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Home > Insurance Division > Small Employer Health Insurance Program > SEH Buyer's Guide
Questions on Enrollment
NJ Small Employer Health Benefits Program Buyer's Guide
 
1. Do I have to wait until the Employer Open Enrollment period to buy a new policy for my employees?

No, there are no restrictions on when a small employer may buy group coverage provided you satisfy the participation and contribution requirements. 
   
2. What are late enrollees?

Generally, a late enrollee is someone who declined coverage when he or she was first eligible to enroll, and then seeks to enroll at a later date. 
   
3. How long does a late enrollee have to wait to enroll?

It depends.  A late enrollee can enroll during the employee annual enrollment period which is defined by the employer and is generally a month or two before the employer’s anniversary date.  So, how long a late enrollee may have to wait depends on the timing of the employee open enrollment period relative to when the late enrollee decides he or she wants to enroll.  A late enrollee can also enroll if he or she experiences a triggering event.  The timing for enrollment depends on what the triggering event is.
   
4. Who is considered an eligible dependent?

An eligible dependent includes a spouse, a civil union partner, and an employee’s child through birth, marriage, civil union, adoption or placement for adoption.  A domestic partner and his or her children may be considered dependents for purposes of coverage under a health benefits plan, at the option of the employer.  When children are covered, they are covered up to a specified limiting age, which is at least to age 26 years old.  “Over-age” children – those who have attained the limiting age, but who are not yet 31 years old – are also eligible to be covered through a continuation law referred to as “Dependent Under 31.”
   
5. Do I have to offer a continuation option?

Yes, you must offer a continuation option to employees and their qualified beneficiaries upon the occurrence of qualifying events.  If you have 20 or more employees, you are required to offer a continuation election option in accordance with the federal law referred to as COBRA as well as the New Jersey State Group Continuation (NJSGC) law.  If you have fewer than 20 employees, you are required to offer a continuation election option in accordance with the NJSGC law only, because COBRA does not apply to employers with fewer than 20 employees. 
   
6. Do I have to contribute to an employee’s premium in the event he or she elects continuation if I was contributing to premium when he was covered as a regular group member?

Not generally.  However, an employer subject to the requirements of the Family Medical Leave Act has to contribute to the premium related to an individual with continuing coverage when the employee is not working because of use of leave under the Family Medical Leave Act.
   
7. What is the duration of the election period for an employee or dependent to make a continuation election?

COBRA permits an employee or dependent, as appropriate, to make an election within 60 days following notice of the opportunity to continue coverage.  NJSGC permits an employee or dependent to make an election within 30 days following the occurrence of a qualifying event (loss of coverage).
   
8. Can dental coverage be continued?

COBRA permits continuation of dental benefits.  Pediatric dental benefits can be continued under the NJSGC law if the pediatric dental benefits are embedded within the medical plan.  If the pediatric dental benefits are purchased and issued separately such benefits are not subject to NJSGC.
   
9. Is the coverage under COBRA and NJSGC really the same coverage the person had when the person was covered as an active employee?

The list of services and supplies that are covered will be the same unless the employer makes a change to the plan.  Coverage under COBRA and NJSGC is treated differently than active coverage whenever coordination of benefits is involved.  This is particularly true with respect to coordination with Medicare.

An example may help.

"Larry’s Lighting" has 25 employees and is subject to COBRA.  Laura and her husband Len have been covered under the plan.  Len is 66 years old and has Medicare Part A but not Part B because he has been getting benefits through his wife’s group plan and that plan is primary.  Laura retires and elects COBRA for herself and her husband.  Laura notices no difference – but Len will unless he enrolls for Medicare Part B.  When the coverage changes to COBRA the employer plan will no longer be primary.  Medicare becomes primary.  Len needs to enroll for Part B.
   
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