New Jersey Small Employer Health Benefits Plans General Information
January 2005
For a more detailed explanation of the Small Employer Health Benefits Program, please consult the law
codified at N.J.S.A. 17B:27A-17 et seq.) and Program regulations (N.J.A.C. 11:21-1.1 et seq.)
This document outlines the basic rules that apply to health coverage for small employers. Do not rely on it
for the details of the law or your specific rights and obligations under a health benefits plan contract. Read
your contract carefully and consult a carrier, broker, agent or attorney if there is anything you do not
understand.
The New Jersey Small Employer Health Benefits Program has a very useful Web site that you can visit at
any time. The address is: www.nj.gov/dobi/reform.htm. If you are an individual shopping for health
benefits for yourself and your family, you should consult a similar buyer’s guide for individual insurance
which may be obtained free of charge by dialing: 1-800-838-0935.The New Jersey Department of Health
and Senior Services publishes a performance report of HMOs which may be obtained free of charge by
dialing: 1-888-393-1062.
Introduction And Summary
In 1992, the New Jersey Legislature enacted two laws that give individuals and New Jersey small
employers guaranteed access to health coverage. If you are a small employer currently offering group
health benefits to your employees, or if you would like to do so, you need up-to-date information on your
rights and responsibilities under New Jersey’s health coverage reforms. This document explains the basic
provisions of the law so that you may understand changes that will affect your existing coverage, and so
that you may shop intelligently for new coverage.
If you employ at least two but not more than 50 employees, in most instances you will be considered a
"small employer" eligible for guaranteed access to small group health benefits coverage. You are also
required to have a minimum number of full-time employees participating in the plan (75 percent), and to
contribute a minimum percentage to the cost of the group plan (10 percent). Section I sets forth eligibility,
participation and contribution requirements in greater detail.
Section II outlines some of the key features of all small group health benefits plans. For example, all
small employer plans must be issued on a guaranteed issue/guaranteed renewal basis, pre-existing
condition limitations may be imposed only under certain limited circumstances and may not be imposed
for periods longer than six months, and plans may be rated only on the basis of age, gender, and
geographic location of the group.
You can receive additional assistance form insurance companies, health maintenance organizations, and
service corporations (referred to collectively as "carriers") which offer small employer health benefits
coverage. A list of carriers offering small group health benefits coverage, with their toll free numbers,
appears as an insert to this Guide. You can also receive assistance from agents selling small employer
coverage; they can be found by referring to the YELLOW pages or similar telephone directory under
"Insurance" or "Health Maintenance Organizations," but be aware that agents do not offer all carriers’
plans.
Section I:
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