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1. What did this law change?
The previous law did not allow dependents to continue coverage after the end of the year the child turned 23. Chapter 375 changes this from 23 years of age to the individual’s 30th birthday.
2. When did the law go into effect?
The law was passed and signed by former Governor Codey on January 1, 2006, and was enacted on May 12, 2006. The law went into effect for the State Health Benefits Program on January 1, 2007.
3. Why didn’t this law go into effect on May 12, 2006?
While Chapter 375 was signed into law on May 12, 2006, the effective date for the continued SHBP coverage was the next renewal date of the SHBP health plans, which was January 1, 2007.
4. Who is eligible?
In order to meet the requirements for continuation of coverage under this law, the individual must be:
- Less than 30 years of age
- Unmarried
- Having no dependents of his or her own
- A NJ resident or enrolled as a full-time student at an accredited institution of higher education
- not receiving coverage as a named subscriber, insured, enrollee, or covered person under any other group or individual health benefits plan, group health plan, church plan, or health benefits plan, or entitled to benefits under Title XVIII of the Social Security Act, Pub.L.89-97 (42 U.S.C. s.1395 et seq.).
5. How does the SHBP define “not receiving coverage?"
“not receiving coverage" means that the individual can receive immediate services under another plan, and is not merely eligible to enroll in or obtain coverage under another plan.
6. When can I sign my dependent up for coverage?
A SHBP covered employee may only enroll an over age child who is Chapter 375 eligible during the Annual SHBP Open Enrollment period — held during the month of October. Coverage for the over age child would begin in January with the start of the benefit plan year.
Retirees covered by SHBP may enroll an over age child who is Chapter 375 eligible at any time by filing an application with the SHBP. The effective date of coverage will be the first of the month following a full two-month waiting period from the date of receipt of the application.
7. What documentation is required to enroll my dependent for coverage?
The SHBP Chapter 375 Application for Coverage and a photocopy of the over age child’s birth certificate are required when enrolling for this extended coverage. If the over age child is adopted, a step child, or a legal ward, an Affidavit of Dependency form and supporting documentation is required, if not already on file with the SHBP. Please send the application and any supporting documentation to: NJ Division of Pensions and Benefits Health Benefits Bureau, P.O. Box 299, Trenton, NJ 08625-0299 or fax to 609-341-3407.
8. May the over age dependent select a different plan than the medical plan that the covered parent has selected?
No. Under Chapter 375, an over age child does not have any choice in the selection of benefits. The over age child must be enrolled for coverage in exactly the same plan or plans (medical and/or prescription drug) that the covered parent has selected.
9. May an over age dependent select to continue dental and/or vision benefits?
There is no provision for eligibility for dental or vision benefits, under Chapter 375.
10. What is the cost for the over age coverage under Chapter 375?
When Chapter 375 coverage is elected, the covered parent will be billed directly by the SHBP for the cost of the coverage. Payroll deductions are not available. The Chapter 375 Rate Chart provides the current premium amounts for the SHBP plans for over age coverage.
11. When will coverage end under Chapter 375 for an over age dependent?
Chapter 375 coverage ends on the first of the month following the event that makes the child ineligible or up until the paid through date in the case of non-payment.
Coverage for an enrolled over age child will end when the child no longer meets any one of the eligibility requirements listed above, or when the covered parent’s coverage ends (for example: termination of employment, divorce, or death of the covered parent). The SHBP may also terminate coverage in the event of non-payment of the required premiums.
There is no provision for the continuation of group coverage under COBRA for a child due to the loss of Chapter 375 coverage. Nor is there any provision for conversion to non-group coverage.
12. Where can I obtain further information about the law?
You can visit the State of New Jersey Division of Pensions and Benefits website for current information, or call a Benefits Specialist at 732/932-3020, ext. 4077.
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