Current through Register Vol. 56, No. 18, September 16, 2024
(a) Program
applicants and beneficiaries are required to identify to the eligibility
determination agency any third party (individual, entity, or program) that is
or may be liable to pay all or part of the medical cost of injury, disease, or
disability of an applicant or beneficiary.
(b) For the purposes of this section, the
terms "health insurance" or "group health plan" do not include:
1. Student coverage which is defined as a
limited coverage policy covering injuries sustained during school or
school-sponsored activities;
2.
Accident-only coverage (including death and dismemberment);
3. Disability income insurance;
4. Credit insurance;
5. Liability insurance, and coverage issued
as a supplement to liability insurance, including automobile
insurance;
6. Worker's compensation
or similar insurance;
7. Personal
injury protection coverage in automobile insurance;
8. Long-term care insurance;
9. Dental-only and vision-only coverage;
and
10. Hospital indemnity or other
fixed dollar indemnity insurance if the benefits of such insurance are provided
under a separate policy, contract or certificate, and, there is no coordination
or integration of the benefits with a group health plan or other health
insurance.
(c) An
applicant is not eligible for NJ FamilyCare if he or she:
1. Is currently covered under a
non-governmental group health plan, is currently covered, or eligible for
coverage, under Medicare, Medicaid or NJ FamilyCare Children's Program, or
under a group health plan sponsored or self-funded by a government unit;
or
2. Has been covered under a
group health plan or Medicare at any time during the three-month period
preceding the date of application for NJ FamilyCare; except that coverage which
has lapsed within the three-month period due to the expiration of an
applicant's continuation rights under the Consolidated Omnibus Budget
Reconciliation Act (COBRA) or other continuation rights available under State
law shall not preclude an applicant from being eligible for NJ FamilyCare. An
applicant who has lost coverage under an employer's plan will also not be
subject to the three-month period if the applicant becomes unemployed through
no fault of his or her own. In addition, an applicant may voluntarily terminate
coverage under COBRA, or any other health insurance purchased through the
individual market, in order to be considered for NJ FamilyCare eligibility.
i. The exceptions noted in (c)2 above with
respect to COBRA and purchases in the individual market shall not apply to
children in families with income greater than 200 percent of the Federal
poverty level.
(d) The provisions of (c)1 and 2 above shall
not apply to those parents, caretakers and children who would qualify for
AFDC-related Medicaid or NJ FamilyCare Plan A but for Federal immigration
residency restrictions.
