New Jersey Administrative Code
Title 17 - TREASURY - GENERAL
Chapter 9 - STATE HEALTH BENEFITS PROGRAM
Subchapter 12 - RETIREE DENTAL EXPENSE PLAN
Section 17:9-12.3 - Plan progressive coinsurance design
Universal Citation: NJ Admin Code 17:9-12.3
Current through Register Vol. 56, No. 6, March 18, 2024
(a) TThe Plan has three progressive coinsurance tiers. The highest tier provides a greater percentage of reimbursement for reasonable and customary charges than the lower two tiers. Each year a retiree remains a member of the Plan, the coinsurance tier rises until the retiree reaches the highest tier.
1. A retiree who was enrolled in a group dental plan immediately preceding eligibility for coverage in the Plan, and who was covered under a group dental plan for at least one year within 60 days of joining this Plan, is eligible for enrollment at the highest tier of reimbursement.
2. A retiree who was not enrolled in a group dental plan for at least one year immediately preceding eligibility for coverage in the Plan shall be enrolled in the lowest tier of reimbursement.
3. A dependent is enrolled at the same tier of reimbursement as the retiree.
(b) The maximum annual benefit amount is the same for each tier.
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