under OPRA shall be made in writing on the required form and submitted
				to the Department of the Treasury Government Records Unit.
(b) To protect the personal privacy of
				individual participants and their families, the mailing addresses of active and
				retired participants and all matters regarding an individual's files that
				relate to an individual's coverage and claims shall be maintained as
				confidential. Protected health information shall not be released to any person,
				except as permitted under HIPAA in response to a valid HIPAA Authorization for
				Release of Information, in a form acceptable to the Division, as described in
45 CFR
				164.508
, or as otherwise authorized
				by HIPAA. The requesting party shall have the burden of demonstrating to the
				satisfaction of the Division that the confidential materials may be released
				under HIPAA.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 1 - ADMINISTRATION › Section 17:9-1.4 - Employer participation

Current through Register Vol. 56, No. 14, July 15, 2024
(a) An employer
				joining the SHBP must adopt the resolution furnished by the Division and must
				agree to comply with the statutes and rules adopted by the Commission. The
				effective date of coverage for employers with fewer than 250 employees, COBRA
				participants, and retired members will be the first day of the month following
				a period beginning 75 days after the receipt by the Division of the completed
				resolution. The effective date of coverage for employers with 250 or more
				employees, COBRA participants, and retired members will be the first day of the
				month following a period beginning 90 days after the receipt by the Division of
				the completed resolution.
(b) The
				Commission may, from time to time, establish a re-entry application period for
				those employers who have terminated coverage. During this period, an employer
				who previously terminated coverage with the program may submit a resolution for
				re-entry.
(c) If an employer
				requests re-entry during any period other than that established by (b) above,
				the Commission shall consider the relevant facts accompanying the resolution,
				including any hardship or emergency, the impact of re-entry on the program and
				individual members, and whether re-entry is consistent with statutory law or
				judicial determinations. The Commission shall approve or disapprove the
				resolution for re-entry and shall so notify the employer within 30 days
				following receipt of the resolution. The Commission may establish an
				administrative charge upon the employer reasonably based upon the approximate
				cost to the Commission of re-enrolling the employer.
(d) Before re-entry is permitted, an employer
				must satisfy all outstanding balances from previous participation.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 1 - ADMINISTRATION › Section 17:9-1.5 - Voluntary termination of employer; notice

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A resolution
				furnished by the Division must be approved and completed by the governing body
				of the employers who wish to voluntarily terminate their participation in the
				program.
(b) When a participating
				employer voluntarily terminates coverage, the coverage for the employer's
				active and retired employees, participants under
52:14-17.29k
, and COBRA
				participants shall terminate as of the first of the month following a 60-day
				period beginning with the receipt of the resolution by the Division.
(c) The employer shall notify all active
				employees of the date their coverage in the program has terminated.
(d) The Division shall act to notify all
				affected COBRA participants, participants under
				52:14-17.2 9k, and retired members
				of the termination of coverage. Upon request from the employer, the Division
				shall forward a list of the names and addresses of terminating retirees,
				participants under
				52:14-17.2 9k, and COBRA
				participants so that the employer may offer them an opportunity to enroll under
				its new group health insurance plan.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 1 - ADMINISTRATION › Section 17:9-1.6 - Default of employer; notice

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A participating
				employer will be considered in default 31 days after the beginning of the
				coverage period for which charges were due. At that point, coverage may
				terminate for all members enrolled through the terminating employer. The
				effective date of termination for the employer's active and retired employees,
				COBRA participants, and participants under
52:14-17.29k
will be the
				first of the month after a 60-day period beginning the date the employer is
				considered in default.
(b) The
				Secretary of the Commission will notify the offices of the State Treasurer; the
				Attorney General; the Department of Community Affairs, Division of Local
				Government Service; and the Department of Education, if applicable. The
				Division will notify the employer and affected COBRA participants, participants
				under 52:14-17.2 9k and retired
				subscribers of the termination of coverage. The employer is responsible for
				notifying its active employees affected by this termination.
(c) Under the provisions of
				P.L.
				2008 c. 24, the
				Division of Revenue of the Department of the Treasury will be responsible for
				collecting any outstanding debt. If necessary, the amount owed will be deducted
				from any amount that might otherwise be remitted by any State agency to the
				debtor.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 1 - ADMINISTRATION › Section 17:9-1.7 - Employer incentives for non-enrollment

