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Enrollment Periods for Employers and Employees
NJ Small Employer Health Benefits Program Buyer's Guide
 
Small Employer Coverage May be Purchased Throughout the Year

An employer may submit an application for small employer coverage at any time.  If the employer qualifies as a small employer, as defined, and satisfies the 75% Participation Requirement and the 10% Contribution Requirement, the small employer plan will be issued with an effective date that will be determined based on the date the application and all supporting documentation is provided. 

If the employer qualifies as a small employer but does not satisfy the participation and/or contribution requirements the employer can buy small employer coverage if the employer applies during the Employer Open Enrollment Period as discussed below.
 
Employer Open Enrollment Period

The Employer Open Enrollment Period is the period from November 15 through December 15 each year beginning in 2014.  During this period, employers that meet the definition of small employer but do not meet the 75% Participation Requirement or the 10% Contribution Requirement will be accepted for a small employer plan.  The effective date of the small employer plan will be January 1 of the year immediately following the Employer Open Enrollment Period.
 
Initial Opportunity for Employees to Enroll

An employee has a 30-day opportunity to enroll for coverage measured from the date the employee is first eligible to enroll.  New employees can enroll throughout the year, provided they enroll during the initial 30-day period. 
 
Employee Open Enrollment Period

The Employee Open Enrollment Period is the 30-day period each year designated by the small employer.  The 30-day Employee Open Enrollment Period is the only time during which employees and dependents who are eligible under the small employer’s plan but who are late enrollees, see definition below, may enroll for coverage under the small employer’s plan.  It is also the time during which employees and dependents that are covered under the small employer’s plan may elect coverage under a different policy, if any, offered by the small employer.
 
Special Enrollment Period

A special enrollment period follows a triggering event (triggering event is defined below) and provides an additional opportunity for late enrollees to enroll for coverage under the small employer’s plan.  In addition, eligible employees and dependents that already have coverage are allowed to replace current coverage with a different plan, if any, offered by the small employer.
 

Late Enrollees, Triggering Events and Late Enrollee Exceptions

Late Enrollee

A Late Enrollee means an eligible employee or dependent that requests enrollment in a small employer health benefits plan after the end of the 30-day enrollment period provided under the small employer’s plan.

Triggering Events

The following dates qualify as triggering events.  The Special Enrollment Period begins on the date of the event and lasts for either 30 or 60 days following the event, as stated below.

  1. The date an eligible employee or dependent loses eligibility for minimum essential coverage, including a loss of coverage resulting from the decertification of a qualified health plan by the marketplace.  A loss of coverage resulting from nonpayment of premium, fraud or misrepresentation of material fact shall not be a Triggering Event.  The Special Enrollment Period lasts for 30 days following this event. 
  2. The date an eligible employee acquires a dependent or becomes a dependent due to marriage, birth, adoption, placement for adoption, or placement in foster care.  The Special Enrollment Period lasts for 30 days following this event. 
  3. The date an eligible employee’s enrollment or non-enrollment in a qualified health plan is the result of error, misrepresentation or inaction by the federal government.  The Special Enrollment Period lasts for 30 days following this event. 
  4. The date an eligible employee or eligible dependent demonstrates to the marketplace that the qualified health plan in which he or she is enrolled substantially violated a material provision of its contract in relation to the enrollee. The Special Enrollment Period lasts for 30 days following this event. 
  5. The date the eligible employee or dependent gains access to new qualified health plans as a result of a permanent move.  The Special Enrollment Period lasts for 30 days following this event. 
  6. The date the eligible employee or dependent loses or gains eligibility under Medicaid or NJFamilyCare.  The Special Enrollment Period lasts for 60 days following this event. 


Late Enrollee Exceptions

If an eligible employee initially waived coverage under the small employer’s plan and stated at that time that such waiver was because he or she was covered under another group plan, and the employee subsequently elects to enroll under the small employer’s plan, the employee and his or her dependents will not be Late Enrollees. 

The employee is not considered to be a Late Enrollee and may enroll under the small employer’s plan within 90 days of the date any of the events described below occurs.  

  1. termination of employment or eligibility;
  2. reduction in the number of hours of employment;
  3. involuntary termination;
  4. divorce or legal separation or dissolution of the civil union or termination of the domestic partnership;
  5. death of the eligible employee’s spouse;
  6. termination of the policyholder’s contribution toward coverage; or
  7. termination of the other plan's coverage.
 
Waiting Period

A small employer may request that a waiting period be applied to employees when they first become eligible for coverage.  However, the waiting period cannot exceed ninety days.  Waiting periods may be applied by class of employee based upon conditions pertaining to employment (examples include number of hours the employees work, salaried v. hourly, union v. non-union).
 
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