Health Plan Coverage for Eligible Dependents (over age 26 and 31) under Chapter 375
During open enrollment or a qualifying event, employees are able to elect to continue insurance coverage under the State Health Benefits Program for their eligible dependents until their 30th birthday. To qualify as an eligible dependent, the individual must be less than age 30, unmarried and have no dependents of his or her own. The dependent must be a resident of New Jersey or a full-time student at an accredited public or private institution of higher education and not covered under any other health plan. The employee must also be a resident of New Jersey.
1. Who is eligible?
Certain over age children may be eligible for health plan coverage under SHBP
until age 30. This includes a child by blood or law who: is under the age of 30,
unmarried, has no dependent(s) of his or her own, is a resident of New Jersey or
is a full time student at an accredited public or private institution of higher
education and is not provided coverage under any other group or individual
health benefits plan, church plan, or entitled to benefits under Medicare.
2. When can I enroll my eligible dependent?
A covered SHBP member may enroll the over age child who meets the eligibility
criteria prior to the child’s 30th birthday during one of the following times:
- Within 30 days prior to December 31 of the year the child reaches age 26,
with coverage effective the following January.
- Within 30 days of coverage loss, provided proof of the loss of other group
coverage (HIPAA) is submitted. Coverage is effective the date that the prior
coverage was terminated. Or
- During the month of October each year if the over age child meets the
eligibility requirements of Chapter 375, with coverage effective the following
January 1
3. Will this Chapter 375 coverage also apply to the Employee
Dental Expense Plan?
No. It is only available for the medical and prescription drug plan.
4. My son is currently under COBRA; can I stop that coverage and
enroll him in the plan?
Yes.
5. Do I have a choice of taking COBRA for my child who attains
age 26 and is covered until December 31 or coverage under Chapter 375?
Yes. You may want to look at the COBRA rates (medical and Prescription Drug Plan
- PDP) to determine which is more cost effective. Please be reminded that COBRA
coverage is up to 36 months. COBRA may also offer greater flexibility in plan
choice.
6. My daughter who is age 29 does not live at home, will she be
eligible?
Yes, provided she is unmarried, has no dependent(s) of her own, is a resident of
New Jersey or is a full time student at an accredited public or private
institution of higher education and is not provided coverage under any other
group or individual health benefits plan, church plan, or entitled to benefits
under Medicare.
7. I am not enrolled in the medical or Prescription Drug Plan,
can I enroll my eligible child?
No. The employee must be a member of the State Health Benefits Program (SHBP).
8. I am in a PPO; can I enroll my dependent in an HMO?
No. The dependent is required to enroll in the same plan as the parent.
9. Who is responsible for the additional cost of the coverage?
The covered parent is responsible for the entire cost of the coverage.
10. How will I make payment?
The covered parent will be billed monthly by the SHBP for the cost of the
coverage.
11. When will the coverage end?
The coverage will end when the child no longer meets any of the eligibility
requirements mentioned in Question 1 or the parent's coverage ends, e.g.,
termination of employment, divorce, or death of the parent. The SHBP may also
terminate coverage in the event of non-payment of the premiums. The coverage
ends on the first of the month following the event that makes the child
ineligible or up until the paid through date in the case of non-payment.
12. Will I be able to convert this coverage to COBRA?
There is no provision for the continuation of group coverage under COBRA for a
child due to the loss of coverage. Nor is there any provision for conversion to
non-group coverage.
