New Jersey Administrative Code
Title 17 - TREASURY - GENERAL
Chapter 9 - STATE HEALTH BENEFITS PROGRAM
Subchapter 6 - RETIREMENT
Section 17:9-6.3 - Retiree coverage; limitation

Universal Citation: NJ Admin Code 17:9-6.3

Current through Register Vol. 56, No. 6, March 18, 2024

(a) A retiree, but not the retiree's surviving dependent, may change coverage to include a spouse, eligible partner and other dependents by submitting a completed application along with appropriate legal documentation, described at 17:9-3.3(a), verifying the dependent's relationship with the subscriber within 60 days of a change in family status (marriage, domestic partnership, civil union, birth or adoption of a child, or a significant change in health coverage due to a spouse's or partner's employment). The dependent shall be enrolled retroactively to the date of the qualifying event.

1. If a retiree, but not the retiree's surviving dependent, wishes to add an eligible spouse, eligible partner or dependent and the completed application and legal documentation is not received within 60 days of a family status change, there shall be a minimum waiting period of two full months upon the Division's receipt of a completed application and legal documentation to change coverage. A dependent may be enrolled as of the first day of the month following the two-month waiting period. A dependent added in this manner may be added to a retiree's contract only once.

(b) Retired employees whose retirement allowance is less than the charge to be deducted to pay for the cost of the coverage for such retired employees will be permitted to continue coverage, provided that the retired employee pays for the cost of such coverage in advance on a monthly basis; in such cases, there will be no health benefit deduction from the retirement allowance.

(c) Any person who is otherwise eligible for benefits as a retired employee or dependent of a retired employee, but who, although eligible to enroll in the Federal Medicare program by reason of age or disability, is not covered by the Federal Medicare Part A and B coverage, is ineligible for coverage under the SHBP.

(d) A retired employee or dependent who has maintained coverage in the SHBP following retirement and is subsequently removed from such coverage for not having the Federal Medicare Parts A and B coverage, as required by statute, will be permitted to obtain prospective reentry into the SHBP once proof of Federal Medicare Part A and B coverage has been provided to the Division.

(e) In the event a retired employee or any dependent of a retired employee enrolls in a non-SHBP Medicare Part D plan, SHBP retiree prescription drug benefits shall immediately terminate for the retired employee and all dependents. However, enrollment in a non-SHBP Medicare Part D plan by a retired employee or any dependent of a retired employee will not affect the continuation of SHBP medical plan benefits for the retired employee and any dependent of the retired employee.

(f) In the event a retired employee or dependent of a retired employee has enrolled in a non-SHBP Medicare Part D plan, the retired employee and dependent(s) will be prospectively enrolled or re-enrolled for SHBP retiree prescription drug benefits provided:

1. The retired employee and dependent(s) have maintained SHBP medical plan coverage; and

In the event a retired employee or dependent of a retired employee has enrolled in a non-SHBP Medicare Part D plan, the retired employee and dependent(s) will be prospectively enrolled or re-enrolled for SHBP retiree prescription drug benefits provided:

Disclaimer: These regulations may not be the most recent version. New Jersey may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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