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Pensions and Benefits

STATE HEALTH BENEFITS PROGRAM (SHBP) and
SCHOOL EMPLOYEES' HEALTH BENEFITS PROGRAM (SEHBP)

HEALTH BENEFITS COVERAGE FOR DEPENDENTS

SPOUSE | CIVIL UNION PARTNER | DOMESTIC PARTNER | CHILDREN UNTIL AGE 26
OVER AGE CHILDREN UNTIL AGE 31 | DEPENDENT OVER AGE CHILDREN WITH DISABILITIES

DEPENDENT DOCUMENTATION REQUIREMENTS

HEALTH BENEFITS HOME | EMPLOYEES | RETIREES | COBRA | EMPLOYERS


GENERAL INFORMATION

Eligible dependents include a spouse, civil union partner, or eligible same-sex domestic partner (as defined below) and/or your eligible children (as defined below).

  • An eligible individual may only enroll in the SHBP/SEHBP as an employee or retiree, or be covered as a dependent — but not both.

  • Eligible children may only be covered by one participating parent.

  • Additional eligibility and enrollment information is available in the Health Benefits Summary Program Description Adobe PDF (597K)

SPOUSE

A spouse is defined as a member of the opposite sex or same sex to whom you are legally married. A photocopy of the marriage certificate and additional supporting documentation are required for enrollment.

CIVIL UNION PARTNER

A Civil Union Partner is a person of the same sex with whom you have entered into a civil union. A photocopy of the New Jersey Civil Union Certificate or a valid certification from another jurisdiction that recognizes same-sex civil unions and additional supporting documentation
are required for enrollment. The cost of civil union partner coverage may be subject to federal tax.

DOMESTIC PARTNER

An eligible Domestic Partner is a person of the same sex with whom you have entered into a domestic partnership as defined under Chapter 246, P.L. 2003, the Domestic Partnership Act. The domestic partner of any State employee, State retiree, or an eligible employee or retiree of a participating local public entity that adopts a resolution to provide Chapter 246 health benefits, is eligible for SHBP or SEHBP coverage as a dependent. A photocopy of the New Jersey Certificate of Domestic Partnership dated prior to February 19, 2007 (or a valid certification from another State or foreign jurisdiction that recognizes same-sex domestic partners) and additional supporting documentation are required for enrollment. The cost of same-sex domestic partner coverage may be subject to federal tax.


DEPENDENT CHILDREN

CHILDREN UNTIL AGE 26

A eligible dependent Child is a natural, step-, adopted, or foster child under age 26 regardless of the child’s marital, student, or financial dependency status.

  • For a natural child, a photocopy of the child’s birth certificate that includes the covered parent’s name is required for enrollment.

  • 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/retiree and spouse/partner.

  • Foster children, and children in a guardian-ward relationship under age 26 are also eligible. A photocopy of the child’s birth certificate and additional supporting legal documentation are required with enrollment forms for these cases. Documents must attest to the legal guardianship by the covered employee.

  • Dependent Documentation Requirements Adobe PDF (33K)

Coverage for an enrolled child ends on December 31 of the year in which he or she turns age 26. Extension of coverage may be available for Over Age Children Until Age 31 and Dependent Over Age Children with Disabilities (see below) or under the provisions of federal COBRA law.

OVER AGE CHILDREN UNTIL AGE 31

Certain children over age 26 may be eligible for coverage until age 31 under the provisions of Chapter 375, P.L. 2005, as amended by Chapter 38, P.L. 2008. This includes a child by blood or law who is under the age of 31; is 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 as a subscriber, insured, enrollee, or covered person under a group or individual health benefits plan, church plan, or entitled to benefits under Medicare.

Under Chapter 375, an over age child does not have any choice in the selection of benefits but is enrolled for coverage in exactly the same plan or plans (medical and/or prescription drug) that the covered parent has selected. The covered parent or child is responsible for the entire cost of coverage. There is no provision for dental or vision benefits.

Coverage for an enrolled over age child will end when the child no longer meets any one of the eligibility requirements or if the required payment is not received. Coverage will also end when the covered parent’s coverage ends. Coverage ends on the first of the month following the event that makes the dependent ineligible or up until the paid through date in the case of non-payment.

CHAPTER 375 RATES Over Age Dependents to Age 31 under Chapter 375 Plan Year 2014

CHAPTER 375 RATES Over Age Dependents to Age 31 under Chapter 375 Plan Year 2015

Chapter 375 Application

Chapter 375 Cost Comparison — Chapter 375 vs. COBRA

DEPENDENT OVER AGE CHILDREN WITH DISABILITIES

If a child is not capable of self-support when he or she reaches age 26 due to mental illness, mental retardation, or a physical disability, he or
she may be eligible for a continuance of coverage. Coverage for children with disabilities may continue only while (1) you are covered through the SHBP or SEHBP, and (2) the child continues to be disabled, and (3) the child is unmarried, and (4) the child remains dependent on you for support and maintenance and lives with you. You will be contacted periodically to verify that the child remains eligible for continued coverage.

A Continuance for Dependent with Disabilities form and proof of the child's condition must be provided to the Division of Pensions and benefits no later than 31 days after the date coverage would normally end. Since coverage for children ends on December 31 of the year they turn 26, the Continuance for Dependent with Disabilities form must be filed prior to January 31 of the year following the child's 26th birthday.

To request continued coverage, contact the Office of Client Services at (609) 292-7524 or write to the Division of Pensions and Benefits, Health Benefits Bureau, 50 West State Street, P. O. Box 299, Trenton, New Jersey 08625 for a Continuance for Dependent with Disabilities form.


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