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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 the time of termination from the eligible parents policy to the individual’s 31st birthday.
2. When did the law go into effect?
The law went into effect for the State Health Benefits Program on January 1, 2007.
3. Who is eligible?
In order to meet the requirements for continuation of coverage under this law, the individual must be:
- Less than 31 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 public or private 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, church plan, or entitled to benefits under Medicare).
4. 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.
5. When can I sign my dependent up for coverage?
A SHBP covered employee or retiree may enroll an over age child who is Chapter 375 eligible until the child's 30th birthday at the following times:
- within 30 days prior to December 31 of the year the dependent reaches age 23 with coverage effective the following January 1;
- within 30 days of coverage loss, the covered employee provides proof of loss of other group coverage (HIPPA) for the Chapter 375 eligible over age child with coverage effective the date that the prior coverage was terminated; or
- during the Annual SHBP Open Enrollment period, typically held during the month of October of each year if the over age child meets the eligibility requirements of Chapter 375 with coverage effective the following January 1.
6. What documentation is required to enroll my dependent for coverage?
The SHBP Chapter 375 Application for Coverage along with the requested 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. NOTE: The application and required documentation must be submitted to the Division of Pensions and Benefits on or before the child's 30th birthday.
7. 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.
8. 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.
9. 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.
10. 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.
11. What is the difference between Chapter 375 and COBRA coverage?
There are several differences between Chapter 375 and COBRA coverage. Visit the comparison chart.
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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