Current through Register Vol. 56, No. 14, July 15, 2024
(a)
				Except as allowed by
				52:14-17.3 1a, an employer shall
				not offer a financial enticement of cash or anything else of value to an
				employee who elects not to enroll or to terminate enrollment in the
				SHBP.
(b) Any participating local
				employer, other than the State, is allowed to pay an employee an incentive to
				waive coverage if that employee is eligible for other health coverage.
1. For waivers filed on or after May 21, 2010
				(the effective date of
				P.L.
				2010, c. 2 ), the
				incentive shall not exceed $5,000 or 25 percent of the amount saved by the
				employer because of the employee's waiver of coverage, whichever is
				less.
2. For waivers filed before
				May 21, 2010 (the effective date of
				P.L.
				2010, c. 2 ), the
				incentive may be up to 50 percent of the amount saved by the
				employer.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 1 - ADMINISTRATION › Section 17:9-1.9 - Certifying officer (employer)

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The chief
				fiscal officer or other officer duly designated by a resolution of each county,
				municipality or public agency, and the personnel officer of the Division,
				Bureau or Institution of the State locations, shall serve as certifying officer
				for that unit.
(b) The certifying
				officer shall be responsible for the duties described by
				52:14-17.4 3, including providing
				documentation requested by the Commission or the Division in a timely
				manner.
(c) The certifying officer
				shall be responsible for all other duties relating to matters concerning the
				SHBP.
(d) Upon the request of the
				Commission, the certifying officer shall be required to sign a statement,
				verifying that any information reported is accurate to the best of the
				officer's knowledge, and conforms with the statutes and rules governing the
				SHBP.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 2 - COVERAGE › Section 17:9-2.1 - Enrollment

Current through Register Vol. 56, No. 14, July 15, 2024
An eligible employee may enroll for coverage for the employee
				  and the employee's eligible dependents. The employee and any dependents must
				  enroll in the same plan.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 2 - COVERAGE › Section 17:9-2.2 - Enrollment form

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Within 60 days of the time an employee
				first becomes eligible to apply for coverage, the employee shall file a
				completed enrollment form indicating the employee's election to enroll or not
				to enroll for coverage on the employee's own behalf; and the employee's
				election to enroll or not to enroll any eligible dependents for coverage under
				one of the SHBP options. A dependent must be listed on the enrollment form to
				be enrolled for coverage. Appropriate legal documentation, as described in
17:9-3.3(a)
, verifying the dependent's relationship with the subscriber is
				required before enrollment is approved. If more than 60 days have passed since
				first eligible for enrollment, then the enrollment form shall not be processed
				and will be returned to the employer. The employee may then file the enrollment
				form during the next open enrollment period with coverage to be effective
				according to the schedule for that open enrollment period.
(b) For Chapter 375 dependents, enrollment
				shall also occur in accordance with
17:9-13.2
.
(c) For overage dependents with disabilities,
				enrollment shall also occur in accordance with
17:9-3.4
.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 2 - COVERAGE › Section 17:9-2.3 - Annual open enrollment period

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Except as
				permitted under
17:9-2.4
,
				any active employee or COBRA subscriber who did not elect to enroll for
				coverage for themselves or for their dependents at the time such employee or
				dependent first became eligible for coverage shall subsequently be permitted to
				enroll themselves and their dependents only during the annual open enrollment
				period, with coverage effective according to the schedule for that open
				enrollment period.
(b) The annual
				open enrollment period will be an opportunity for employees to change plan
				participation for themselves and their dependents. The change in the election
				cannot be made more frequently than once a year except as permitted under
				17:9-2.4 or 2.10.
(c) The Commission may establish a special
				enrollment period at any time it deems necessary to do so.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 2 - COVERAGE › Section 17:9-2.5 - Employee coverage requirements

