reglab/statecodes huggingface dataset:
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 5 - CHARGES › Section 17:9-5.4 - Local employer resolution; P.L. 1974, c. 88; P.L. 1979, c. 54; P.L. 1999, c. 48

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A local employer will satisfy the
				requirements of P.L. 1974, c. 88, by adopting a resolution designed to:
1. Apply to all eligible present and future
				pensioners of the employer and their dependents;
2. Continue as long as the employer
				participates in the program;
3.
				Provide for local employer reimbursement of Federal Medicare charges for
				eligible pensioners and/or their spouses and partners, as well as the payment
				of health insurance charges required by the program, on a basis comparable to
				the reimbursement made by the State to its eligible pensioners and their
				spouses and partners in accordance with the provisions of P.L. 1972, c. 75 (see
				17:9-5.5 );
4. Require the local employer to pay all or
				some of the health benefits costs for retiree coverage if other conditions are
				met; P.L.
				2011, c. 78, also
				requires local retirees who attain 25 years of service credit on or after June
				28, 2011, to pay a percentage of the premium based on their retirement
				allowance; and
5. Provide for an
				effective date not earlier than the first day of the month at least 90 days
				following receipt of the local employer's resolution on forms approved by the
				Division.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 5 - CHARGES › Section 17:9-5.5 - Medicare refunds

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Where the State, directly or indirectly,
				reimburses the retiree for the Medicare Part B charges:
1. The amount of the reimbursements made for
				Medicare Part B shall be determined by law or, through a collective bargaining
				agreement or contract, but in no case shall it exceed the standard monthly cost
				of Medicare Part B.
2. As Medicare
				Part B premium reimbursements are dependent upon sufficient annual
				appropriations from the Legislature, eligible reimbursements for Medicare Part
				B premiums will include only those premiums that have been paid for the period
				up to 12 months immediately preceding receipt of proof of Medicare and not
				those paid prior to the 12 months immediately preceding receipt of proof of
				full Medicare entitlement.
3.
				Wherever possible, the reimbursement will be added directly to the retirement
				allowance.
4. Where the
				reimbursement cannot be added to the retirement allowance, a separate check for
				the reimbursement will be mailed to the retiree annually for the Medicare Part
				B payments paid in the previous year; for ABP members, the reimbursement is
				mailed monthly. All reimbursements made for Medicare Part B shall be made
				payable to the retiree.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 5 - CHARGES › Section 17:9-5.6 - Refunds rejected

Current through Register Vol. 56, No. 14, July 15, 2024
Any request for refund not specified in
17:9-5.5
shall be
				  denied. For example, if one spouse or eligible partner applies for Medicare
				  reimbursement for the member and spouse or eligible partner, the other shall
				  not receive duplicate reimbursement.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 5 - CHARGES › Section 17:9-5.7 - Retroactive charges; payment due

Current through Register Vol. 56, No. 14, July 15, 2024
Retroactive charges covering the entire period of
				  retroactivity will be calculated on the basis of the charge in effect on the
				  subscriber's effective date of coverage.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 5 - CHARGES › Section 17:9-5.8 - Charges and coverage; 10-month employees

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Employees hired
				as of September 1 under a 10-month contract shall have any premiums for which
				they may be responsible deducted from the wages they received in September to
				establish their coverage as of the beginning date of their employment. In order
				to continue a 10-month employee's coverage during the months of July and
				August, sufficient charges will be deducted prior to the expiration of their
				10-month contract to continue their coverage during the heretofore mentioned
				months.
(b) Regarding 10-month
				contract State employees paid on a biweekly basis through the State's
				Centralized Payroll System, the effective date of coverage for September
				enrollments will be the period which is the one nearest September 1.
(c) A 10-month employee whose employment
				resumes in September may enroll eligible dependents within 60 days of the
				qualifying event. Should any part of the 60-day period occur during July and
				August, that period will be extended day for day up to 60 days after the
				employee resumes work in September.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 5 - CHARGES › Section 17:9-5.9 - Health Contribution for active employee State Health Benefit Coverage

Current through Register Vol. 56, No. 14, July 15, 2024
(a)
				Pursuant to P.L. 2007, c.
				103 and
				P.L.
				2011, c. 78
				(
52:14-17.28c
), a health
				contribution that is determined as a specific percentage of the cost of health
				care coverage for each salary range and coverage level specified in
52:14-17.28c
, shall be
				deducted from each covered State employee's base salary. The health
				contribution that is deducted may not be less than 1.5 percent of base
				salary.
(b) For purposes of this
				section, base salary means an employee's annual base salary, not including any
				bonuses, overtime, or longevity payment.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 6 - RETIREMENT › Section 17:9-6.2 - Coverage for prospective retirants

