New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM
Appendix - APPENDIX
Exhibit D
Current through Register Vol. 56, No. 18, September 16, 2024
OVER-AGE DEPENDENT COVERAGE RIDER
[Policy]holder:
Group Policy No:
Effective Date:
This Rider amends the Group [Policy] and the [Certificates] issued to over-age dependents who elected coverage under the NEW JERSEY CONTINUATION RIGHTS FOR OVER-AGE DEPENDENTS provision.
I. The DEPENDENT COVERAGE section is deleted in its entirety and replaced with the following section entitled OVER-AGE DEPENDENT COVERAGE.
OVER-AGE DEPENDENT COVERAGE
Eligible Dependents
An Employee's child by blood or law who:
a has reached the limiting age of 19 or 23, as applicable, but is less than 31 years of age;
b is not married or in a domestic partnership or civil union partnership;
c has no Dependents of his or her own;
d is either a resident of New Jersey or is enrolled as a full-time student at an Accredited School; and
e is not covered under any other group or individual health benefits plan, group health plan, church plan or health benefits plan, and is not entitled to Medicare on the date the over-Age Dependent continuation coverage begins.
Enrollment Requirement
To continue group health benefits, the Over-Age Dependent must make written election to [the Carrier].
For a Dependent whose coverage has not yet terminated due to the attainment of age 19 or 23, as applicable, the written election must be made within 30 days prior to termination of coverage due to the attainment of age 19 or 23.
For a person who did not qualify as an Over-Age Dependent because he or she failed to meet all the requirements of an Over-Age Dependent, but who subsequently meets all of the requirements for an Over-Age Dependent, written election must be made within 30 days after the person first subsequently meets all of the requirements for an Over-Age Dependent.
This election opportunity is explained in greater detail as follows:
An Over-Age Dependent may make written election to continue coverage during a 30 day period beginning on each anniversary date of the date the dependent lost coverage due to attaining the limiting age, provided he or she meets the definition of an "Over-Age Dependent" during that 30-day period.
When Over-Age Dependent Coverage Starts
The effective date of the continued coverage will be the later of:
When Over-Age Dependent Coverage Ends
An Over-Age Dependent's continued group health benefits end on the first of the following:
II. Coverage for an Over-Age Dependent is single coverage. Any Deductible, Coinsurance and/or Copayments paid by an Over-Age Dependent is independent of any Deductible, Coinsurance and/or Copayments paid by the Over-Age Dependents parents, or siblings. Any provision in the Group [Policy] [and] [,] [Certificate] [and optional benefit rider] allowing for a family deductible or a family Maximum Out of Pocket does not apply to the coverage for the Over-Age Dependent.
III. The following provisions are deleted in their entirety: