Group underwriting, eligibility, contributory and noncontributory plans, COBRA and coordination of benefits are covered in the national Group Health Insurance guide. This guide covers New Jersey's group health rules: what counts as a group policy, the state continuation laws for small employers and disabled employees, and dependent coverage. The small employer market itself (who qualifies, guaranteed issue) is in the New Jersey Medical Plans guide.

What counts as group health insurance

In New Jersey, a health policy that covers more than one person is treated as a group policy unless it is blanket insurance or a family policy. It must fit one of the group types the statute authorizes (N.J.S.A. 17B:27-26).

Dependents and newborns

• Group health benefits may cover members' families and dependents, except loss-of-time (disability income) benefits (N.J.S.A. 17B:27-30).
• A newborn is covered from the moment of birth, including congenital defects. If a specific premium is needed, notice of the birth and payment are due within 90 days for coverage to continue past that point (N.J.S.A. 17B:27-30).
• Dependent coverage must stay available for an adult child until age 26, whether or not the child lives with the insured or is a tax dependent (N.J.S.A. 17B:27-30.1a).

State continuation for small employer plans

New Jersey requires small employer health plans to offer continuation (N.J.S.A. 17B:27A-27). It fills the gap for people who aren't covered by federal COBRA.

• Who it doesn't apply to: anyone who is a qualified beneficiary under federal COBRA (N.J.S.A. 17B:27A-27f).
• Election: the employee, spouse or dependent child elects in writing within 30 days of the qualifying event (N.J.S.A. 17B:27A-27a(3)).
• Premium: no more than 102% of the group premium, or 150% during a disability extension (N.J.S.A. 17B:27A-27c).

(N.J.S.A. 17B:27A-27g.)

Continuation ends early when the employer drops all coverage, the premium isn't paid, or the person becomes covered under another plan or entitled to Medicare (N.J.S.A. 17B:27A-27d(3)(b)).

Continuation for totally disabled employees

A group medical policy must let an employee who stops work because of total disability continue coverage (N.J.S.A. 17B:27-51.12):

• The employee must have been insured under the group for the full 3 months before coverage ended.
• The employee pays the employer monthly in advance, and the charge can't exceed the group rate for the coverage continued.

Common exam traps

• More than one person on a health policy makes it a group policy in New Jersey, except blanket and family policies.
• Dependents can't get loss-of-time benefits under a group health policy.
• Newborn: 90 days to give notice and pay any required premium.
• Small employer continuation: 30 days to elect, 18 / 29 / 36 months, and 102% of premium (150% during the disability extension).
• People with federal COBRA rights don't use the state continuation law.
• Disabled-employee continuation requires 3 months of prior coverage, and the cost is capped at the group rate.