NEW JERSEY SMALL EMPLOYER HEALTH BENEFITS PLANS GENERAL INFORMATION
January 2005
For a more detailed
explanation of the Small Employer Health Benefits Program, please
consult the Law (codified at N.J.S.A 17B:27A-17 et seq.) and Program
Regulations (N.J.A.C. 11:21-1.1 et seq.)
This document outlines the basic rules that apply to health coverage for small employers. Do not rely on it for the details of the law or your specific rights and obligations under a health benefits plan contract. Read your contract carefully and consult a carrier, broker, agent or attorney if there is anything you do not understand.
The New Jersey Small Employer Health Benefits Program has a very useful Web site that you can visit at any time. The address is: www.nj.gov/dobi/reform.htm . If you are an individual shopping for health benefits for yourself and your family, you should consult a similar buyer's guide for individual insurance which may be obtained free of charge by dialing: 1-800-838-0935. The New Jersey Department of Health and Senior Services publishes a performance report of HMOs which may be obtained free of charge by dialing: 1-888-393-1062.
INTRODUCTION AND SUMMARY
In 1992, the New Jersey Legislature enacted two laws that give individuals and New Jersey small employers guaranteed access to health coverage. If you are a small employer currently offering group health benefits to your employees, or if you would like to do so, you need up-to-date information on your rights and responsibilities under New Jersey's health coverage reforms. This document explains the basic provisions of the law so that you may understand changes that will affect your existing coverage, and so that you may shop intelligently for coverage.
If you employ at least two but not
more than 50 employees, in most instances you
will be considered a “small employer” eligible for guaranteed access to
small group
health benefits coverage. You are also required to have a minimum
number of full-time employees participating in the plan (75 percent),
and to contribute a minimum percentage
to the cost of the group plan (10 percent). Section I sets forth
eligibility, participation
and contribution requirements in greater detail.
Section II outlines some of the key features of all small group health benefit plans. For example, all small employer plans must be issued on a guaranteed issue/guaranteed renewal basis, pre-existing conditions limitations may be imposed only under certain limited circumstances and may not be imposed for periods longer than six months, and plans may be rated only on the basis of age, gender, and geographic location of the group.
You can receive additional assistance from insurance companies, health maintenance organizations, and service corporations (referred to collectively as “carriers”) which offer small employer health benefits coverage. A list of carriers offering small group health benefits coverage, with their toll free numbers, appears as an insert to this Guide. You can also receive assistance from agents selling small employer coverage; they can be found by referring to the YELLOW pages or similar telephone directory under “Insurance” or “Health Maintenance Organizations,” but be aware that agents do not offer all carriers' plans.
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