Current through Register Vol. 56, No. 14, July 15, 2024
(a) For each
				employee who shall elect to be covered, coverage shall become effective only
				after all of the following conditions have been satisfied:
1. The contract or contracts are
				effective;
2. In the case of local
				coverage, the employer's participation has been approved by the
				Commission;
3. The employee
				satisfies the definition of "employee," is eligible for coverage;
4. An enrollment form has been legibly
				completed by the employee and the certifying officer of the employer and filed
				with the Health Benefits Bureau of the Division within the prescribed time
				limits;
5. The employee has
				provided a valid Social Security number for each individual to be enrolled. A
				Tax Identification Number will be accepted when an employee or dependent is not
				eligible for a Social Security number. The employee must submit a valid Social
				Security number within six months of the birth or adoption of a child.
				Employees and dependents who are foreign nationals must provide a valid Social
				Security number once it is obtained; and
6. The employee has provided appropriate
				legal documentation for each dependent to be enrolled showing the dependent's
				relationship with the subscriber, as set forth in
				17:9-3.3(a).
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 2 - COVERAGE › Section 17:9-2.6 - Effective date for new hires; State employees and dependents

Current through Register Vol. 56, No. 14, July 15, 2024
For State employees and their dependents for whom an
				  enrollment application has been filed with the Division of Pensions and
				  Benefits, coverage is effective on the first day of the fifth payroll period of
				  employment for a sub-group which reports on a biweekly basis and is paid
				  through the State Centralized Payroll System, or the first day following the
				  completion of two months of continuous service for a sub-group which reports on
				  a monthly basis. If employee deductions are required for coverage, deductions
				  begin on the first day of the third payroll period of employment for biweekly
				  sub-groups and approximately one month prior to the effective date of coverage
				  for monthly sub-groups.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 2 - COVERAGE › Section 17:9-2.7 - Effective date for new hires; local employees and dependents

Current through Register Vol. 56, No. 14, July 15, 2024
For local employees and their dependents for whom an
				  enrollment application has been filed with the Division of Pensions and
				  Benefits, coverage is effective on the first day following the completion of
				  two months of continuous service. If employee deductions are required for
				  coverage, deductions begin approximately one month prior to the effective
				  date.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 2 - COVERAGE › Section 17:9-2.8 - Transfers

Current through Register Vol. 56, No. 14, July 15, 2024
(a) In order to provide mobility to employees
				transferring their employment from one SHBP or SEHBP participating employer to
				another, the employee may continue coverage under the program, as long as they
				enter the service of the new employer in a period for which contributions have
				already been made; however, if coverage has been terminated, the employee will
				again have to satisfy the two-month, continuous-employment waiting period in
				order to obtain the coverage again. An employee hired in September under a
				10-month contract is eligible for SHBP coverage during the months of July and
				August of the following year if they work the full 10-month contract and
				sufficient charges are deducted prior to the expiration of their 10-month
				contract to continue their coverage during the heretofore mentioned months
				pursuant to
52:14-17.32
.
(b) For employees who will have the option of
				changing plans and coverage upon a transfer, as described in (a) above, a
				30-day period will be available for the selection of coverage during which
				period their former coverage will be continued. State biweekly employees
				transferring from one State biweekly payroll location to another while coverage
				is still in force cannot make any plan changes since they are not changing
				employers.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 2 - COVERAGE › Section 17:9-2.9 - HMO; elections

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Subscribers who
				locate in an area serviced by a participating HMO will have a 30-day period for
				the selection of coverage during which period their former coverage will be
				continued.
(b) Subscribers who are
				participating in an eligible HMO but who move out of the area serviced by that
				HMO will have a 30-day period to select one of the following options:
1. Continue participation in their current
				HMO Plan; or
2. Transfer
				participation to one of the other plans available under the SHBP.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 2 - COVERAGE › Section 17:9-2.10 - Coverage for survivors-death of active employee

