N.J. Admin. Code § 11:20-12.4

Current through Register Vol. 57, No. 1, January 6, 2025

Section 11:20-12.4 - Replacement during annual open enrollment period

(a) Except as stated in N.J.A.C. 11:20-12.5 with respect to the special enrollment period, a person who is covered under a standard health benefits plan, standard health benefits plan with rider, or group health benefits plan may only elect during the annual open enrollment period to replace the plan or coverage with a standard health benefits plan or a standard health benefits plan with rider. The application must be submitted during the annual open enrollment period.

(b) The effective date of the replacement plan will be January 1 of the year following the annual open enrollment period if the application is submitted during the annual open enrollment period.

(c) The existing standard health benefits plan, standard health benefits plan with a rider, or group health benefits plan coverage must be terminated with the effective date of termination being no later than the effective date of the replacement plan. The carrier that issued the existing plan will terminate the existing plan or coverage as of the midnight on the day before the effective date of the replacement plan if the existing carrier is notified of the replacement within 30 days after the effective date of the replacement plan. The new carrier issuing the replacement plan may require evidence of the termination of the existing plan. If the effective date of the termination of the existing plan or coverage is not before the effective date of the replacement plan, the replacement plan shall be of no force and effect and premium paid shall be refunded.

N.J. Admin. Code § 11:20-12.4

Amended by R.2009 d.45, effective 12/29/2008.
See: 40 N.J.R. 6904(a), 41 N.J.R. 799(b).
Section was "Covered under an individual plan: replacement only during Open Enrollment Period". In (a), (b), (c) and (d), inserted "or Special Open Enrollment Period"; in (c), substituted "an indemnity, preferred provider (PPO) or point of service (POS)" for "non-HMO" and "a non-HMO"; added new (e); recodified former (e) through (h) as (f) through (i); in (f), inserted "or Special Open Enrollment Period"; in (g), deleted "items" preceding "(a)" and inserted "and no later than April 1, 2009 in the case of the Special Open Enrollment Period"; and in (i), substituted "(b), (d), (e) and (f)" for "(b) (d) and (e)".
Amended by R.2011 d.163, effective 6/6/2011.
See: 43 N.J.R. 131(a), 43 N.J.R. 1353(a).
Section was "Covered under an individual plan: replacement only during Open Enrollment Period or Special Open Enrollment Period". Deleted "or Special Open Enrollment Period" following "Open Enrollment Period" throughout; and in (g), deleted "and no later than April 1, 2009 in the case of the Special Open Enrollment Period" from the end.
Amended by R.2011 d.254, effective 9/13/2011 (operative November 1, 2011).
See: 43 N.J.R. 1813(a), 43 N.J.R. 2668(a).
In (a), substituted "Except as stated below, a" for "A" and inserted the last sentence.
Amended by R.2013 d.130, effective 10/1/2013 (operative January 1, 2014).
See: 45 N.J.R. 2310(a), 45 N.J.R. 2385(a).
Section was "Covered under an individual plan: replacement only during Open Enrollment Period". Rewrote the section.
Amended by R.2016 d.127, effective 10/17/2016 (operative January 1, 2017).
See: 48 N.J.R. 1555(a), 48 N.J.R. 2153(a).
Rewrote (b).
Amended by R.2017 d.225, effective 12/4/2017 (operative January 1, 2018).
See: 49 N.J.R. 3093(a), 49 N.J.R. 3755(a).
Rewrote (b).
Amended by R.2018 d.197, effective 6/12/2018.
See: 50 N.J.R. 1412(a), 50 N.J.R. 2329(a).
In (a), substituted "submitted" for "received"; and in (b), substituted "during the annual open enrollment period" for "on or before December 15".