Current through Register Vol. 56, No. 14, July 15, 2024
(a) For purposes of
				retired coverage, continuity of coverage may be extended until such time as the
				application for retirement is formally approved or denied by the Board of
				Trustees of the retirement system paying the benefit or by the investment
				carrier underwriting the individual annuity contracts.
1. If it is not necessary for a Board of
				Trustees to approve the application, then the retirement application will be
				considered approved when the necessary action has been taken by the Division,
				the local retirement system, or the investment carrier.
2. The retiring employee or eligible
				dependent of a retired employee must submit personal payments to the Health
				Benefits program in order to continue coverage.
3. Should coverage lapse through no fault of
				the retired employee, the retired employee's spouse or eligible partner who
				would be eligible to continue such coverage, retroactive coverage for no more
				than six months may be granted, provided that the retroactive and currently due
				premiums are received.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 6 - RETIREMENT › Section 17:9-6.3 - Retiree coverage; limitation

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A retiree, but
				not the retiree's surviving dependent, may change coverage to include a spouse,
				eligible partner and other dependents by submitting a completed application
				along with appropriate legal documentation, described at
				17:9-3.3(a),
				verifying the dependent's relationship with the subscriber within 60 days of a
				change in family status (marriage, domestic partnership, civil union, birth or
				adoption of a child, or a significant change in health coverage due to a
				spouse's or partner's employment). The dependent shall be enrolled
				retroactively to the date of the qualifying event.
1. If a retiree, but not the retiree's
				surviving dependent, wishes to add an eligible spouse, eligible partner or
				dependent and the completed application and legal documentation is not received
				within 60 days of a family status change, there shall be a minimum waiting
				period of two full months upon the Division's receipt of a completed
				application and legal documentation to change coverage. A dependent may be
				enrolled as of the first day of the month following the two-month waiting
				period. A dependent added in this manner may be added to a retiree's contract
				only once.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 6 - RETIREMENT › Section 17:9-6.4 - Suspension of allowance

Current through Register Vol. 56, No. 14, July 15, 2024
A retired employee, whose retirement allowance has been
				  suspended, shall have his or her health insurance terminated upon the
				  suspension of the allowance. Upon the reinstatement of the individual's
				  allowance, coverage will resume.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 6 - RETIREMENT › Section 17:9-6.5 - Discontinuance of allowance

Current through Register Vol. 56, No. 14, July 15, 2024
When a retired employee's or beneficiary's retirement
				  allowance is discontinued, the retired employee's or beneficiary's coverage may
				  be terminated upon such discontinuance. Upon the reinstatement of the
				  individual's retirement allowance, health insurance coverage will be resumed
				  and may be made retroactive to the date of reinstatement of the retirement
				  allowance, but in no case for more than one year.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 6 - RETIREMENT › Section 17:9-6.6 - Beneficiary, dependent or survivor

Current through Register Vol. 56, No. 14, July 15, 2024
(a) An eligible
				beneficiary or survivor will have their coverage discontinued upon the death of
				the retired employee but will be given the opportunity to continue coverage.
				Coverage may be made retroactive for as much as six months provided the
				necessary charges are paid.
(b) An
				eligible surviving spouse or eligible partner will be offered the opportunity
				to continue participation in the SHBP subsequent to the death of the retired
				member. The coverage will be no greater than the coverage that was in effect at
				the time of the retired member's death and will be limited to only those
				dependents covered at the time of the member's death. If the surviving spouse
				or partner is not the recipient of any monthly retirement allowance from a
				State-administered retirement system upon the death of the retired member, the
				Division will bill the surviving spouse or partner at the group rate.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 6 - RETIREMENT › Section 17:9-6.7 - Coverage for PFRS and SPRS accidental death benefit recipients

