N.J. Admin. Code § 11:21-7.3
Current through Register Vol. 56, No. 21, November 4, 2024
Section 11:21-7.3 - Eligibility and issuance(a) A small employer carrier shall issue a health benefits plan to any small employer which requests it, pays the premiums therefor, and meets the contribution and participation requirements, if any, of the small employer carrier. All health benefits plans shall provide coverage for all full-time employees and their dependents who elect to participate regardless of health status-related factors and without exclusionary riders. 1. A small employer carrier shall not refuse to issue coverage, or discriminate in the issuance of coverage, to a small employer based upon the geographical location of the employees of the small employer, except that an HMO carrier or other carrier issuing a network-based plan may refuse to issue coverage to an employer to cover an employee that does not live, work, or reside in the small employer carrier's service area.2. Every small employer carrier except small employer carriers that are HMOs, shall, as a condition of transacting business in this State, actively offer to small employers at least three of standard health benefits Plans B, C, D, and E, including all riders it has elected to write, except as such riders may be restricted to specific standard health benefits plans. Small employer carriers that are HMOs shall, as a condition of transacting business in this State, actively offer to small employers every standard health benefits plan it writes, including all riders it has elected to write, except as such riders may be restricted to specific standard health benefits plans.3. A small employer carrier shall consider the number of all employees of all affiliated companies of a small employer in determining whether an employer is a small employer and in determining participation levels.4. At the time of application, the determination of whether an employer is a small employer shall be based upon the small employer's completed New Jersey Small Employer Certification form. i. If an employer qualifies as a small employer in the immediately preceding calendar year, the employer shall be considered a small employer regardless of the status of the employer on the date of application or the effective date of coverage so long as it employs at least one employee on the first day of the plan year. ii. If an employer did not qualify as a small employer in the immediately preceding calendar year, the employer shall not be considered a small employer, regardless of the status of the employer on the date of application or the proposed effective date of coverage, if any.iii. In the case of an employer that was not in existence during the preceding calendar year, refer to 11:21-7.2(e).(b) A small employer carrier shall issue only standard health benefits plans to an association, trust, or multiple employer arrangement to provide coverage to member small employers. 1. No carrier shall issue a health benefits plan to any association, trust or multiple employer arrangement which bases membership criteria of any small employer or employee of the small employer, in whole or in part, upon the health status or claims experience of the employer or employee.2. Every small employer member of an association, trust or multiple employer arrangement shall be offered coverage under every health benefits plan issued to the association.(c) Employees who enroll within 30 days of first becoming eligible for coverage shall be accepted for coverage by the small employer carrier without any restrictions or limitations on coverage related to their risk characteristics or that of their dependents. Employees who are late enrollees shall be accepted for coverage by the small employer carrier if enrollment is requested during the employee open enrollment period.(d) In the event that the previous health benefits plan of a small employer group was cancelled for nonpayment of premiums or fraud, a small employer carrier may require the small employer group to pay up to six months of premiums in advance of the issuance of a health benefits plan.N.J. Admin. Code § 11:21-7.3
Amended by 48 N.J.R. 2360(a), effective 11/7/2016