Governor Chris Christie • Lt.Governor Kim Guadagno  
The Official Web Site For The State of New Jersey - Department of Treasury
Global Navigation
FAQs Departments/ Agencies Services A to Z NJ Home Page
Disclaimer
Twitter YouTube Facebook
Pensions and Benefits

State Health Benefits Program and
School Employees' Health Benefits Program

HEALTH COVERAGE OF CHILDREN UNTIL AGE 26
U
nder the Patient Protection and Affordable Care Act

Under the provisions of the federal Patient Protection and Affordable Care Act (Affordable Care Act) the State Health Benefits Program (SHBP) and School Employees’ Health Benefits Program (SEHBP) began coverage of the children of eligible members until age 26 as of January 1, 2011.

ELIGIBILITY

Under the Affordable Care Act:

  • A “child” is defined as an enrollee’s child until age 26, regardless of the child’s marital, student, or financial dependency status — even if the young adult no longer lives with his or her parents.

  • Coverage will be available to eligible children through December 31 of the year they turn age 26.

ENROLLMENT

October 2010 was set aside by the SHBP/SEHBP as the period when parents could enroll/re-enroll children who meet the above criteria and who would be under age 26 as of December 31, 2010. 

  • Employees who did not enroll an eligible child during the October 2010 enrollment period, must wait until the Fall Open Enrollment to enroll the child — if eligible — with coverage to be effective as of following January.

  • Retirees who did not enroll an eligible child during the October 2010 enrollment period, may submit a SHBP/SEHBP Retired Change of Status Application Adobe PDF (39K) to the Health Benefits Bureau of the Division of Pensions and Benefits. An eligible child of a retiree will be added on a timely basis, but it can be no earlier than 60 days after receipt of the application and all required supporting documentation by the Health Benefits Bureau of the Division of Pensions and Benefits.

  • Covered children who turned age 23 during 2010 did not need to be enrolled/re-enrolled to continue coverage in 2011. Coverage of enrolled children who were age 23 was continued automatically — provided they were and remained eligible under the new provisions of the Affordable Care Act.

  • For all enrollments a photocopy of the child's birth certificate that includes the covered parent’s name must be submitted along with the application.

    For a stepchild provide a photocopy of the child’s birth certificate showing the spouse/ partner’s name as a parent and a photocopy of marriage/partnership certificate showing the names of the employee and spouse/partner.

    For a legal guardianship, grandchild, or foster child provide a photocopy of a Final Court Order with the presiding judge’s signature and seal attesting to the legal guardianship by the covered employee.

CHAPTER 375 AND COVERAGE UNTIL AGE 31

Children ages 23 through 26 who are currently enrolled for extended SHBP/SEHBP coverage under the provisions of Chapter 375, P.L. 2005, were required to re-enrolled during October for SHBP/SEHBP coverage as a child under age 26.

  • The child of an employee who was not enrolled during the October 2010 enrollment period, will remain enrolled for Chapter 375 coverage while eligible. Enrollment as a covered child under the SHBP/SEHBP will then be permitted — if the child remains eligible — during the Fall Open Enrollment with coverage to be effective as of the following January.

  • Retirees must submit a SHBP/SEHBP Retired Change of Status Application Adobe PDF (39K) to the Health Benefits Bureau of the Division of Pensions and Benefits. An eligible child of a retiree will be added on a timely basis, but it can be no earlier than 60 days after receipt of the application and all required supporting documentation by the Health Benefits Bureau of the Division of Pensions and Benefits.

FIND OUT MORE

You may read more about this provision of the Affordable Care Act on the U.S. Department of Health and Human Services Web site: http://www.hhs.gov/ociio/regulations/adult_child_fact_sheet.html

 
spacer

Pensions and Benefits: Home | Employer Manual | Health Benefits | Forms and Publications | Counseling Appointments
Treasury: Home | ServicesPeopleBusinesses | Divisions/AgenciesFormsContact Us
Statewide:
NJ Home | Services A to Z | Departments/Agencies | FAQs
Copyright © State of New Jersey, 1996 -
This site is maintained by the Division of Pensions and Benefits.
 

Reports Accessibility Statement Legal Statement Privacy Notice Contact Us Open Public Records Act Proposed Rules and Amendments Comment or Petition for new Rule Division/Ageny Statutes and Rules Electronic Notification Twitter YouTube Facebook