New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 20 - INDIVIDUAL HEALTH COVERAGE PROGRAM
Subchapter 12 - PURCHASE OF A STANDARD HEALTH BENEFITS PLAN BY A PERSON COVERED UNDER AN INDIVIDUAL PLAN OR COVERED UNDER A GROUP PLAN
Section 11:20-12.5 - Replacement during special enrollment period

Universal Citation: NJ Admin Code 11:20-12.5

Current through Register Vol. 56, No. 24, December 18, 2024

(a) A person covered under a standard health benefits plan or a standard individual health benefits plan with a rider or group health benefits plan may enroll for coverage under a different standard health benefits plan or standard individual health benefits plan with a rider during a 60-day special enrollment period that follows a triggering event. With respect to a loss of coverage the special enrollment period also includes the 60 days prior to the loss of coverage.

(b) The effective date of the new standard health benefits plan or standard health benefits plan with a rider will be no later than the first of the month following the date the carrier receives the application. In addition to the first of the month effective date, carriers may permit the effective date to be the 15th of the month following the date the carrier receives the application. However, the effective date of coverage issued following a triggering event of birth, adoption, including placement for adoption, or placement in foster care shall be the date of birth, adoption, or placement for adoption or the date of placement in foster care unless the applicant requests a later effective date. The effective date of coverage issued pursuant to a court order shall be the date stated in the court order unless the applicant requests a later effective date.

(c) Carriers may require that an applicant submit proof of the triggering event.

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