New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 2 - COVERAGE › Section 17:9-2.4 - Coverage changes; exceptions

Current through Register Vol. 56, No. 14, July 15, 2024
(a) An employee may
				change the employee's enrollment and the enrollment of the employee's
				dependents to any type of coverage if such changes result from a change in the
				family, dependency, or employment status of the employee or the employee's
				dependents. Such changes will be permitted under the following conditions:
1. Marriage and civil unions. Any employee
				who marries or enters into a civil union may enroll the employee and eligible
				dependents, if any, for any appropriate type of coverage by applying for
				coverage within 60 days after such marriage or civil union. In the event that
				the spouse or partner is already enrolled in the SHBP or SEHBP as an employee,
				the provisions of
17:9-3.5
,
				regarding the prohibition of multiple coverage shall apply to such spouse's or
				partner's enrollment. A copy of the marriage certificate or certificate of
				civil union must be submitted with the completed application to add the
				spouse/partner.
2.
Divorce; separation; termination of domestic partnership or end of
				civil union
. Any employee who has been enrolled or has been covered as
				a dependent of an enrolled employee and is subsequently divorced or ends a
				civil union pursuant to N.J.S.A. 2A:34 or terminates a domestic partnership
				pursuant to
				26:8A-10 may enroll and delete
				from coverage or cover any eligible dependents by completing and forwarding a
				new enrollment form within 60 calendar days after the divorce or termination of
				the domestic partnership or civil union of such employee or dependent of an
				employee who was covered previously under the spouse's/partner's contract. A
				change of enrollment of this nature may also be made in the case of
				separation.
3.
Death of
				spouse, civil union partner, eligible domestic partner or dependent
				child
. Any employee who is enrolled as the dependent of their
				spouse/partner who dies may thereupon enroll as an employee, and may enroll any
				eligible dependents, for any appropriate coverage by completing and forwarding
				a new enrollment form within 60 days following the death.
4.
Return from military
				leave
. Any employee, upon return from any period of military leave
				without pay, may enroll the employee and any eligible dependents for any
				appropriate coverage by completing and forwarding an enrollment form within 60
				days after the date of the employee's return to active full-time employment. In
				the event a dependent of an employee is discharged from military service, the
				employee may enroll such dependent for any appropriate coverage within the time
				specified above.
5. When last
				covered child reaches age 26, marries, or enters into a civil union prior to
				that time. On December 31 of the year in which the child reaches age 26, the
				child shall be removed from coverage by the SHBP and the level of coverage of
				the employee or retiree shall be adjusted accordingly, unless the child is
				otherwise eligible for continued coverage as an overage child with
				disabilities. Any employee who shall have enrolled one or more children as
				dependents may enroll for any coverage at the time the last such child reaches
				age 26, marries prior to that time, enters into a domestic partnership or civil
				union or becomes otherwise ineligible, by completing and forwarding a new
				enrollment form.
6. When last
				covered child obtains other group health coverage through employment, marriage,
				or upon entering into a civil union or domestic partnership prior to attaining
				age 26. Any employee who shall have enrolled one or more children will be
				removed from dependent coverage at the time the last such child obtains other
				health benefits through employment or marriage, or upon entering into a civil
				union or domestic partnership prior to attaining age 26, or becomes otherwise
				ineligible. A subscriber may complete and forward a new enrollment form to
				change coverage level.
7. An
				employee, spouse, eligible domestic or civil union partner, or dependent ceases
				to be covered by other group health coverage. If the employee, spouse, domestic
				or civil union partner, or other dependent has other group health coverage, and
				then becomes ineligible for that employment, divorce, termination of domestic
				or civil union partnership, death, or reduction in hours worked, the employee
				may enroll in any plan or for any coverage in the SHBP, provided that the
				employee submits a new enrollment application accompanied by proof of the prior
				coverage, within 60 days of the qualifying event.
8. Birth, adoption, or guardianship of
				children. When an employee acquires qualified dependents through birth,
				placement for adoption, adoption, legal guardianship of children, or the
				assumption of direct support of children, the employee may enroll the employee
				and any eligible dependents for any appropriate type of coverage by completing
				and forwarding a new enrollment form within the period beginning 60 days prior
				to and ending 60 days after the birth, placement for adoption, the adoption,
				the guardianship, or the assumption of direct support of children. Such
				application regarding placement for adoption, adoption, assumption of direct
				support of children, and guardianship shall be accompanied by legal
				documentation evidencing the relationship.
9. COBRA enrollment. When an employee or
				dependent enrolls in the COBRA group, the employee or dependent may, within 60
				days of the qualifying event, select any plan. In order for an employee or
				dependent to enroll in health benefit, dental, or prescription coverage through
				COBRA, the subscriber must have been eligible for that coverage in the active
				group.
i. A Chapter 375 dependent who
				thereafter becomes ineligible for group medical and prescription coverage under
				Chapter 375 is not eligible for group medical and prescription coverage under
				COBRA.
ii. Chapter 375 dependents
				are permitted to continue vision and/or dental coverage under COBRA at the time
				they enroll in group medical and prescription coverage under Chapter 375,
				because Chapter 375 does not provide vision or dental coverage.
10.
Upon return to
				employment from an approved leave of absence
. Within 60 days after the
				return to employment from an approved leave of absence, the employee may elect
				to change coverage to add any eligible dependent(s) who had been removed from
				this group coverage while the employee was on such leave. If the employee
				elected not to continue his or her benefits while on leave or missed the open
				enrollment period, the employee may elect to enroll in any plan or coverage
				level as appropriate.
11.
Deference to local employer contracts
. When a local employer's
				contract limits coverage choices of an employee for a specified period of time
				after the employee's hire date, the employee may increase coverage levels
				provided an enrollment application is submitted within 60 days following the
				attainment of additional benefits provided in the contract.