New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM
Subchapter 7 - PROGRAM COMPLIANCE
Section 11:21-7.2 - Determination of small employer status

Universal Citation: NJ Admin Code 11:21-7.2

Current through Register Vol. 56, No. 18, September 16, 2024

(a) To determine whether an employer qualifies as a small employer, as defined in 11:21-1.2 , a carrier shall evaluate whether an employer satisfies the requirements of the definition.

(b) A small employer carrier shall add the number of full-time employees (where full-time means 30 or more hours per week for purposes of the determination of small employer status) to the number that results from the part-time employee calculation in subsection 2 below, and if the sum is at least one but not more than 50, the employer shall be considered to be a small employer.

1. Employees working 30 or more hours per week are full-time employees and each full-time employee counts as one.

2. Employees working fewer than 30 hours per week are part-time and counted as the sum of the hours each part-time employee works per week multiplied by four and the product divided by 120 and rounded down to the nearest whole number.

3. Small employer carriers shall not include an individual and his or her spouse when the business is owned by the individual or by the individual and his or her spouse, sole proprietors, partners of partnerships, or two percent or more owners of Subchapter S corporations, or their immediate family members as employees even if such persons will be covered under the employer's plan.

(c) Subsequent to the issuance of a health benefits plan to a small employer and for the purpose of determining continued eligibility, the size of a small employer shall be determined annually. Except as otherwise specifically provided, provisions of P.L. 1992, c. 162 (17B:27A-17 et seq.) that apply to a small employer shall continue to apply at least until the plan anniversary following the date the small employer no longer meets the requirements of this definition.

(d) In the case of an employer that was not in existence during the preceding calendar year, the determination of whether the employer is a small or large employer shall be based on the average number of employees that it is reasonably expected that the employer will employ on business days in the current calendar year.

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