N.J. Admin. Code § 11:21-7.8

Current through Register Vol. 56, No. 21, November 4, 2024

Section 11:21-7.8 - Effective date of employer's coverage

(a) A small employer carrier, prior to issuing a health benefits plan, may require the following:

1. A completed small employer standard application form including the small employer certification form in accordance with 11:21-6.1(a) and (b);

2. Complete employee enrollment forms and waiver forms; and

3. An advance premium payment not to exceed one month's premium, which shall be refunded to the employer if the health benefits plan is not issued by the small employer carrier.

(b) A small employer carrier shall provide notice to the employer within 15 business days of receipt by the small employer carrier of the information set forth in (a) above whether the small employer carrier approves or disapproves the employer's application for the health benefits plan. Except as stated in (c) below, if approved, the effective date of coverage under the health benefits plan shall be no later than the first day of the month following the date of notice of such approval by the small employer carrier unless the small employer has requested a later effective date which is agreed to by the small employer carrier.

(c) The effective date of coverage under a health benefits plan issued to an employer as a result of an application received during the employer annual open enrollment period shall be January 1 of the year following the employer annual open enrollment period.

(d) At the option and upon the request of the small employer, a waiting period may be applied by the small employer carrier with respect to employees when they first become eligible for coverage, not to exceed 90 days. Waiting periods may be applied to these employees by class of employee based upon conditions pertaining to employment.

(e) A small employer carrier may offer an automatic checking withdrawal option to small employer groups for the monthly or quarterly payment of premiums. In the event that a small employer carrier elects to offer an automatic checking withdrawal option, the carrier shall offer the same option to all small employer groups, regardless of the size of the group or the type of health benefits plan.

N.J. Admin. Code § 11:21-7.8

Amended by 48 N.J.R. 2360(a), effective 11/7/2016