N.J. Admin. Code § 17:9-6.1

Current through Register Vol. 56, No. 21, November 4, 2024

Section 17:9-6.1 - Retired employee defined

(a) "Retired employee" means a person who is eligible for coverage under the SHBP's retiree group. This "retired employee" status, once established, shall continue in effect even if the employer is subsequently disbanded and no successor agency is created upon the dissolution of such employer.

(b) The definition of "retired employee" also includes the following classes of retired employees who are eligible for coverage:

1. Retired employees of the State of New Jersey and of employers defined as State agencies in 52:14-17.2 6, who were eligible for coverage as active employees immediately prior to retirement and who continued coverage at retirement;

2. Retired employees of educational and local employers participating in this Program who were eligible for coverage as active employees immediately prior to retirement and who continued coverage at retirement;

3. Retired employees of educational and county college employers, regardless of the employer's participation in the SHBP who:

i. Were full-time employees as defined by 17:9-4.6;

ii. Were eligible for group health plan coverage prior to leaving employment; and

iii. Retired on disability retirements or on benefits based upon 25 or more years of service credit in the Teachers' Pension and Annuity Fund, the Public Employees' Retirement System, the Alternate Benefit Program or in a locally administered pension fund established by 18A:66-94 et seq. under the provisions of P.L. 1987, c. 384, P.L. 1992, c. 126, or P.L. 1995, c. 357 (52:14-17.32f, 52:14- 17.32f1, and 52:14-17.32f2, respectively);

4. Qualified retired employees of boards of education who receive a retirement benefit from a State or locally administered retirement system and who:

i. Have continued their employer's plan;

ii. Become entitled to and enroll in Parts A and B of the Federal Medicare Program; and

iii. Within 60 days of enrollment in Parts A and B of the Federal Medicare Program, elect to join the SHBP under the provisions of P.L. 1993, c. 8 (52:14-17.3 2h). A retired employee, upon enrollment in the SHBP pursuant to this rule, who qualified for benefits under the provisions of 52:14-17.3 2f, 17.32f1 or 17.32f2 shall be eligible for coverage paid by the State;

5. Qualified retired employees of local or educational employers who are enrolled for coverage in that employer's plan and who enroll in the SHBP when the employer joins the SHBP;

6. Qualified retired employees of participating local employers who retired before the employer joined the SHBP but who enroll when offered coverage due to the employer's adoption of the provisions of P.L. 1979, c. 54 (52:14-17.3 8);

7. Qualified retired employees of participating local employers who did not continue coverage into retirement but who elect to enroll in the SHBP when offered coverage due to the employer's adoption of the provisions of P.L. 1981, c. 436 (52:14-17.3 8); and

8. Qualified retired employees under the provisions of P.L. 1997, c. 330 (52:14-17.3 2i) codified at 17:9-6.9.

(c) "Retired employee" also means an employee whose coverage terminated prior to retirement, if that employee is awarded a disability retirement allowance under the PFRS, SPRS, or JRS, or under the PERS or TPAF, if enrolled prior to May 21, 2010. Eligibility for retired coverage in the SHBP shall begin on the employee's retirement date, but should the approval of the retirement allowance be delayed, coverage shall not be retroactive for more than one year.

(d) The definition of "retired employee" shall include the spouse or eligible domestic or civil union partner of an active or retired employee, provided the spouse or eligible partner was covered as a dependent under the SHBP immediately preceding the death of the active or retired employee, and further provided that in the case of death of an active employee, the spouse or eligible partner is receiving a periodic pension or survivorship benefit from a State or locally administered retirement system or plan.

(e) The definition of "retired employee" shall also include the spouse or eligible partner of the employee, provided the spouse or partner was eligible for coverage immediately preceding retirement and is enrolled for coverage when the employee retires or is added to coverage pursuant to 17:9-6.3(a).

(f) The definition of "retired employee" shall include an employee who is eligible to receive a Federal pension based upon employment with the Cooperative Extension service staff of Rutgers University. This coverage is contingent upon the employee applying for and receiving a Federal pension immediately following the cessation of employment and further provided that the pension to which the employee is entitled is being granted by reason of age or disability and coverage based on employment with Rutgers University.

(g) The definition of "retired employee" shall also include an employee who is eligible to receive a monthly annuity or long-term disability benefits based on the employee's participation in the New Jersey Alternate Benefit Program, provided the employee who is receiving a monthly annuity applied for and began receiving the annuity immediately following the termination of employment in a position covered by the Alternate Benefit Program.

(h) The definition of "retired employee" shall also include an employee who enrolled in the PERS or TPAF on or after May 21, 2010, and who is approved for long-term disability benefits under P.L. 2010, c. 3, provided the member meets all other eligibility requirements.

(i) The definition of "retired employee" shall include any former employee, who retired from a State or locally administered retirement system or the spouse or eligible partner of the former employee of an employer who becomes a participating employer if the employee, spouse or eligible partner:

1. Is receiving a periodic retirement allowance or survivorship benefit from a State or locally administered retirement system;

2. Was insured under a group medical insurance plan of the employer immediately prior to the date the employer became a participating employer; and

3. Elects to enroll in the SHBP at the time the employer becomes a participating employer.

(j) The definition of "retired employee" shall include an employee who is eligible for continuation of coverage in the SHBP at the time of retirement who waives coverage at that time, or at a later date, because the employee has health benefit coverage (active or retired) through an employer or eligible retiree association as a dependent or as an active employee and who applies for continuation of coverage within 60 days after termination of coverage as a dependent or active employee. An eligible retiree association is an association whose membership is limited based on the employment of the employee or the employee's dependent. A certificate of continued coverage or employer or association letter certifying when coverage terminated must accompany the retiree application.

(k) The definition of "retired employee" shall not include an employee who on cessation of employment, elects a vested, deferred retirement benefit under which payments begin at a future date unless that employee is eligible for coverage under the provisions of P.L. 1987, c. 384 or P.L. 1992, c. 126 (52:14-17.3 2f and 52:14-17.3 2f1).

(l) The employer liability for payments on behalf of eligible retired employees, which includes those employees who are eligible to receive long-term disability benefits, is payable in accordance with the provisions of 52:14-17.32, 52:14-17.38, 18A:66-39.1, and 43:15A-42.1.

N.J. Admin. Code § 17:9-6.1

Amended by 48 N.J.R. 2387(a), effective 11/7/2016