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X-Ell Employee Benefits, LLC |
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Eligible Dependents |
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NJ Small Employer (2-50) Reform Law Summary |
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State regulations say that an
employee's child dependents—legally adopted or natural - are eligible for
coverage up to their 19th birthday, though some carriers carry the child till
the end of the month or calendar year.
If an over-age child does attend an accredited higher learning
institution/school full-time - in most instances 12 credits or more per
semester - he/she is permitted to continue coverage up to his/her 23rd
birthday or date of graduation, whichever should come first. Again, some carriers opt to extend
coverage till the end of the graduating month or calendar year. Always check with the carrier for the
actual assigned term date. The child need not reside with
the subscriber and is not required to share the same last name. Children born out of wedlock are eligible for coverage.
Adopted children are eligible for coverage. An employee who is divorced may cover
children even if they reside out-of-state or with the former spouse. A child for whom the employee has legal
guardianship can also be covered. When the child is determined not to be the employee’s
natural born child, a copy of the Court's divorce, adoption, or guardianship
decree may be requested by the carrier to properly determine eligibility. Handicapped child dependents
will be covered without limit on age provided that they are truly dependent
on the employee for day to day care and live with the employee. The disability must have started prior to
the child's 19th birthday, or while a full-time student. Employees who claim over-age children on
their annual tax returns will usually be allowed to cover those children
health benefits coverage. The carrier will periodically require proof of the
child's handicapped status to properly determine eligibility. Child dependents whom have
exceeded the eligibility age and/or graduated college may be eligible for
NJ Continuation or
COBRA. If the overage child is a New
Jersey resident, he/she may also qualify to
continue coverage up to age 31, should the
parent continue to maintain group coverage. Only the employee's first
generation family will be eligible for coverage. If eligible children have
their own child dependents, the grandchildren will not be considered eligible
for coverage. Upon having their own children,
an employee's child dependents will be enrolled under Medicaid, or the
employee's child dependent can terminate their own coverage as a dependent
and obtain individual coverage for herself and the newborn. State-sponsored
NJ Family
Care is also an option for children
whose parents meet the stated income requirements under the program. The employee’s parents are not
eligible as dependents regardless of the level of dependency or residency
status with the insured employee.
Dependent parents should seek coverage in the individual market or,
most likely will qualify for Federal or State health benefits:
Medicare, Medicaid. An employee's divorced spouse is
not an eligible dependent. The former
spouse must seek his/her own coverage and, in most instances, a court order
may require the employee to pay for the total or partial cost of that
coverage. However the divorced spouse may become eligible for
COBRA or
NJ
Group Continuation coverage if the
divorce occurred while the spouse was a covered dependent under the employee. Effective 10/1/2004, New Jersey does recognize same-sex partners as eligible dependents. Consult with the respective carrier for
required documentation. |
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1680 Route 23 North, Suite 310, Wayne, NJ 07470 |