Current through Register Vol. 56, No. 18, September 16, 2024
(a) A small
employer carrier shall issue a health benefits plan to any small employer which
requests it, pays the premiums therefor, and meets the contribution and
participation requirements, if any, of the small employer carrier. All health
benefits plans shall provide coverage for all full-time employees and their
dependents who elect to participate regardless of health status-related factors
and without exclusionary riders.
1. -2. (No
change.)
1. A small employer
carrier shall not refuse to issue coverage, or discriminate in the issuance of
coverage, to a small employer based upon the geographical location of the
employees of the small employer, except that an HMO carrier or other carrier
issuing a network-based plan may refuse to issue coverage to an employer to
cover an employee that does not live, work, or reside in the small employer
carrier's service area.
2. Every
small employer carrier except small employer carriers that are HMOs, shall, as
a condition of transacting business in this State, actively offer to small
employers at least three of standard health benefits Plans B, C, D, and E,
including all riders it has elected to write, except as such riders may be
restricted to specific standard health benefits plans. Small employer carriers
that are HMOs shall, as a condition of transacting business in this State,
actively offer to small employers every standard health benefits plan it
writes, including all riders it has elected to write, except as such riders may
be restricted to specific standard health benefits plans.
3. A small employer carrier shall consider
the number of all employees of all affiliated companies of a small employer in
determining whether an employer is a small employer and in determining
participation levels.
4. At the
time of application, the determination of whether an employer is a small
employer shall be based upon the small employer's completed New Jersey Small
Employer Certification form.
i. If an
employer qualifies as a small employer in the immediately preceding calendar
year, the employer shall be considered a small employer regardless of the
status of the employer on the date of application or the effective date of
coverage so long as it employs at least one employee on the first day of the
plan year.
ii. If an employer did
not qualify as a small employer in the immediately preceding calendar year, the
employer shall not be considered a small employer, regardless of the status of
the employer on the date of application or the proposed effective date of
coverage, if any.
iii. In the case
of an employer that was not in existence during the preceding calendar year,
refer to 11:21-7.2(e).
(b) A small employer
carrier shall issue only standard health benefits plans to an association,
trust, or multiple employer arrangement to provide coverage to member small
employers.
1. No carrier shall issue a health
benefits plan to any association, trust or multiple employer arrangement which
bases membership criteria of any small employer or employee of the small
employer, in whole or in part, upon the health status or claims experience of
the employer or employee.
2. Every
small employer member of an association, trust or multiple employer arrangement
shall be offered coverage under every health benefits plan issued to the
association.
(c)
Employees who enroll within 30 days of first becoming eligible for coverage
shall be accepted for coverage by the small employer carrier without any
restrictions or limitations on coverage related to their risk characteristics
or that of their dependents. Employees who are late enrollees shall be accepted
for coverage by the small employer carrier if enrollment is requested during
the employee open enrollment period.
(d) In the event that the previous health
benefits plan of a small employer group was cancelled for nonpayment of
premiums or fraud, a small employer carrier may require the small employer
group to pay up to six months of premiums in advance of the issuance of a
health benefits plan.
