Chapter 172 Frequently Asked Questions

Question 1 - Why is coverage restricted to NJ PLUS?

Answer 1 - The law states that coverage will be in the State's managed care plan, which is the NJ PLUS plan.

Question 2 - Why is the prescription drug coverage extra?

Answer 2 - The State's managed care plan does not include prescription drug coverage because it is designed to operate in conjunction with a separate stand-alone drug plan. The State Health Benefits Commission has a policy that all members enrolled under the SHBP be offered a prescription drug benefit.

Question 3 - Why do the plans available under Chapter 172 cost more than the same plans for full-time State employees?

Answer 3 - The law requires the covered employee to pay the full cost of the coverage plus an administrative fee so the State would incur no expense for this program. The SHBP actuaries valued the plans and the Commission approved the rates being charged.

Question 4 - Are all part-time employees eligible for this coverage?

Answer 4 - No. To be eligible, the part-time employee must be a member of a retirement system administered by the State of New Jersey and must work for the State, a State college or university, the Palisades Interstate Parkway Commission, the New Jersey Building Authority, the NJ State Library, or the New Jersey Commerce and Economic Growth Commission.

Question 5 - Are all part-time faculty members at institutions of higher education eligible for coverage?

Answer 5 - No. The part-time faculty member must be a member of a retirement system administered by the State of New Jersey and must work at an institution of higher education that participates in the SHBP.

Question 6 - Since Chapter 172 is effective on January 1, 2004, why is the initial coverage not effective until March 1, 2004?

Answer 6 - The statutes governing the State Health Benefits Program require a 60-day waiting period when an employee first becomes eligible for coverage.

Question 7 - Can the employer use payroll deductions to pay for the part-time employee's coverage?

Answer 7 - No. The sole payment system will be direct billing from the Division of Pensions and Benefits.

Question 8 - Does Chapter 172 entitle part-time employees to any other benefits, such as dental coverage or Tax$ave, the State's Section 125 Program?

Answer 8 - No. Chapter 172 entitles eligible employees only to NJ PLUS plan coverage at their own expense.

Question 9 - If an adjunct teaching at two colleges which participate in the SHBP terminates employment at the college through which he or she has enrolled in the Chapter 172 coverage, can the employee immediately enroll at the other college without a waiting period?

Answer 9 - Yes, but the application must be submitted within 60 days of the termination of employment.

Question 10 - If an eligible part-time employee or faculty member opts not to enroll during this initial offering, when is the next opportunity for him or her to enroll?

Answer 10 - During the SHBP annual open enrollment period unless a HIPAA qualifying event occurs, that is, if the employee loses other group coverage from a spouse or other employment.

Question 11 - Because of the nature of adjunct employment, we sometimes don't know if an adjunct will be teaching until after the semester starts. When do we file the Transmittal of Deletions and what termination date do we use - the end of the previous semester?

Answer 11 - You file the Transmittal of Deletions when you know that the adjunct will not be re-employed that semester. Use the date when you know the adjunct won't be working, not the end of the previous semester.

Question 12 - When am I required to send out a COBRA Notice to a Chapter 172 covered employee and family?

Answer 12 - You must send the initial general COBRA Notice advising on the future eligibility for COBRA when the employee first enrolls. You must send a specific COBRA Notice when an employee or family member loses coverage because of a COBRA event.

Question 13 - When am I required to send out a HIPAA Notice to a Chapter 172 covered employee and family?

Answer 13 - You must send the SHBP's Notice of HIPAA Compliance when the employee first enrolls. You must send a Certificate of Coverage when an employee or family member loses coverage, regardless of the cause.

Question 14 - Since the Chapter 172 employees are paying for coverage directly to the Division of Pensions and Benefits, how will I know if they are covered and are eligible for COBRA when an COBRA event occurs?

Answer 14 - You will be able to check for coverage through the Chapter 172 monthly Alpha listing of your covered employees. In the near future, you will be able to get that information from the SHIPS application on EPIC (Employer Pensions and Benefits Information Connection) when that feature is activated in 2004.

Question 15 - If a part-time employee or faculty member has Chapter 172 coverage upon retirement, would he or she be eligible for post-retirement medical coverage?

Answer 15 - Yes, but enrollment will be limited to the NJ PLUS as it was while they were actively at work. The retiree NJ PLUS plan, however, has prescription drug coverage built into it.

Question 16 - If the part-time employee or faculty member with Chapter 172 coverage upon retirement has over 25 years of pension service, would he or she be eligible for employer-paid post-retirement medical coverage?

Answer 16 - No. Chapter 172 specifically states that Chapter 172 coverage does not qualify for employer-paid post-retirement medical coverage.

Question 17 -Why does eligibility for Chapter 172 coverage, whether I enroll or not, cause me to lose my New Jersey Individual Health Coverage Program (ICHP) policy?

Answer 17 - The laws governing the IHCP were written to encourage the use of employer-provided group coverage and therefore require the termination of the IHCP policy if group coverage is available. There is a provision in the IHCP law that allows the employee to re-enroll in the IHCP policy, under certain conditions, during the IHCP open enrollment period in October. You should contact the IHCP Board at the Department of Banking and Insurance at 1-800-838-0935 for more information about this subject.