May 12, 2006
New Jersey Dependents to Age 30 Continuation Option (Chapter 375)
[Please note that the following pertains to Health Net proprietary business
(for small group and middle market). This does NOT pertain to Guardian and
Health Net Healthcare Solutions business, which follows a different
process.]
The state of New Jersey has enacted legislation that gives eligible dependents who have reached the standard limiting age of their medical policy the option to continue coverage until age 30 (Chapter 375). This change in dependent eligibility is effective for group medical plans issued or renewed on or after May 12, 2006. Please read below to learn more about this legislation as well as Health Net's application of the legislation.
In order to qualify for this extended coverage the dependent must:
- Be an insured's child by blood or by law;
- Be less than 30 years of age;
- Be unmarried;
- Have no dependents;
- Reside in New Jersey or is enrolled as a full-time student at an accredited institution;
- Not be covered under an individual/group plan, church plan, health benefits plan or Title XVIII of Social Security (or entitled to coverage under Title XVIII).
An eligible dependent may elect, in writing to the employer, coverage to age 30:
- During an open enrollment period for the group;
- Within 30 days prior to the plan's standard limiting age;
- Within 30 days of meeting the definition of dependent described above if coverage had already terminated.
Eligibility guidelines for the period of 5/12/06 through 5/12/07:
- Dependents whose coverage terminated prior to May 12, 2006 may make a written election to reinstate coverage any time within the period of 5/12/06 to 5/11/07, regardless of the anniversary date of the group
Ex. A group has a 1/1/07 anniversary date. A subscriber has a dependent that reached the limiting age for the plan on 10/1/05 and was terminated. Once this law goes into effect, the dependent can be added on the plan effective 6/1/06 or any month they choose prior to the renewal date. Once enrolled in our system, the dependent will be linked to the contract of the parent/guardian. (Therefore, if the parent/guardian should terminate coverage, the system will notify Health Net to terminate the dependent as well.) The member does not have to wait upon the group's renewal because he/she had previously aged out of the plan prior to 5/12/06.
- Dependents whose coverage terminated on or after May 12, 2006 may not make a written election until the anniversary date of the group.
Ex. A group has a 1/1/07 anniversary date. A subscriber has a dependent that reaches the standard limiting age for the plan on 10/1/06. The dependent cannot be added back on to the plan until the group's anniversary on 1/1/07 since they do not fall within the legal boundaries of reaching the limiting age prior to 5/12/06. They may elect COBRA or state continuation in the interim.
Frequently Asked Questions
Q. Will there be an additional charge for this mandate?
A. Yes. Dependents enrolled under this legislation will be charged up to 102% of the applicable portion of the dependent premium previously paid.
Q. How will enrollment be administered?
A. The employer should send the enrollment request to Health Net via the same means utilized today. (For electronic data interchange (EDI) enrollment, please contact your Health Net representative for further details.) If enrolling via paper, a supplemental information form must accompany the standard enrollment form and a distinctive group number must be indicated. Should you need to enroll a dependent under this legislation prior to your next group renewal (for dependents who aged out prior to May 12, 2006), please contact your Sales Representative to obtain distinctive group numbers. The dependent will be issued an individual contract that is not linked to the family deductible, maximum out of pocket, or other cost-sharing facets on the parent’s policy.
Please note that the dependent is required to fill out the supplemental information form every time the dependent joins Health Net up to the limiting age of 30.
Please click here to view a copy of the supplemental enrollment information form.
Please click here to view a copy of the standard enrollment form that must
be filled out and attached to the supplemental information form above.
Q. How will billing be handled?
A. The dependent will receive individual monthly bills for their premium.
If you have any questions, please contact your Health Net Sales Representative.
For Brokers and Consultants only: The purpose of this newsletter is to provide information about industry trends and Health Net news of general interest to our general agents and brokers. Information about products, offerings, service, or benefits is illustrative and general in description, and is not intended to be relied on as complete information. Please contact your Health Net sales representative for more detail about specific products or services. While every attempt is made to ensure the accuracy of the information provided, Health Net does not warranty the accuracy of the information.
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