Current through Register Vol. 56, No. 14, July 15, 2024
(a) For the
				purposes of this section, "eligible person" means the surviving spouse,
				eligible partner pursuant to
				17:1-5.5 and child, as defined in
				43:16A-1, of a member of the
				Police and Firemen's Retirement System, to or for whom an accidental death
				benefit is payable under
				43:16A-10, and the surviving
				spouse, eligible partner and child, as defined in
				53:5A-3, of a member of the State
				Police Retirement System, to or for whom an accidental death benefit is payable
				under 53:5A-14.
(b) An eligible person may participate in the
				SHBP regardless of whether the member's employer is a participating employer.
				The premiums for the coverage shall be paid by the State of New Jersey, as
				provided in P.L. 1989, c. 271.
(c)
				Persons eligible to participate in the program under this section shall
				participate in the retiree group. If there is a surviving spouse or eligible
				partner, eligible children shall participate as dependents of the surviving
				spouse or partner. If there is no surviving spouse or partner, eligible
				children shall participate as members of the program, and their eligibility to
				participate shall continue, as long as they qualify as children under the laws
				governing the retirement system of the deceased member.
(d) An eligible person, as defined in (a)
				above, shall be eligible for coverage under the program as of February 1, 1990,
				or the effective date for an accidental death benefit under the retirement
				system of the deceased member, whichever is later. An eligible person shall
				receive a refund for premiums paid for health insurance coverage comparable to
				that provided under the program for the period from the date of eligibility for
				coverage under this section and the effective date of enrollment, but the
				refund shall not exceed the cost of the coverage under the program. An eligible
				person who is covered under Part B of the Federal Medicare program shall
				receive a refund for the amount paid for Part B. While an application for an
				accidental death benefit is pending, an eligible person enrolled in the program
				may continue coverage on a direct payment basis. If an accidental death benefit
				is granted, the eligible person shall receive a refund of the payments
				made.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 6 - RETIREMENT › Section 17:9-6.8 - Premium-sharing for retired employee State Health Benefit Coverage and reimbursement for Medicare Part B costs

Current through Register Vol. 56, No. 14, July 15, 2024
(a) All State
				employees, except nonaligned uniformed State Police officers, who accrue 25
				years of service credit in a State-administered retirement system or retire on
				a disability retirement after July 1, 1997, for whom there is no majority
				representative for collective negotiations purposes, and who were hired by the
				State prior to July 1, 1995, and were continuously employed, shall, upon
				retirement, receive Medicare Part B reimbursement after retirement up to a cap
				of $46.10 per month per eligible employee and the employee's spouse or eligible
				partner and be subject to payroll deductions for coverage in advance of the
				coverage period in accordance with standard payroll procedures as set forth
				below. State employees, except nonaligned uniformed State Police officers, who
				accrue 25 years of service credit in a State-administered retirement system or
				who retire on a disability retirement after July 1, 1997, for whom there is no
				majority representative for collective negotiations purposes, and who were
				hired by the State on or after July 1, 1995, shall not be entitled to receive
				Medicare Part B reimbursement after retirement.
(b) For employees hired before December 11,
				1995, who accrue 25 years of service credit in a State-administered retirement
				system or retire on a disability retirement after July 1, 1997 but before July
				1, 2000, payroll deductions for NJ DIRECT10 or Aetna Freedom 10 coverage shall
				be determined using a base salary as of the first pay period of the calendar
				year in which retirement occurred, as follows:
1. Upon retirement, retirees with a base
				salary of $40,000 or more in the year of retirement shall pay the difference
				between the cost of the NJ DIRECT10 or Aetna Freedom 10 and the average cost
				for NJ DIRECT15 and participating HMOs, as determined hereinafter.
2. Upon retirement, retirees with a base
				salary of less than $40,000 in the year of retirement shall pay, on a monthly
				basis, one percent of the base salary but not less than $20.00 per
				month.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 6 - RETIREMENT › Section 17:9-6.9 - Eligibility for State payment of retiree coverage under P.L. 1997, c. 330

Current through Register Vol. 56, No. 14, July 15, 2024
(a) For the purposes of this section,
				"qualified retiree" means a person who:
1. Is
				a retiree from:
i. The Police and Firemen's
				Retirement System of New Jersey (43:16A-1 et seq.),
				hereinafter referred to as PFRS;
ii. The Consolidated Police and Firemen's
				Pensions Fund (43:16-1 et seq.),
				hereinafter referred to as CPFPF; or
iii. The Public Employees' Retirement System
				of New Jersey (43:15A-6 et seq.),
				hereinafter referred to as PERS, from a position included in the definition of
				"law enforcement officer" under section 1 of P.L. 1955, c. 257 (43:15A-97 ), from a PFRS-covered
				position that would have made the member eligible for enrollment in the PFRS
				but for age, from a position that would have been eligible for enrollment in
				the PFRS had the employer joined the PFRS by referendum under the provisions of
				43:16A-3(2)  or
				from a position that is eligible for participation in PFRS as provided in
				section 9 of P.L. 1989, c. 204 (43:16A-1.2
				);
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 6 - RETIREMENT › Section 17:9-6.11 - Aggregation of nonconcurrent pension credit to qualify for employer-paid retired SHBP benefits under P.L. 2001, c.209

