N.J. Admin. Code § 17:9-12.3

Current through Register Vol. 56, No. 24, December 18, 2024

Section 17:9-12.3 - Plan progressive coinsurance design

(a) TThe Plan has three progressive coinsurance tiers. The highest tier provides a greater percentage of reimbursement for reasonable and customary charges than the lower two tiers. Each year a retiree remains a member of the Plan, the coinsurance tier rises until the retiree reaches the highest tier.

1. A retiree who was enrolled in a group dental plan immediately preceding eligibility for coverage in the Plan, and who was covered under a group dental plan for at least one year within 60 days of joining this Plan, is eligible for enrollment at the highest tier of reimbursement.

2. A retiree who was not enrolled in a group dental plan for at least one year immediately preceding eligibility for coverage in the Plan shall be enrolled in the lowest tier of reimbursement.

3. A dependent is enrolled at the same tier of reimbursement as the retiree.

(b) The maximum annual benefit amount is the same for each tier.

N.J. Admin. Code § 17:9-12.3

Amended by 48 N.J.R. 2387(a), effective 11/7/2016