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Proposals - Comment Period OPEN

• Comment Period ended January 11, 2013: Proposal to Include a Provision Regarding the Distribution of the Summary of Benefits and Coverage
  • Proposal
  • Group Policy Plan A
  • Group Policy Plans B - E
  • Group Contract HMO
  • Group Contract HMO-POS
  
  
  
• Comment Period ended September 4, 2012: Amendments to the Standard Plans to Comply with State and Federal Law
  • Standard Plan A Policy: Appendix Exhibit A
  • Standard Plans B, C, D & E: Appendix Exhibit F
  • Standard HMO Plan Contract: Appendix Exhibit G
  • Standard Plan A Certificate: Appendix Exhibit V
  • Standard Plans B, C, D & E Certificates: Appendix Exhibit W
  • Standard HMO Plan Evidence of Coverage: Appendix Exhibit Y
  • Standard HMO Plan POS Contract: Appendix Exhibit HH
  • Standard HMO Plan POS Evidence of Coverage: Appendix Exhibit II
    
    
• Comment Period ended December 22, 2011: Proposed Amendments to comply with the Rescission Requirements under PPACA
  • Proposal Summary
  • Appendix Exhibits
    • Plan A
    • Plan A Certificate
    • Plans B-E
    • Plans B-E Certificate
    • HMO Plan
    • HMO Plan Evidence of Coverage
    • HMO-POS Plan
    • HMO-POS Plan Evidence of Coverage

• Comment Period ended January 19, 2009: SEH Proposed Readoption with Amendments

  • Proposal Readoption Summary and Rule Text
  • Appendix Exhibits for the Standard Plans
    • Plan A
    • Plans B-E
    • HMO Plan
    • HMO-POS Plan
    • Prescription Drug Rider
    • Open Face Rider
    • Over-Age Dependent Rider
      
  • Appendix Exhibit for Employers and Employees
    • Employer Application
    • Employer Certification
    • Waiver of Coverage
  • Exhibits for Carrier Reporting
    • Certification of Compliance
    • Market Share Report
    • Certification of Non-Member Status
      
      
• Comment period ended April 2, 2008: Proposed Amendments to the Standard Plans and Regulations to Address Coverage Required by P.L. 2006, c. 103 Relating to Civil Union Partners
  
  
• Comment period ended August 15, 2006: Over-Age Dependent Coverage Proposal
  
  
• Comment period ended February 17, 2006: Proposed amendments to comply with Federal Law and Participation Credit for Medicaid and NJ FamilyCare
  
  
• Comment period ended August 9, 2005: SEH State Continuation Adoption
  
  
• Comment period ended January 2, 2004: SEH Proposed Readoption with Amendments
  • Summary and Rules
• Small Employer Purchasing Alliance adopted rule

• January 24, 2013: Amendments to Address the Distribution of the Summary of Benefits and Coverage
  • Group Policy Plan A
  • Group Policy Plans B - E
  • Group Contract HMO
  • Group Contract HMO-POS
  
  
• September 21, 2012: Amendments to the Standard Plans to Comply with State and Federal Law
  • Standard Plan A Policy: Appendix Exhibit A
  • Standard Plans B, C, D & E: Appendix Exhibit F
  • Standard HMO PLan Contract: Appendix Exhibit G
  • Standard Plan A Certificate: Appendix Exhibit V
  • Standard Plans B, C, D & E Certificates: Appendix Exhibit W
  • Standard HMO Plan Evidence of Coverage: Appendix Exhibit Y
  • Standard HMO Plan POS Contract: Appendix Exhibit HH
  • Standard HMO Plan POS Evidence of Coverage: Appendix Exhibit II

• January 18, 2012: Amendments to the Standard Plans to Comply with Federal Law
  • Adopted Appendix Exhibits
    • Plan A - PDF or MS Word
    • Plan A Certificate - PDF or MS Word
    • Plans B-E - PDF or MS Word
    • Plans B-E Certificate - PDF or MS Word
    • HMO Plan - PDF or MS Word
    • HMO Plan Evidence of Coverage - PDF or MS Word
    • HMO-POS Plan - PDF or MS Word
    • HMO-POS Plan Evidence of Coverage - PDF or MS Word

• November 18, 2010 (operative date April 1, 2011): Changes to the Standard Plans to Comply with State and Federal Law and Addition of Alternate Delivery System Language
  • Adopted Amendments: Exhibits A, F, G, O, V, W, Y, HH and II of the Appendix to N.J.A.C. 11:21
    • Plan A: PDF or MS Word
    • Plan A Certificate: PDF or MS Word
    • Plans B-E: PDF or MS Word
    • Plans B-E Certificate: PDF or MS Word
    • HMO Plan: PDF or MS Word
    • HMO Plan Evidence of Coverage: PDF or MS Word
    • HMO-POS Plan: PDF or MS Word
    • HMO-POS Plan Evidence of Coverage: PDF or MS Word
    • Employer Certification: PDF or MS Word
      
      
• November 24, 2009 (operative date December 20, 2009): Adopted Amendments to N.J.A.C. 11:21-7.13 Regarding Payment of Benefits
  
  

• April 24, 2008: Adopted Amendments to the Standard Plans and Regulations to Address Coverage Required by P.L. 2006, c. 103 Relating to Civil Union Partners
  
  • Policy Plan A (MS Word)
  • Certificate Plan A (MS Word)
  • Policy Plans B - E (MS Word)
  • Certificate Plans B - E (MS Word)
  • HMO Contract (MS Word)
  • HMO Evidence of Contract (MS Word)
  • HMO-POS Contract (MS Word)
  • HMO-POS Evidence of Contract (MS Word)
    
    
• August 22, 2006: Over-age Dependent Coverage Adoption
  
  • Over-Age Dependent Rider (MS Word)
  • Standard Plans (with proposed text included)
    • Policy Plan A (MS Word)
    • Certificate Plan A (MS Word)
    • Policy Plans B-E (MS Word)
    • Certificate Plans B-E (MS Word)
    • HMO Contract (MS Word)
    • HMO Evidence of Coverage (MS Word)
    • HMO-POS Contract (MS Word)
    • HMO-POS Evidence of Coverage (MS Word)
      
      
• March 22, 2006: Adopted amendments to comply with Federal Law and Participation Credit for Medicaid and NJ FamilyCare
  • Policy Plan A (MS Word)
  • Certificate Plan A (MS Word)
  • Policy Plans B-E (MS Word)
  • Certificate Plans B-E (MS Word)
  • HMO Contract (MS Word)
  • HMO Evidence of Coverage (MS Word)
  • HMO-POS Contract (MS Word)
  • HMO-POS Evidence of Coverage (MS Word)
    
    
• March 18, 2004: SEH Withdrawals of Standard SEH Plan of Operation Benefit Riders
  
  
• February 19, 2004: SEH Adopted Readoption with Amendments - SEH Board