Current through Register Vol. 56, No. 14, July 15, 2024
(a) For purposes of
				the continuity of coverage in the event of accidental or ordinary death where
				the survivors are eligible for periodic pension benefits for life, or until a
				dependent child is no longer eligible for such benefits, coverage may be
				extended until such time as the application for such death benefits is formally
				approved by the Board of Trustees of the retirement system paying the benefit,
				or by the investment carrier underwriting the individual annuity contracts. If
				it is not necessary for the Board of Trustees to approve the application, then
				the application for such benefits will be considered approved when the
				necessary action has been taken by the Division of Pensions and Benefits, the
				local retirement system, or the investment carrier.
(b) Unless the employer or the State pays for
				surviving spouses or surviving eligible domestic or civil union partners, the
				eligible survivor of the deceased employee must submit personal payments to the
				health benefits program in order to continue coverage. Once the survivor's
				annuity begins, the cost of benefits shall be deducted directly from the
				retirement benefit.
(c) Should
				coverage lapse through no fault of the survivor, who would be eligible to
				continue such coverage, retroactive coverage up to one year may be granted
				provided the payment of charges is made.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 2 - COVERAGE › Section 17:9-2.11 - Out-of-network PPO and high deductible health plan; eligible charges at enrollment (local employees)

Current through Register Vol. 56, No. 14, July 15, 2024
(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.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 2 - COVERAGE › Section 17:9-2.12 - Extension of coverage charges

Current through Register Vol. 56, No. 14, July 15, 2024
(a) For purposes of
				the payment of claims, if immediately prior to entry into the eligible classes,
				an employee or dependent was covered under the extension of coverage
				provisions, such coverage will be effective immediately but solely with respect
				to charges incurred in connection with the illness for which such person was
				covered under said extension if the following conditions are satisfied:
1. The charges would have been considered
				eligible charges had the extension not terminated;
2. The coverage under the extension would
				have not otherwise terminated.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 2 - COVERAGE › Section 17:9-2.13 - Duplication of benefits

Current through Register Vol. 56, No. 14, July 15, 2024
If the State or local employer adopts separate plans for all
				  employees or for some portion of covered employees, largely duplicating
				  benefits provided under the SHBP medical plan, such services or benefits for
				  the participants of such separate plans will no longer be considered eligible
				  for reimbursement under the employee's medical plan.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 2 - COVERAGE › Section 17:9-2.14 - Policy provisions adoption

Current through Register Vol. 56, No. 14, July 15, 2024
The Commission adopts by reference all of the policy
				  provisions contained in the contracts between the health, prescription drug and
				  dental plans and the Commission, as well as any subsequent amendments thereto,
				  to the exclusion of all other possible coverages. The plans handbook
				  supplements the master contracts and contains the specific provisions for
				  services to be covered and those which are excluded.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 3 - DEPENDENTS › Section 17:9-3.1 - Dependents and children defined

Current through Register Vol. 56, No. 14, July 15, 2024
The following words and terms, when used in this chapter,
				  shall have the following meanings, unless the context clearly indicates
				  otherwise.
"Children" includes stepchildren living with the subscriber,
				  legally adopted children, children placed in the employee's custody pending
				  adoption, foster children, and children of an eligible domestic or civil union
				  partner who are substantially dependent upon the employee for support and
				  maintenance. This includes children in a guardian-ward, legal relationship who
				  are living with the employee.
"Dependents" means an employee's spouse, eligible domestic or
				  civil union partner and the employee's children through the end of the calendar
				  year in which they reach the age of 26 years. "Dependents" also means unmarried
				  children and those not in a domestic partnership or civil union, covered by
				  their parents under the SHBP prior to the attainment of age 26, who:
1. Are incapable of self-sustaining
				employment by reason of mental or physical disabilities;
2. Became so incapable prior to attainment of
				age 26; and
3. Are substantially
				dependent upon such employees for support and maintenance while the insurance
				of the employees remain in force and the dependents remain in such conditions.
"Living with" shall be defined so as to include children in
				  the case of divorce or termination of a domestic partnership or civil union who
				  may not actually be living with the covered parent, but where such covered
				  parent is required to provide for the support and maintenance of such children,
				  and the parent's application for dependent coverage is documented by a copy of
				  an appropriate court order. Stepchildren and children of an eligible domestic
				  or civil union partner must reside with the employee.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 3 - DEPENDENTS › Section 17:9-3.2 - Military service