Current through Register Vol. 56, No. 14, July 15, 2024
(a) To qualify for
				employer-paid SHBP coverage based on combined service in more than one New
				Jersey public retirement systems, members must:
1. Retire and collect a benefit from each
				retirement system;
2. Have 25 or
				more years of nonconcurrent pension service credit in total;
3. Retire from the last retirement system
				after the effective date of
				P.L.
				2001, c. 209, August
				15, 2001;
4. Be eligible for
				employer-paid SHBP coverage immediately prior to retirement from the last
				contributing employer in the retirement system for retirees of the State or
				participating local employers. Retirees of the State or participating local
				employers, except school boards and county colleges, are not eligible for SHBP
				coverage if they elect a deferred retirement benefit; or
5. Be eligible for employer-paid coverage
				immediately prior to retirement or separation from a school board or county
				college in New Jersey. The school board or county college must have been the
				retiree's last contributing employer in order to receive State-paid SHBP
				coverage as a retiree of a school board or county college.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 7 - TERMINATION › Section 17:9-7.1 - Termination effective date

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Cessation of
				active SHBP employee coverage shall be deemed to occur on the last day of
				eligibility for the coverage period for which charges have been paid.
(b) If a SHBP subscriber does not remit
				payment by the end of the month in which payment is due and owing, the SHBP
				shall notify the member by regular mail that the right to continue coverage
				will be suspended if payment in full is not remitted within 30 days of the
				suspension notice. If no payment is made, the SHBP shall generate a notice of
				termination to the member indicating the termination date and restating the
				amounts due to reinstate coverage. Termination shall be effective on the last
				day of the month for which premiums were paid. The SHBP shall not reinstate the
				member unless the member remits the entire balance due. Once coverage
				terminates, reinstatement is not automatic and will only be done after a review
				of the individual's circumstances by the SHBP.
(c) Unless the subscriber requests
				termination of coverage, SHBP coverage for a member who is awaiting approval of
				a retirement benefit shall continue until the retirement is either approved or
				denied provided the member makes the appropriate remittance for coverage. Any
				retroactive SHBP premiums owed by the subscriber shall be deducted from the
				retirement benefit when approved, the withdrawal check, the return of pension
				contributions, or from any retirement or death benefit received by the member's
				named beneficiary(ies).
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 7 - TERMINATION › Section 17:9-7.2 - Termination of eligibility

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The coverage of
				an employee and such employee's eligible dependents shall terminate whenever
				such employee's eligibility shall cease for any of the reasons given in (c)
				below.
(b) The effective date of
				termination shall be the last day of the coverage period corresponding to the
				payroll period or month in which the last payroll deduction was made from the
				employee's salary for coverage, if any are required, or the last charge shall
				have been paid by the State for the employee's and/or the employee's
				dependents' coverage or by the local employer for the employee and/or the
				employee's dependents, as the case may be.
(c) Coverage for the employee and the
				employee's dependents will terminate if:
1.
				The subscriber voluntarily terminates coverage;
2. The employee terminates
				employment;
3. The employee's hours
				are reduced so the employee no longer qualifies for coverage as a full-time
				employee. An employee whose coverage terminated as a result of a change from
				full-time to part-time status cannot be reenrolled until the employee has
				reestablished eligibility for coverage by serving the normal waiting period
				prescribed for new enrollees. In no event will the waiting period include any
				part-time service rendered by the employee;
4. The employee is on a leave of absence and
				the employee does not make required premium payments. The coverage of an
				eligible employee and of an employee's dependents during any period of
				authorized leave of absence without pay shall terminate on the last day of the
				second coverage period following the last payroll period or month for which the
				employee received a salary payment if the total charge for the coverage is not
				paid by the employee;
5. The
				employee enters the Armed Forces, is eligible for government-sponsored health
				services and is not receiving differential pay from the State or local
				employer;
6. The subscriber's
				employer ceases to participate in the SHBP;
7. The subscriber dies;
8. The employee is suspended; or
9. The employee is on a furlough or extended
				furlough and fails to make required premium payments in advance.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 7 - TERMINATION › Section 17:9-7.3 - Continuation of coverage

