NJ Small Employer Health Benefits Program Buyers' Guide

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	Small Employer Health Benefits (SEH)
	SEH Buyer's Guide
		Introduction/Eligibility
		What is a Small Employer?
		Program Features
		Other Features
		Standard Benefits Plans
		Other Information
		Obtain/Renew Coverage
		Worksheet: Determining Eligibility/Participation
		Questions/Examples
SEH Buyer's Guide (PDF)

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NJ Small Employer Health Benefits Program Buyers' Guide

2008 Edition

Table of Contents


	Introduction/Eligibility for Small Employer Coverage
		Purpose of this Buyer's Guide Overview of the Law and Small Employer Health Benefits Program Eligibility for Small Employer Coverage
	What is a Small Employer?
		Eligible Employees Worksheet for Determining Small Employer Status Bona fide Employees Affiliated Companies Newly-formed Businesses Plan Year What is an Employee Participation Requirement? Worksheet for Calculating Participation Group Health Plan Classes of Employees and Participation What is an Employer Contribution Requirement?
	SEH Program Features for Health Benefits Plans
		Guaranteed Issue Guaranteed Renewal Pre-existing Condition Restrictions Late Enrollees Creditable Coverage Waiting Periods Rating Restrictions Continuation of Coverage Brief Comparison of COBRA and NJSGC Employees, qualifying events, and duration of continued coverage Dependents, qualifying events, and duration of continued coverage Limits on duration of coverage Employer’s obligation
	Other Important Features
		Domestic Partners and Civil Union Partners “Dependent Under 31” Continuation Election Appealing Unfavorable Medical Necessity Determinations
	The Standard Small Employer Health Benefits Plans
		Plan A Plans B, C, D and E HMO Plan Chart: Snapshot of the Standard Small Employer Health Benefits Plans More about Health Benefits Plan Design and Options Delivery Systems: Indemnity and Network-based Health Benefits Plans Riders Health Savings Accounts and Other Tax-favored Options More about Cost-Sharing Requirements Deductibles Coinsurance Copayments Maximum Out-of-Pocket (MOOP) Allowed Charges and Usual, Customary and Reasonable (UCR)
	Other Information Available
	Obtaining and Renewing Coverage
	Combined Worksheet: Eligible Employees and Participation Calculation
	Questions and Answers, and Some Examples
		Eligibility, Participation and Contribution Issues Health, Dependents and Continuation Issues Rates, Cost-sharing and Administrative Issues



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