Current through Register Vol. 56, No. 14, July 15, 2024
A spouse, eligible domestic or civil union partner or child
				  enlisting or inducted into military service shall not be considered eligible
				  for coverage during such military service.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 3 - DEPENDENTS › Section 17:9-3.3 - Certification of dependency

Current through Register Vol. 56, No. 14, July 15, 2024
(a) An employee who
				elects to enroll an eligible dependent for any coverage shall report such
				dependent's relationship or status on the enrollment form and provide
				appropriate legal documentation for each dependent to be enrolled, verifying
				the dependent's relationship with the subscriber. Examples of acceptable
				documentation, as provided on the Division's website as Required Documentation
				for SHBP/SEHBP Dependent Eligibility and Enrollment, include birth
				certificates, marriage certificates, certificates of domestic partnership or
				civil union, divorce and separation decrees, custody agreements, and court
				orders. This list is not meant to be all inclusive and does not imply
				acceptance of any of the above without proper authentication.
(b) A person who, although listed as an
				eligible dependent, is found to be ineligible, shall be removed from coverage
				by the SHBP and the level of coverage of the employee or retiree shall be
				adjusted accordingly. Coverage for that person as a dependent shall be restored
				if acceptable documentation is provided to the Division, by the employee, or
				retiree, within 60 days of written notification of the dependent's termination.
				If acceptable documentation is received after 60 days, the dependent shall not
				be restored retroactively and can only be added at the next permissible
				enrollment opportunity.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 3 - DEPENDENTS › Section 17:9-3.4 - Children with disabilities age 26 or older; determination of eligibility for continuation of coverage

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The
				determination as to the continuation of certain children with disabilities as
				"dependents" as defined by
17:9-3.1
shall be made
				by the SHBP's medical advisors. A form requesting continuance of enrollment for
				an eligible dependent with disabilities must be submitted to the SHBP no later
				than January 31 of the year following the calendar year in which the child
				attained the age of 26.
(b)
				Children with disabilities who are age 26 or older at the time their parents
				obtain coverage under the SHBP who are determined by the SHBP's medical
				advisors to be incapable of self-sustaining employment by reason of mental or
				physical disabilities and who meet the requirements of "dependents" as defined
				by
17:9-3.1
, shall not be
				enrolled for coverage as "dependents" as defined by
N.J.A.C. 17:9-
				3.1
, unless:
1. They were covered as
				dependents under a public employer's group plan immediately preceding that
				employer's entrance into the SHBP; or
2. They were covered as dependents under a
				public employer's group plan immediately preceding their parents' entrance into
				the SHBP under the provisions of
				52:14-17.3 2f (qualified retirees
				of the Teachers' Pension and Annuity Fund), 52:14-17.3 2f1 (qualified retirees
				of the Public Employees' Retirement System who retired from boards of education
				or county colleges), 52:14-17.3 2i (qualified firefighter or law enforcement
				retirees from the Police and Firemen's Retirement System, Public Employees'
				Retirement System and Consolidated Police and Firemen's Pension Fund) or the
				provisions of the Intergovernmental Transfer Program (established under
				11A:2-11 ).
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 3 - DEPENDENTS › Section 17:9-3.5 - Multiple coverage prohibited

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Multiple
				coverage under the SHBP/SEHBP as an employee, dependent, or retiree shall be
				prohibited, in accordance with
52:14-17.31
.
1. No employee shall have coverage as both a
				subscriber and a dependent in any plan offered by the SHBP/SEHBP.
2. No subscriber or dependent shall have both
				active and retired coverage under the SHBP/SEHBP.
3. If both parents of eligible children are
				participating subscribers of the SHBP/SEHBP, only one may cover the children;
				children are not eligible for coverage under both SHBP/SEHBP-covered
				parents.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 4 - EMPLOYEES › Section 17:9-4.1 - State employee defined