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The coverage of
				an employee, and an employee's dependents, may be continued if:
1. The employee has an award pending or
				received an award of periodic benefits under Workers' Compensation and the
				employee is not otherwise covered as an employee or retiree under the SHBP. The
				employee may continue coverage and the coverage of the employee's dependents,
				provided that the employee shall pay to the employer in advance that portion,
				if any, of the charges due from the employee to continue the
				coverage;
2. The employee is on an
				approved leave of absence without pay. The coverage of such employee and such
				employee's dependents may be continued by such employee, provided that the
				employee shall pay in advance the total charge required for the employee's
				coverage and coverage of the employee's dependents during such period of
				authorized leave of absence without pay; provided that no period of continued
				coverage, as provided above, shall exceed a total of 20 biweekly payroll
				periods, or nine months, during which the employee receives no pay. After the
				20 biweekly payroll periods, or nine months, the employee may continue coverage
				through COBRA for the remaining balance of the COBRA continuation period;
				or
3. The employee is on an
				approved State or Federal Family Leave.
i. The
				State Family Leave Act (34:11B-1 et seq.)
				entitles an employee to continue 12 weeks of SHBP coverage in any 24-month
				period at the expense of their employer. This includes all health care
				benefits, including Prescription Drug, Dental and Vision Care benefits if the
				employer provides them. State Family Leave includes leave from employment to
				provide care for the birth or adoption of a child, or the serious illness of a
				child, parent, spouse or partner. It does not provide for a leave due to the
				personal illness of the employee.
ii. The Federal Family Leave Act (Family and
				Medical Leave Act of 1993,
				29 U.S.C. §§
												2601 et seq.) has benefits similar to the
				State Family Leave Act with the exception that the Federal act also requires
				that leave be permitted for the employee's own serious illness of up to 12
				weeks in any 12-month period.
iii.
				In cases where the employee on an approved Family Leave has a deduction, the
				employer must make arrangements with the employee to receive direct payment for
				the required employee contribution. If the SHBP does not receive full payment
				from the employer, then the employee's benefit coverage will be terminated
				under the termination provisions of the SHBP program.
iv. The time an employee spends on Federal or
				State family leave shall not count as part of the COBRA eligibility period
				should an employee receive approval from their employer to extend the
				leave.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 7 - TERMINATION › Section 17:9-7.4 - Voluntary termination

Current through Register Vol. 56, No. 14, July 15, 2024
A subscriber may elect voluntarily to terminate coverage for
				  the subscriber or the subscriber's dependents at any time, but termination of
				  the subscriber's own coverage shall automatically terminate the coverage of the
				  subscriber's dependents. Such voluntary termination shall be effected by
				  written notice thereof to the State Health Benefits Bureau by use of the New
				  Jersey SHBP application. Coverage may be reinstated for active employees after
				  termination for the eligible employee and eligible dependents in accordance
				  with the provisions of the Health Insurance Portability and Accountability Act
				  of 1996 (HIPAA) and during any subsequent open enrollment period. Coverage may
				  be reinstated for retirees after termination of the retiree and eligible
				  dependents only as permitted in N.J.A.C. 17:9-6.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 8 - EMPLOYEE PRESCRIPTION DRUG PLAN › Section 17:9-8.1 - Employee Prescription Drug Plan

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Employee
				Prescription Drug Plan was established under the provisions of
				52:14-17.2 9(F).
(b) Separate election shall be required for
				enrollment and for a change in, or a termination of, coverage in the Employee
				Prescription Drug Plan.
(c) The
				rules for eligibility and for determining the effective dates of coverage are
				the same as those of the SHBP as administered by the Commission in accordance
				with the provisions of
52:14-17.25
et seq., with the following exceptions:
1.
				Except under the provisions of the Federal COBRA law, prescription drug
				coverage is not continued in the event of death or other termination of the
				group coverage;
2. Employers, other
				than the State of New Jersey, may offer to their employees and eligible
				dependents enrollment in the State Employee Prescription Drug Plan, or another
				free-standing prescription drug plan, or elect to have prescription drug
				coverage under the offering of their SHBP medical plans.
i. If the employer elects to offer the State
				Employee Prescription Drug Plan, the employee's share of the cost for this
				prescription drug plan may be determined by a formula different from that used
				to determine the employee's share of the cost of health coverage. The employee
				may pay a share of the cost of prescription drug coverage for the employee and
				for the employee's covered dependents as required by a bargaining unit
				agreement. The employer may establish by ordinance or resolution, rules for the
				employee's share of the cost for those employees not covered under a bargaining
				agreement.
ii. If an employer,
				other than the State of New Jersey, offers a free-standing prescription drug
				plan other than the State Employee Prescription Drug Plan, this plan must be
				comparable in design, as determined by the Commission, to the State Employee
				Prescription Drug Plan. If an employee declines the employer's offering of a
				prescription drug plan, no reimbursement for prescription drugs will be
				provided under the SHBP medical plan in which the member is enrolled;
				and
3. Prescription drug
				classifications that are not eligible for coverage under the employer's
				prescription drug plan are also not eligible for coverage under the SHBP
				medical plans except as Federally or State mandated.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 8 - EMPLOYEE PRESCRIPTION DRUG PLAN › Section 17:9-8.2 - Prescription drug cards

