N.J. Admin. Code § 10:78-9.6

Current through Register Vol. 56, No. 23, December 2, 2024

Section 10:78-9.6 - Applicant's responsibilities during the application process

(a) The Premium Support Program applicant shall provide employer health benefit plan information regarding all family members for whom coverage is sought.

(b) The applicant shall assist the Division as needed in obtaining employer health benefits plan information.

(c) If the employee fails to provide the Division with the information needed to complete the application review, the application for premium support shall be denied.

1. If the application for premium support is denied due to lack of cooperation by the employer, the applicant (and family, if applicable) shall continue to participate in a State-contracted managed care plan through the NJ FamilyCare program.

2. If the application for premium support is denied due to lack of cooperation by the applicant, after three attempts by the Premium Support Program to contact the applicant by letter (in addition, a phone call will be made if a phone number is available), the NJ FamilyCare participation of the applicant and any other adult eligible members of the household shall be terminated immediately. The eligible children in the household will continue to remain eligible until the next annual redetermination, at which time the applicant's failure to cooperate and provide necessary information shall result in termination of NJ FamilyCare eligibility for all members of the household.

N.J. Admin. Code § 10:78-9.6

Amended by R.2003 d.231, effective 6/16/2003.
See: 35 N.J.R. 354(a), 35 N.J.R. 2667(a).
Rewrote (c)2.