Key Takeaways
- New Jersey group health insurance is regulated under both state and federal law (ERISA, ACA)
- COBRA continuation coverage applies to employers with 20 or more employees
- New Jersey has state continuation coverage for employers with fewer than 20 employees
- Small Employer Health Benefits (SEH) Program covers groups of 2-50 employees
- Mental health parity requirements apply to group health plans
New Jersey Group Health Insurance
New Jersey group health insurance is heavily regulated at both state and federal levels to protect employees and their dependents.
Regulatory Framework
| Regulation | Applies To |
|---|---|
| ERISA | Most private employer plans |
| ACA | All health plans |
| Title 17B N.J.S.A. | Insured group plans |
| SEH Program | Small employer groups (2-50) |
Group Size Definitions
New Jersey uses these group size definitions:
| Market Segment | Employee Count |
|---|---|
| Small Group (SEH) | 2-50 full-time equivalent |
| Large Group | 51 or more full-time equivalent |
Small Employer Health Benefits Program
The New Jersey SEH Program requires:
- Guaranteed issue (cannot deny coverage)
- Community rating (limited health-based rates)
- Standardized plan types available
- No pre-existing condition exclusions
COBRA Continuation Coverage
The federal COBRA law requires continuation coverage:
COBRA Basics
| Aspect | Requirement |
|---|---|
| Applies To | Employers with 20+ employees |
| Duration | 18-36 months depending on event |
| Premium | Up to 102% of group rate |
| Coverage | Same as active employees |
Qualifying Events
| Event | Duration |
|---|---|
| Employment termination | 18 months |
| Reduced hours | 18 months |
| Divorce/legal separation | 36 months |
| Death of employee | 36 months |
| Medicare entitlement | 36 months |
| Dependent child aging out | 36 months |
Exam Tip: COBRA applies to employers with 20 or more employees. For smaller employers, New Jersey provides state continuation coverage.
New Jersey State Continuation Coverage
For employers with fewer than 20 employees, New Jersey provides continuation coverage:
State Continuation Coverage
| Aspect | New Jersey Requirement |
|---|---|
| Applies To | Employers not subject to COBRA |
| Duration | Up to 18 months |
| Premium | At group rate |
| Coverage | Continuation of group benefits |
When State Continuation Applies
- Employee loses coverage due to termination or reduced hours
- Dependent loses coverage due to qualifying event
- Not eligible for COBRA
Mental Health Parity
New Jersey requires mental health parity in group health plans:
Parity Requirements
| Aspect | Must Be Equal |
|---|---|
| Copays | Same as medical/surgical |
| Deductibles | Same as medical/surgical |
| Annual Limits | Same as medical/surgical |
| Lifetime Limits | Same as medical/surgical |
| Treatment Limits | Same as medical/surgical |
Covered Conditions
New Jersey mental health parity applies to:
- All mental health conditions
- Substance use disorders
- Autism spectrum disorders
- Behavioral health conditions
HIPAA Portability
Group health plans must comply with HIPAA portability:
Key HIPAA Provisions
- Cannot deny enrollment based on health status
- Must provide certificate of creditable coverage
- Limits pre-existing condition exclusions
- Protects against discrimination
What is the minimum employer size for federal COBRA to apply?
What does mental health parity require in New Jersey group health plans?
What is the definition of a small group under the New Jersey SEH Program?
How long can New Jersey state continuation coverage last for employers with fewer than 20 employees?