Current through Register Vol. 56, No. 14, July 15, 2024
Identification cards shall be issued by the carrier upon
				  initial enrollment or change of coverage. Identification cards may be reissued
				  periodically. For State employees, each issue may reflect the bargaining unit
				  in which the State employee participates. All cards will be mailed directly to
				  the subscriber's home.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 8 - EMPLOYEE PRESCRIPTION DRUG PLAN › Section 17:9-8.3 - Termination; effective date

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The effective
				date of termination shall be the last day of the coverage period corresponding
				to the payroll period or month in which the last payroll deduction was made
				from the employee's salary for the coverage, if any are required, or the last
				charge shall have been paid by the State for employee's and/or his or her
				dependents' coverage or by the local employer for the employee and/or his or
				her dependents, as the case may be. Coverage may continue under the conditions
				set forth in
				17:9-7.3.
(b) Eligibility shall be terminated in
				accordance with the provisions of
				17:9-7.2.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 9 - EMPLOYEE DENTAL PLANS › Section 17:9-9.1 - Employee Dental Plans

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Employee
				Dental Plans were established under the provisions of
52:14-17.29(F)
and were extended to local participating employers as of January 1,
				2005. The Employee Dental Plans are available to full-time employees and their
				eligible dependents. Newly eligible employees may enroll by completing an
				application during the first 60 days of employment. The Employee Dental Plans
				offer a choice between two types of dental plans: a Dental Expense Plan and a
				Dental Plan Organization (DPO). The Dental Expense Plan is a PPO that allows
				the employee to select any licensed dentist for dental care. The Dental Plan
				Organizations (DPOs) are companies that contract with a network of providers
				for dental services. The employee must use providers participating with the DPO
				selected.
(b) The Plans are
				voluntary. A separate election will be required for enrollment and for a change
				in, or a voluntary termination of, coverage in the Employee Dental
				Plans.
(c) The rules are the same
				as those of the SHBP as administered by the Commission in accordance with the
				provisions of N.J.S.A. 52:14- 17.25 et seq., with the following exceptions:
1. Coverage may be continued during an
				approved leave of absence without pay of not more than three months (six
				biweekly pay periods) provided the employee pays the entire premium in advance
				(employer and employee shares of the premium for employees and
				dependents);
2. All employees
				enrolled for coverage are required to participate in the Plan for a minimum
				12-month period while eligibility for coverage exists unless the minimum
				enrollment requirement is waived by the Commission;
3. An employer who participates in the
				Employee Dental Plans is not eligible to request a premium delay of 30 or 60
				days for payment of the premium charges pursuant to
				17:9-5.2(a);
4. If an employer elects to participate in
				the Employee Dental Plans, the employee's share of the cost for the Plans may
				be determined by a formula different from that used to determine the employee's
				share of the cost of health coverage. The employee may pay a share of the cost
				of dental coverage for the employee and for the employee's covered dependents
				as required by a collective negotiations agreement. The employer may establish
				by ordinance or resolution, rules for the employee's share of the cost for
				those employees not covered under a collective negotiations
				agreement;
5. An employer who does
				not participate in the SHBP or School Employees' Health Benefits Program is
				ineligible for participation in the Employee Dental Plans; and
6. An employer who elects to participate in
				the Employee Dental Plans must remain in the Plans for a minimum of 12 months
				before terminating coverage unless the employer terminates participation in the
				SHBP or School Employees' Health Benefits Program.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 9 - EMPLOYEE DENTAL PLANS › Section 17:9-9.2 - Dental identification cards

Current through Register Vol. 56, No. 14, July 15, 2024
Identification cards will be issued by the carrier upon the
				  initial enrollment or change of coverage. Identification cards will be reissued
				  periodically to assure the validity of coverage. All cards will be mailed
				  directly to the employee's home.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 9 - EMPLOYEE DENTAL PLANS › Section 17:9-9.3 - Enrollment charges

Current through Register Vol. 56, No. 14, July 15, 2024
Each eligible employee who enrolls for coverage shall be
				  required to authorize the taking of deductions in order to pay for the
				  employee's share of the cost of coverage for the employee and enrolled
				  dependents.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 9 - EMPLOYEE DENTAL PLANS › Section 17:9-9.4 - Waiting period-Orthodontics under the Dental Expense Plan

Current through Register Vol. 56, No. 14, July 15, 2024
Credit for qualified service with the same employer
				  immediately preceding the employee's election to participate in the Plan or
				  during any annual enrollment period shall count towards establishing the 10
				  months or more of continuous service required for orthodontics. Otherwise, all
				  other benefits will be available and such participants will become eligible for
				  orthodontics as soon as 10 months of continuous qualified service has been
				  accumulated.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 9 - EMPLOYEE DENTAL PLANS › Section 17:9-9.5 - Covered expenses

