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. 18, September 16, 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:
"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.
