N.J. Admin. Code § 11:20-24.4

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

Section 11:20-24.4 - Effective date of coverage

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

1. A completed individual application form;

2. Proof of the applicant's residency;

3. If a person is applying during a special enrollment period, evidence of the triggering event;

4. If a person is applying for a catastrophic plan and is not under age 30, a copy of the notice with an exemption certification number (ECN) from the Marketplace indicating that the person qualifies for an exemption; and

5. Premium payment not to exceed one month's premium, which shall be refunded to the individual if the health benefits plan is not issued by the carrier.

(b) With respect to applications submitted during the annual open enrollment period, the effective date of coverage shall be January 1 of the following calendar year if the application is submitted on or before December 15.

(c) With respect to applications submitted during the special enrollment period, the effective date of coverage shall be the 1st of the month following the date the carrier receives the application. In addition to the 1st 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, 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 as a result of a court order shall be the date stated in the court order unless the applicant requests a later effective date.

N.J. Admin. Code § 11:20-24.4

Amended by 46 N.J.R. 2416(b), effective 11/17/2014

Amended by 48 N.J.R. 2153(a), effective 10/17/2016

Amended by 49 N.J.R. 3755(a), effective 12/4/2017

Amended by 50 N.J.R. 2329(a), effective 11/19/2018