Current through Register Vol. 56, No. 14, July 15, 2024
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 9 - EMPLOYEE DENTAL PLANS › Section 17:9-9.6 - Deductible

Current through Register Vol. 56, No. 14, July 15, 2024
Eligible charges incurred under a local employer's group
				  dental coverage by an employee prior to the employer's enrollment in the
				  Employee Dental Plans shall be considered toward satisfying the annual Employee
				  Dental Plans deductible.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 10 - PROCUREMENT OF STATE HEALTH BENEFITS PROGRAM CONTRACTS › Section 17:9-10.1 - Purpose

Current through Register Vol. 56, No. 14, July 15, 2024
This subchapter establishes the rules governing the
				  procurement of contracts by the Commission for health benefit services and
				  related actuarial and auditing services. The Commission, created by Section 3
				  (52:14-17.2 6) of the New Jersey
				  Health Benefits Program Act, P.L. 1961, c. 49 (52:14-17.2 5 et seq.) as amended
				  and supplemented, is responsible for negotiating and arranging for the purchase
				  of such services.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 10 - PROCUREMENT OF STATE HEALTH BENEFITS PROGRAM CONTRACTS › Section 17:9-10.2 - Source for public information

Current through Register Vol. 56, No. 14, July 15, 2024
The public may obtain information concerning the
				  Commission's procurement program and pending procurements by writing to the
				  Director, Division of Pensions and Benefits, PO Box 295, Trenton, New Jersey
				  08625-0295.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 10 - PROCUREMENT OF STATE HEALTH BENEFITS PROGRAM CONTRACTS › Section 17:9-10.4 - Procurement methodology

Current through Register Vol. 56, No. 14, July 15, 2024
(a) All purchases
				shall be through formal, advertised sealed bidding, except as provided in this
				subchapter.
(b) The Director shall
				prepare the RFP for formal, advertised, sealed bidding at the request of the
				Commission.
(c) The Director shall
				structure the RFP for formal, advertised, sealed bidding to provide for a
				single contract award to a single bidder, unless contract awards to two or more
				bidders are permitted as hereinafter provided in this subchapter.
(d) The Director may structure an RFP for
				formal, advertised, sealed bidding to include multiple price lines encompassing
				more than one service or group of services, with a separate contract award for
				each price line.
(e) The Director
				may structure an RFP for formal, advertised, sealed bidding to be awarded to
				two or more bidders on the basis of one or more of the following criteria:
1. The anticipated demand for health care
				services by employees of the State and their dependents and employees and
				dependents of participating local government employers and the ability of
				potential bidders to meet the anticipated demand;
2. The need for comprehensive in-State and
				out-of-State health care networks and/or the need for diversity in health care
				plans offered; and/or
3. The need
				for cost efficient, timely delivery of auditing and actuarial
				services.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 10 - PROCUREMENT OF STATE HEALTH BENEFITS PROGRAM CONTRACTS › Section 17:9-10.5 - Notice of formal, advertised, sealed bidding opportunities

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A notice of bid
				opportunity shall be advertised in newspapers or other such media as allowed by
				law and selected by the Commission, as will give best notice thereof to
				bidders. Advertisements shall be placed a minimum of 30 calendar days in
				advance of bid opening.
(b) Notice
				of bid opportunity and the RFP shall be published on the Division's website a
				minimum of 30 calendar days in advance of bid opening.
(c) If an amendment to a published RFP is
				necessary, notice of the amendment and the amendment shall be published on the
				Division's website a minimum of five working days in advance of bid
				opening.
(d) The Division shall
				maintain a list of vendors having expressed an interest in bidding in response
				to a particular contract initiative. Vendors on the list shall be provided
				e-mail notice of the publication on the Division's website of any RFP that they
				have expressed an interest in receiving and e-mail notice of the publication on
				the Division's website of any subsequent amendment to such RFP. However, the
				mere placement of a vendor's name on the bid list does not create an absolute
				entitlement to notice. It is the vendor's responsibility to exercise due
				diligence in reviewing legal notices and the Division's website to ensure its
				participation in bidding opportunities.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 10 - PROCUREMENT OF STATE HEALTH BENEFITS PROGRAM CONTRACTS › Section 17:9-10.6 - Requirements for formal, advertised, sealed bidding

