New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 155 - CATASTROPHIC ILLNESS IN CHILDREN RELIEF FUND PROGRAM › Subchapter 1 - CATASTROPHIC ILLNESS IN CHILDREN RELIEF FUND PROGRAM › Section 10:155-1.2 - Definitions

Current through Register Vol. 56, No. 14, July 15, 2024
The following words and terms, as used in this subchapter,
				  shall have the following meanings, unless the context clearly indicates
				  otherwise.
"Act" means P.L. 1987, Chapter 370, codified at
				  26:2-148
				  et seq., which establishes the Catastrophic Illness in Children Relief
				  Fund.
"Batch" means a grouping of applications for the purpose of
				  applying the provisions of
				  10:155-1.6,
				  1.7 and 1.8.
"Catastrophic Fund" or "Fund" means the Catastrophic Illness
				  in Children Relief Fund.
"Catastrophic illness" means any illness or condition for
				  which the incurred medical expenses are not covered by any other source,
				  including, but not limited to, other State or Federal agency programs,
				  insurance contracts, trusts, proceeds from fundraising, or settlements relative
				  to the medical condition of a child that is equal to 10 percent of the first $
				  100,000 of annual income of a family plus 15 percent of the excess income over
				  $ 100,000.
"Chairperson" means the chief executive officer of the
				  Commission who is elected by the Commission membership from the public members
				  for a term of one year.
"Child" means a person 21 years of age and under.
"Commission" means the 12 member Catastrophic Illness in
				  Children Relief Fund Commission created by the Act and appointed by the
				  Governor to administer the Fund. The Commission, chaired by a public member, is
				  in the Executive Branch of the State government. For purposes of complying with
				  the provisions of Article V, section IV, paragraph 1 of the New Jersey
				  Constitution, the Commission is allocated within the Department of Human
				  Services, but notwithstanding that allocation, the Commission shall be
				  independent of any supervision or control by the Department of Human Services
				  or by any board or officer thereof.
"Days" means calendar days.
"Eligibility standard" means that dollar amount equal to 10
				  percent of the first $ 100,000 of annual income of a family plus 15 percent of
				  the excess income over $ 100,000.
"Executive director" means the professional employed by the
				  Commission, in accordance with New Jersey Civil Service Commission procedures,
				  to administer the Fund on a day-to-day basis on behalf of the
				  Commission.
"Family" means a child and the child's parent, parents, or
				  legal guardian, as the case may be, who is legally responsible for the child's
				  medical expenses.
"Family responsibility" means the amount equal to 10 percent
				  of the eligibility standard.
"Health coverage premium" means a premium for contracts,
				  excluding automobile insurance contracts, whereby an insurer is obligated to
				  pay or allow a benefit for the child who is covered under the policy or
				  contract, due to bodily injury, disablement, sickness or because of any expense
				  relating thereto or because of expense incurred in the prevention of sickness
				  to include limited scope plans, such as hospital, medical and
				  prescription.
"Income" means the following:
1. Wages before deductions;
2. Public Assistance;
3. Social Security Benefits;
4. Supplemental Security Income;
5. Unemployment and Workers'
				Compensation;
6. Strike Benefits
				from Union Funds;
7. Veteran's
				Benefits;
8. Training
				Stipends;
9. Alimony;
10. Child Support;
11. Military Family Allotment;
12. Regular Support from Absent Family
				Member;
13. Pension
				Payments;
14. Insurance or Annuity
				Payments;
15. Income from Estates
				and Trusts;
16.
				Dividends;
17. Interest
				Income;
18. Rental
				Income;
19. Royalties;
				and
20. Other sources of income not
				mentioned above. However, income does not include the following money receipts:
				withdrawals from a bank; sale of property, house or car; tax refunds; gifts;
				one-time insurance payments; or compensation from injury, unless the injury
				directly relates to a child's condition, which is the basis for an application
				being made to the Fund. Also disregarded is non-cash income and any money
				raised by fundraising.
"Local agency" means the Special Child Health Services Office
				  responsible for assisting families in the application process, forwarding
				  applications to the State Office, and making appropriate referrals to other
				  State programs and benefits.
"Special education," shall mean as defined at
				  20
				  U.S.C. §
											1401(29),
				  specially designed instruction, at no cost to the parents, to meet the unique
				  needs of a child with a disability, including:
1. Instruction conducted in a classroom, in
				the home, in hospitals and institutions, and in other settings; and
2. Instruction in physical education.
"State Office of Catastrophic Illness in Children Relief
				  Fund" or "State Office" means the Office of the Executive Director of the Fund,
				  which has responsibility for administering the Fund on a day-to-day basis on
				  behalf of the Commission.
"Threshold" means the point at which a child's out-of-pocket
				  medical expenses exceed 10 percent of the first $ 100,000 of annual income of a
				  family plus 15 percent of the excess income over $ 100,000. After the child's
				  medical expenses reach this threshold, a child has passed the initial screen
				  for eligibility for assistance from the Fund.