Guidelines for requesting NJ Dependents to Age 31 Coverage
The State of New Jersey recently revised law P.L. 2005 c 375 - requiring health care insurers to provide certain adult dependents with the opportunity to maintain their dependent coverage under their parents’ health insurance policies. Previously, the law, Chapter 375, provided coverage opportunities until the dependents’ 30th birthdays if certain requirements were met. Now, coverage has been extended until the dependents’ 31st birthdays. Before this law, these “over-age dependents” would have become ineligible for coverage under their parents’ polices when they reached the limiting age under their group health plan. As mandated by the legislation, however, specific eligibility and underwriting requirements apply to the enrollment process for these individuals. These requirements are outlined below as a reference for benefits managers.
How to enroll
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Request the over-age dependent application from your AmeriHealth Broker Representative or your customers may request the application from Customer Service.
- Have the over-age dependent complete the HINT application and verification form and submit the completed forms along with the first month’s premium to your AmeriHealth Broker Representative at either of the following addresses:
AmeriHealth AmeriHealth
8000 Midlantic Drive 485C U.S. Highway 1 South
Suite 333 Suite 300
Mt. Laurel, NJ 08054 Iselin, NJ 08830
Mandate eligibility requirements
An individual may elect for over-age dependent continuation of coverage if several conditions are met. The dependent’s parent(s) must be actively covered under a New Jersey-issued group health insurance contract. In addition, the eligible dependent must be the insured’s child (by blood or by law) and must meet the following criteria:
- be under age 31;
- be unmarried;
- have no dependent of his or her own;
- have proof of prior creditable coverage;
- reside in New Jersey or be enrolled as a full-time student at an accredited public or private institution of higher education;
- not be covered under another group health plan or receiving Social Security benefits.
Eligibility period defined
Individuals who meet the Chapter 375 eligibility standards may make Chapter 375 elections in any of the following situations:
- within 30 days prior to the date a dependent is scheduled to “age-out” of the policy;
- within 30 days after an adult child meets the Chapter 375 eligibility standards for reasons other than age (for example, an adult child who had been working in California decides to return to live in New Jersey);
- either during the group’s annual open enrollment period, or annually during the 30-day period following the anniversary of the adult child's loss of coverage, if the adult child is seeking coverage under a small-employer health benefits plan.
AmeriHealth underwriting guidelines
The following guidelines apply when a request is made to add continuation of coverage for over-age dependent-eligible lines of business:
- The over-age dependent must make written application to AmeriHealth. The effective date of the continued coverage will be the later of:
- the date the over-age dependent gives written notice to the carrier;
- the date the over-age dependent pays the first premium;
- the date the dependent would otherwise lose coverage due to attainment of the limiting age for dependents.
No retroactive enrollments will be accepted. The applicant may specify an effective date after the above events but it may not be prior to the fulfillment of the eligibility requirements listed above. If the applicant misses his or her eligibility window, he or she will not be eligible to enroll in Dependent to Age 31 coverage until the next anniversary date of the employer group.
- Dependent to Age 31 rates apply exclusively to dependents who meet the requirements of the Dependent to Age 31 Mandate.
- Eligibility will be determined prior to enrollment of the over-age dependent.
- Eligibility of the over-age dependent is contingent upon continued eligibility of the parent’s contract. If the parent’s contract terminates, the coverage for the over-age dependent will terminate.
- The benefits plan of the over-age dependent must be the same as that of the parent’s contract. Any change of benefit plan for the parent will result in the need for a benefit plan change for the over-age dependent to continue coverage. In cases where the employer allows dependents to make benefits elections separate from the parent, the dependent has the right to continue only the coverage he or she had in place on the date that he or she reached the limiting age. There should not be any election of coverage options at the time of electing over-age dependent continuation of coverage.
- The over-age dependent will be billed directly and will be responsible for full payment of the premium.
- Over-age dependent rates are not guaranteed and are subject to change if the group policy’s rates change.
- Underwriting will not require the over-age dependent to sign off on a rate page, although this is strongly recommended.
Premium Calculations
For each eligible over-age dependent, AmeriHealth’s premium rate will be calculated at 67.4 percent of the single rate for the same plan of benefits in which the parent is actively enrolled. The over-age dependent rate will always be a multiple of the NJ single rate and never the PA or DE rates (51+ HMO/POS). So, even if the parent of the over-age dependent has selected a PA provider and has a PA rate, the rate for the over-age dependent will be based on the NJ rate for the parent’s plan, even if the dependent also selects a PA provider. Please contact your AmeriHealth Broker Representative for the exact over-age dependent rate. An over-age dependent must include a check for the premium amount when he or she mails in the completed HINT application. AmeriHealth will bill the over-age dependent directly. Ongoing premium payments must be received within 30 days of the due date or, coverage will automatically be terminated.
Additional resources
Click the links below for additional resources including form instructions, a member question and answer, and samples on how forms should be completed:
For more information, please contact your AmeriHealth Broker Representative.
