Overage Dependents

(The following information is summarized from State Health Benefits Program Fact Sheet #74, “Health Benefit Coverage of Children Until Age 31 under Chapter 375, P.L. 2005. The fact sheet can be downloaded from www.state.nj.us/treasury/pensions/shbp.htm)

Eligible Children

Under the provisions of Chapter 375, certain over age children may be eligible for coverage until age 31. This includes a child by blood or law who:

  • is under the age of 31;
  • unmarried;
  • has no dependents of his/her own;
  • is a resident of NJ or is a full-time student at an accredited public or private institution of higher education; and
  • is not provided coverage as a subscriber, insured, enrolled, or covered person under a group or individual health benefits plan, church plan or entitled to benefits under Medicare.

Enrolling for Chapter 375 Coverage

A covered employee may enroll an eligible child until the child’s 30th birthday at the following times:

  • within 30 days prior to December 31 of the year the dependent reaches age 23 with coverage effective the following January 1;
  • if, within 30 days of coverage loss, the covered employee provides proof of loss of other group coverage for the eligible child; or
  • during the month of October of each year, with coverage effective the following January 1.

Required Documentation

A completed Chapter 375 Application for Coverage, a photocopy of the over age child’s birth certificate and a photocopy of the top half of the front page of the covered parent’s most recently filed federal tax return that includes the child or if the over age child is not listed on the covered parent’s tax return, a copy of the top half of the child’s most recently filed tax return. The application and required documentation must be submitted to the Division of Pensions and Benefits on or before the child’s 30th birthday. An application form can be downloaded from the above web-site, or you can contact HR.

Plan Selection

Under Chapter 375, an eligible over age child is enrolled for coverage in exactly the same medical and/or prescription plans that the covered parent has selected. There is not a provision for dental benefits.

Coverage Costs

The covered parent will be billed directly for the cost; therefore, the covered parent is held responsible for the payment of the Chapter 375 coverage. A current rate chart is available over the internet at: www.state.nj.us/treasury/pensions/shbp.htm. Enrollment of overage children for coverage under Chapter 375 is voluntary. Chapter 375 does not require an employer to pay all or any part of the cost of coverage for any election of this coverage.

For further information, you can contact the Division of Pensions and Benefits’ Office of Client Services at 609-292-7524, or email the Division at pensons.nj@treas.state.nj.us