N.J. Admin. Code § 11:20-12.5

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

Section 11:20-12.5 - Replacement during special enrollment period

(a) A person covered under a standard health benefits plan or a standard individual health benefits plan with a rider or group health benefits plan may enroll for coverage under a different standard health benefits plan or standard individual health benefits plan with a rider during a 60-day special enrollment period that follows a triggering event. With respect to a loss of coverage the special enrollment period also includes the 60 days prior to the loss of coverage.

(b) The effective date of the new standard health benefits plan or standard health benefits plan with a rider will be no later than the first of the month following the date the carrier receives the application. In addition to the first of the month effective date, carriers may permit the effective date to be the 15th of the month following the date the carrier receives the application. However, the effective date of coverage issued following a triggering event of birth, adoption, including placement for adoption, or placement in foster care shall be the date of birth, adoption, or placement for adoption or the date of placement in foster care unless the applicant requests a later effective date. The effective date of coverage issued pursuant to a court order shall be the date stated in the court order unless the applicant requests a later effective date.

(c) Carriers may require that an applicant submit proof of the triggering event.

N.J. Admin. Code § 11:20-12.5

Amended by R.2009 d.45, effective 12/29/2008.
See: 40 N.J.R. 6904(a), 41 N.J.R. 799(b).
In (a), substituted "Period or Special Open Enrollment Period" for "period", and inserted "or no later than April 1, 2009 in the case of the Special Open Enrollment Period"; and in (d), inserted the second sentence.
Amended by R.2011 d.163, effective 6/6/2011.
See: 43 N.J.R. 131(a), 43 N.J.R. 1353(a).
In (a), deleted "or Special Open Enrollment Period" following the first occurrence of "Open Enrollment Period" and "or no later than April 1, 2009 in the case of the Special Open Enrollment Period" following the second occurrence of "Open Enrollment Period"; and in (d), deleted the second sentence.
Repeal and New Rule, 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 or eligible to participate in a group health benefits plan".
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).
In (a) and (b), inserted the last sentence; in (b), inserted "no later than"; and added (c).
Amended by R.2018 d.197, effective 6/12/2018.
See: 50 N.J.R. 1412(a), 50 N.J.R. 2329(a).
In (b), inserted "unless the applicant requests a later effective date" twice.