Current through Register Vol. 56, No. 14, July 15, 2024
(a) For purposes of
				State coverage, "employee" shall mean an appointive or elective officer or
				full-time employee of the State or, for those enrolled in the SHBP on or after
				May 21, 2010, a full-time appointive or elective officer or a full-time
				employee of the State whose hours are fixed at 35 or more hours per week.
				Employees of the State shall include employees of:
1. Rutgers, the State University of New
				Jersey;
2. Palisades Interstate
				Park Commission;
3. University
				Hospital;
4. New Jersey Institute
				of Technology;
5. The State
				colleges and universities as designated by their boards of trustees;
				and
6. Agencies or special projects
				which are supported from or whose employees are paid from sources of revenue,
				other than general funds, which other funds will bear the cost of benefits
				under this Act.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 4 - EMPLOYEES › Section 17:9-4.2 - State; full-time defined

Current through Register Vol. 56, No. 14, July 15, 2024
(a) For purposes of
				State coverage, "full-time" shall mean:
1.
				The normal full-time weekly schedule for the particular class title, and in any
				case not less than 35 hours per week;
2. Employment for 12 months, except in the
				case of those employees engaged in activities where the regular and normal work
				schedule is ten months;
3.
				Sabbaticals where the compensation paid is 50 percent or more of the salary
				granted just prior to the leave and the period of eligibility terminates with
				the end of the fiscal year.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 4 - EMPLOYEES › Section 17:9-4.3 - Ineligible employees defined

Current through Register Vol. 56, No. 14, July 15, 2024
(a) For purposes of
				State and local coverage, "employee" shall not mean:
1. Any person with less than two months of
				continuous service;
2. Any person
				whose compensation is limited to reimbursement of necessary expenses actually
				incurred in the discharge of his official duties;
3. Any person compensated on a fee basis (see
				17:9-4.5 );
4. Any person who is employed on short-term,
				seasonal, intermittent or emergency basis such as a person whose compensation
				is in the nature of a "retainer", or is for occasional services or whose
				service is for brief periods at intervals, such as substitute
				teachers;
5. Any person whose
				compensation is paid or payable by voucher;
6. Any person whose services are not
				full-time;
7. Any person granted a
				sabbatical where the compensation paid is less than 50 percent of the salary
				granted just prior to the leave;
8.
				Any person who is an aide or patient employee in a State, county or municipal
				institution;
9. Any person
				suspended from work without pay for more than one full coverage period as the
				result of disciplinary action for the period of suspension.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 4 - EMPLOYEES › Section 17:9-4.4 - State; ineligible employees defined

Current through Register Vol. 56, No. 14, July 15, 2024
(a) For purposes of
				State coverage, "employee" shall not mean any person who is paid:
1. An hourly rate (payroll compensation code
				7) except that a full-time employee with a Civil Service title assigned an
				hourly salary range is eligible;
2.
				A daily rate (payroll compensation code 8);
3. A rate per meeting or session (payroll
				compensation code 8);
4. A salary
				based on a percentage of full-time (payroll compensation code 6);
5. Any person who is not on a State, college
				or university payroll or payroll of agencies identified in
				17:9-4.1;
6. Any otherwise eligible employee for whom
				the State, directly or indirectly, provides benefits under any other plan,
				which benefits have a value equal to or in excess of the benefits payable under
				the State Health Benefits Act.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 4 - EMPLOYEES › Section 17:9-4.5 - Local; employee defined

Current through Register Vol. 56, No. 14, July 15, 2024
(a) For purposes of
				local coverage, "employee" shall mean an appointive or elected officer or
				full-time employee of the local employer, including an employee who is
				compensated on a fee basis as a convenient method of payment of wages or
				salary, but who is not a self-employed, independent contractor compensated in a
				like manner.
(b) To qualify for
				coverage as an appointive officer, an employee must be:
1. Appointed to an office specifically
				established by law, ordinance, resolution or such other official action
				required by law for establishment of a public office by an appointing
				authority. A person appointed under a general authorization, such as, "to
				appoint officers" or "to appoint such other officers," or similar language, is
				not eligible to participate as an appointive officer and must qualify for
				participation as a full-time employee; and
2. The employee must be invested with some
				portion of political power partaking in any degree in the administration of
				civil government, and the duties of such employment must emanate from the
				sovereign authority. The employee's duties must be integral to local
				government, and the employee must have some authority to make decisions on
				behalf of the civil government.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 4 - EMPLOYEES › Section 17:9-4.6 - Local; full time defined

