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N.J. Dependent to Age 30 Law

Frequently Asked Questions: N.J. Dependent to Age 30 Law

What groups are subject to Dependent to Age 30, Adult Child, P.L 2005, Chapter 375 legislation?
Who qualifies?
Can an Adult Child re-establish eligibility?
How much does coverage cost?
When can a dependent enroll?
How do I enroll?
An Adult Child is not eligible for Chapter 375 coverage. Do they still qualify for COBRA / N.J. Continuation?
If an employee qualifies for COBRA / N.J. Continuation, can an Adult Child remain on continuation?
Must the parent or employee reside in N.J.?
When enrolling as an Adult Child, will the deductible and MOOP carry over?
If an employee loses coverage, does Adult Child coverage end as well?
Can an Adult Child choose a plan other than that selected by the employee?
Do expenses incurred by the Adult Child count toward family expenses?
What are the Employer Notification requirements?
Does the Adult Child lose eligibility due to pregnancy/childbirth?
How can I learn more?

1. What groups are subject to Dependent to Age 30, Adult Child, P.L 2005, Chapter 375 Legislation?
According to the State Health Benefits Plan from January 1, 2007:

Effective May 12, 2006, all size N.J.-contracted fully insured groups.
Existing groups are also subject upon their renewal.

2. Who qualifies?
To qualify, a young adult must:

Have become ineligible under the parent/employee N.J. fully insured plan, or be approaching ineligibility;
Be under the age of 30;
Be unmarried;
Have no dependents;
Live in N.J. or be a full-time student at an accredited school in any state or country;
Not be covered by another plan (a young adult can be covered prior to Chapter 375 election, but cannot be covered by two policies simultaneously);
Not be entitled to Medicare;
Be part of a group plan that offers coverage to dependents.

3. Can an Adult Child re-establish eligibility?
An Adult Child can re-establish eligibility as long as they meet all criteria.

4. How much does coverage cost?
Charges range from 60.8% to 76.5% of the single rate of the specific group. Employers are not obligated to pay for any portion of the coverage.

5. When can a dependent enroll?
When a policy renews, an Adult Child who meets Chapter 375 eligibility standards may make elections as follows:

30 days PRIOR to the date they are scheduled to age out of the policy.
30 days AFTER they meet Chapter 375 eligibility standards for reasons other than age, OR
For Mid-market, during the group’s annual open enrollment period; and for Small Groups, annually during the 30-day period following the anniversary of the loss of coverage.

If they must wait until the following renewal to enroll, the dependent may elect COBRA or N.J. Continuation under the parent's plan to avoid a break in coverage.

6. How do I enroll?
Each carrier has designated Adult Child enrollment forms. AmeriHealth also requires a verification form, while CIGNA requires that the dependent call 1-800-315-6011 to qualify and receive forms in the mail.
Health Net 51+ asks for a supplemental form, and Oxford requires a member enrollment in addition to the dependent enrollment form.

7. An Adult Child is not eligible for Chapter 375 coverage. Do they still qualify for COBRA / N.J. Continuation?
The Department of Labor and the Department of Banking & Insurance have ruled against continuation, but if the employee/parent becomes eligible for COBRA / N.J. Continuation, the Adult Child may continue as well.

8. If an employee qualifies for COBRA / N.J. Continuation, can an Adult Child remain on continuation?
The Department of Banking & Insurance ruled that an Adult Child may remain on continuation.

9. Must the parent or employee reside in N.J.?
The parent or employee must be covered by a N.J. fully insured plan. The Adult Child must be a N.J. resident or full-time student at an accredited school in any state or country.

10. When enrolling as an Adult Child, will the deductible and MOOP carry over?
The deductible and MOOP carry over, but only with Guardian and Wellchoice.

11. If an employee loses coverage, does Adult Child coverage end as well?
Yes, though an Adult Child may remain on the parent's COBRA / N.J. Continuation plan.

12. Can an Adult Child choose a plan other than that selected by the employee?
No, they must remain on the employee plan.

13. Do expenses incurred by the Adult Child count toward family expenses?
This is covered in the Department of Banking & Insurance Bulletin 06-13, and depends on whether the carrier uses the Integrated or Stand-Alone method.

14. What are the Employer Notification requirements?
Employers must advise covered employees:

On or before the date an eligible dependent's coverage terminates
For small groups: Before the 30-day period annually following the year coverage terminated due to aging out
For the 51+ markets: Before any open enrollment period

15. Does the Adult Child lose eligibility due to pregnancy/childbirth?
Only an employee’s newborn is covered. When an Adult Child leaves the hospital, she loses coverage.

16. How can I learn more?
To learn more, view Department of Banking & Insurance bulletins at www.N.J.dobi.org.