Current through Register Vol. 56, No. 14, July 15, 2024
(a) In order to be
				eligible for consideration for award of contract, the bidder's bid proposal
				must:
1. Be submitted on or before the
				opening date and time and at the place specified in the RFP;
2. Be signed by an individual with the
				authority to legally bind the bidder;
3. Include all required completed
				forms;
4. Be accompanied by bid
				security when required;
5. Include
				pricing information;
6. Be preceded
				by the bidder's attendance at any pre-bid conference for which attendance is
				mandatory. However, the Director reserves the right to allow a vendor to meet a
				pre-bid conference attendance requirement by listening to a tape recording of
				the pre-bid conference. This right may be exercised by the Director upon a
				vendor's verifiable demonstration of extenuating circumstances, which prevented
				attendance, or for other factors deemed, by the Director, to be in the State's
				best interest;
7. Contain initials
				of an individual with the authority to legally bind the bidder adjacent to any
				price alterations. If a unit price in a bid proposal has been altered or
				appears to be an alteration, the initials must appear adjacent to the
				alteration. Examples of alterations include, but are not limited to, cross
				outs, erasures, whiteouts, writeovers, and strikeovers, with re-entered
				prices;
8. Be prepared in ink or
				typewritten. If information essential to a bid evaluation, including, but not
				limited to, price, terms and production description, is submitted in pencil,
				the bid proposal shall be rejected unless that same essential information
				appears elsewhere in the bid proposal, either typewritten or printed, and
				provided that the information is entirely consistent with the information
				submitted in pencil and does not invite any other interpretation;
9. Include a completed Ownership Disclosure
				Form or have a completed Ownership Disclosure Form on file with the State, in
				conformance with
				52:25-24.2; and
10. Be sealed. Telephone, telefacsimile or
				electronic bid proposals will not be accepted for publicly advertised bid
				solicitations requiring the submittal of sealed bids.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 10 - PROCUREMENT OF STATE HEALTH BENEFITS PROGRAM CONTRACTS › Section 17:9-10.7 - Performance security

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Based upon the
				Director's review of market conditions and evaluation of potential risk to the
				Commission and the State, the RFP may require that performance security be
				posted by the selected bidder prior to contract execution.
(b) Performance security, in the amount set
				forth in the RFP, shall consist of a certified or cashier's check drawn to the
				order of "New Jersey State Health Benefits Commission," a performance bond
				issued by an insurance or security company authorized to do business in the
				State of New Jersey, or an irrevocable letter of credit issued by a Federally
				insured financial institution and naming the "New Jersey State Health Benefits
				Commission" as beneficiary.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 10 - PROCUREMENT OF STATE HEALTH BENEFITS PROGRAM CONTRACTS › Section 17:9-10.8 - Bid opening

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Bid proposals
				must be received prior to or at the time and place designated in the RFP for
				bid opening. Late bid proposals will be rejected. The Director may extend the
				time for bid opening when a vendor notifies the Director of the vendor's intent
				to bid but, due to an emergency, timely delivery of the bid proposal is not
				possible. The bidder making such request must do so prior to the time of the
				scheduled bid opening. If the Director determines that a delayed bid opening is
				in the State's best interest, the Director shall designate a revised bid
				opening time.
(b) For RFPs not
				having a negotiation component, the bidder's name, address and bid pricing will
				be read at bid opening. Bid proposals will be made available for public review
				thereafter upon request and as scheduled by the Director.
(c) For RFPs having a negotiation component,
				only the names and addresses of the bidders will be read at bid opening. Bid
				proposals shall be made available for public review, upon request and
				scheduling by the Director, after issuance of the Notice of Intent to Award by
				the Director.
(d) Each bid proposal
				and, if applicable, each best and final offer will be available for public
				inspection in accord with the Open Public Records Act,
				47:1A-1 et seq. Within its bid
				proposal, the bidder must identify any data or materials it asserts are exempt
				from public inspection under the Act and explain the basis for such assertion.
				The assertion that the entire bid proposal or prices bid are exempt from public
				inspection under the Act is not acceptable and will result in the rejection of
				the bid proposal.
New Jersey Administrative Code › Title 17 - TREASURY - GENERAL › Chapter 9 - STATE HEALTH BENEFITS PROGRAM › Subchapter 10 - PROCUREMENT OF STATE HEALTH BENEFITS PROGRAM CONTRACTS › Section 17:9-10.9 - Bid errors

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Prior to bid
				opening, a bidder discovering an error in its bid proposal may withdraw the bid
				proposal by notifying the Director in writing. The bidder may submit a revised
				bid proposal provided it is received prior to bid opening.
(b) After bid opening, a bidder discovering
				an error in its bid proposal must make written application to the Director for
				authorization to withdraw its bid proposal. The Director shall consider the
				bidder's good faith in making the request, as evidenced by whether the mistake
				relates to a material term of the RFP; whether the mistake occurred
				notwithstanding the bidder's exercise of reasonable care; and whether the State
				would be significantly prejudiced by granting the request.