Current through Register Vol. 56, No. 14, July 15, 2024
(a) For purposes of
				local coverage, "full-time" shall mean:
1.
				Employment of any eligible employees who appear on a regular payroll and who
				receive a salary or wages for an average of the number of hours per week as
				prescribed by the governing body of the participating employer. Each
				participating employer shall, by resolution, determine the number of hours
				worked, which shall be considered to be "full-time." In no case shall the
				number of hours for "full-time" be less than 25.
2. The employer, at its option, may
				grandfather all employees who were eligible for coverage under the location's
				previous definition of "full-time."
3. Sabbaticals where the compensation paid is
				50 percent or more of the salary granted just prior to the leave and the period
				of eligibility terminates with the end of the fiscal year.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 4 - EMPLOYEES › Section 17:9-4.7 - Multiple positions

Current through Register Vol. 56, No. 14, July 15, 2024
For purposes of State and local coverage, "full-time" shall
				  mean employment of an employee who holds multiple public positions with the
				  same employer which in the aggregate would meet the eligibility requirements
				  for coverage as a full time employee. If an employee holds multiple public
				  positions with multiple employers, the employee must meet the eligibility
				  requirements for coverage with each employer to get coverage from that
				  employer.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 5 - CHARGES › Section 17:9-5.1 - Separate experience; State and local

Current through Register Vol. 56, No. 14, July 15, 2024
The experience of local employers may be considered
				  separately from that of the State. The Commission may particularize subgroups
				  for the purposes of determining rates.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 5 - CHARGES › Section 17:9-5.2 - Charges; interest charges

Current through Register Vol. 56, No. 14, July 15, 2024
(a) By adoption of
				the appropriate resolution, the employer may request a premium delay of 30 or
				60 days after the customary due date for such charges. If the employer
				terminates participation, any amounts outstanding must be paid with the final
				billing. An employer who requests re-entry but has an outstanding balance from
				previous participation will not be granted a premium delay.
(b) For the purpose of local coverage, the
				employer must remit to the Division charges covering a one-month period by the
				due date printed on the bill.
(c)
				If the transmittal report and full payment of health benefits charges are not
				received within 15 days of the due date, as cited on the monthly transmittal
				mailed from the Division, interest at the rate of one percent per annum above
				the average annualized daily rate of return on the State Cash Management Fund
				as published by the Division of Investment for the most recent fiscal year
				shall be applied to the total transmittal of health benefits charges from the
				16th day until the payment is received. The interest penalty will also be
				applied if payment is received by the Health Benefits Bureau without the
				transmittal report for proper distribution.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 5 - CHARGES › Section 17:9-5.3 - Local employer payment of charges

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The obligations
				of a participating employer other than the State to pay the premium or periodic
				charges for health benefits coverage may be determined by means of a binding
				collective negotiations agreement.
(b) With respect to employees for whom there
				is no majority representative for collective negotiations purposes, the
				employer may, in its sole discretion, modify the respective payment obligations
				set forth in law for the employer and such employees for the coverage of the
				employee and enrolled dependents in a manner consistent with the terms of any
				collective negotiations agreement binding on the employer. In the absence of
				any collective negotiations agreement, the employer may modify the payment
				obligations as it deems appropriate.
(c) Should the payment obligations of
				employees change as a result of the implementation of a collection negotiations
				agreement binding on the employer, or upon the extension of such an agreement
				to employees for whom there is no majority representative for collective
				negotiations purposes, the employer must notify the Division of Pensions and
				Benefits by submission of the appropriate resolution.
(d) The employer shall give all affected
				employees an opportunity for completing and forwarding a new enrollment form
				within 60 days following the change in the employee's cost.
(e) Any affected employee who fails to
				complete and for-ward the required form within the time limits, which have been
				prescribed, may effect such change of enrollment only during the annual
				enrollment period.
(f) The Division
				assumes no responsibility for maintaining coverage in accordance with the
				employer's legal obligations.
(g)
				No retroactive enrollment, coverage changes or terminations will be processed
				to meet the contract provisions.