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New Jersey - Compensation & Benefit Legislation

NEW JERSEY - AASHOWME

Demonstrates www.BenefitsReview.com™ site. Illustrates insurance carriers' coverages within the State.

 

NEW JERSEY - ADOPTED CHILD HEALTH CARE MANDATE

OBRA 1993 (Federal) requires group health plans to honor medical and child support orders. Also, plans must treat adopted children like biological children covered by the plan, and plans are precluded from applying pre-existing condition exclusions to an adopted child where no such exclusion applies to a newborn biological child. Health plans that covered the cost of pediatric vaccines as of May 1, 1993, and fail to continue that level of coverage, will be subject to an excise tax penalty applicable to plans that fail to meet the health care continuation coverage requirements under OBRA 1993.

 

Mandatory coverage of birth of adopted children is included in state's newborn health care mandate.

 

Preventive care for children: Yes, immunizations and lead screening.

 

(New Jersey Rev. Stat. Sections 17B:30, 17B:27-46.1 et seq.)

 

NEW JERSEY - ALCOHOLISM & DRUG ABUSE

Mandatory coverage (alcoholism treatment only).

 

Minimum yearly inpatient coverage: no statutory requirements.

 

Minimum yearly outpatient coverage: no statutory requirements.

 

Minimum lifetime coverage. No less than lifetime maximum for physical illness.

 

(New Jersey Rev. Stat. Section 17B.27-46.1)

 

NEW JERSEY - CAFETERIA PLAN TAX LAWS

State income tax, unemployment insurance tax on salary reduction: For purposes of New Jersey Income and Unemployment Insurance Taxes, cafeteria plan payments are counted as wages to the extent that employees can elect cash. An exception applies to salary reductions under so-called premium conversion plans. Under this exception, if the employer requires that employees participate in a group health and/or group term life insurance program as a condition of employment and also requires that employees contribute toward the premium for such coverage, salary reductions to pay for the benefit may be excluded from wages. The value of an employee's option to receive cash is not taxable, as long as the employee does not elect to receive cash. Employee deferrals, however, will still not decrease taxable wages. For state Unemployment Insurance purposes, the total amount of employees' salary reductions and any cash that the employee has the option to receive (whether or not the employee chooses the cash option) must be treated as wages.

 

NEW JERSEY - CONTINUATION OF COVERAGE CONVERSIONS

Events Triggering Continuation of Coverage:

 

NEW JERSEY - COORDINATION OF BENEFITS

Requires use of the birthday rule if coordinating benefits. Based on 1986 National Association of Insurance Commissioner Rules model. (New Jersey Admin. Code tit. 11, Section 11:4-28.1 et seq)

 

NEW JERSEY - COST-OF-LIVING

ERI's Relocation Assessor™ is a recommended source for U.S./Canadian cost-of-living data and U.S. Automobile Cost Survey.

 

NEW JERSEY - DRUG TESTING AND EMPLOYEE ASSISTANCE BENEFITS

State has no statutory requirements.

 

NEW JERSEY - GROUP HEALTH CODE ADDITIONS (MANDATED)

Alcoholism Treatment: Policies must cover such treatment in inpatient or outpatient hospital facility or licensed detoxification or residential treatment facility. (New Jersey Stat. Ann. Sections 17:48-6a, 48A-7a, 48E-34, 17B:27-46.1.)

 

Blood Products: Policies covering hospital treatment of bleeding episodes associated with hemophilia must cover costs of blood products and infusion equipment required for home treatment of such episodes. (New Jersey Stat. Ann. Sections 17:48-6d, 48E-35.1, 17B:27-46.1c.)

 

Breast Reconstruction and Prostheses: Costs must be covered. Policies providing outpatient x-ray or radiation therapy must cover outpatient chemotherapy following surgery for breast cancer. (New Jersey Stat. Ann. Sections 17:48-6b, 48A-7b, 48E-35, 17B:27-46.1a.)

 

Childhood Immunizations: Coverage for immunizations must be provided as recommended by the Advisory Committee on Immunization Practices of the U.S. Public Health Service and the Department of Health; deductibles must not be required. Written notification of any change in coverage of childhood immunizations must be given to those insured. (S1014, 1996) (New Jersey Stat. Ann. Section 1014, 316.)

 

Coverage Continuation and Conversion: Policies must provide for continuation of coverage for employees terminated due to disability. (New Jersey Stat. Ann. Sections 17:48-6.11, 48E-32, 17B:27-51.12.) Health service corporation contracts must permit continued coverage of dependents of insured for at least 180 days after death of insured. (New Jersey Stat Ann. Section 17:48E-31.) Health service corporations must provide for conversion of coverage to spouses ceasing to be eligible due to divorce. (New Jersey Stat. Ann. Section 17B:26-2( i).)

 

Diabetes: Group health policies, including HMOs, must provide benefits to covered individuals for diabetic equipment and supplies, if recommended or prescribed by a physician or by a nurse practitioner or clinical nurse specialist. Covered diabetic equipment or supplies include blood glucose monitors for the legally blind; test strips for glucose monitors and visual reading and urine testing strips; insulin injection aids; cartridges for the legally blind; syringes; insulin pumps and related materials; insulin infusion devices; and oral agents for controlling blood sugar. Benefits must be provided for medically necessary self-educational visits to registered dietitians, health care professionals, or registered pharmacists upon a significant change in the condition, and upon determination that reeducation or refresher education is necessary. Diabetes benefits must be provided to the same extend as for any other sickness. The list of medically necessary diabetic equipment and supplies to be covered may be updated periodically by the Commissioner of Insurance. (S1759, 1996.)

 

Handicapped Dependents: Coverage for dependent children cannot be terminated while the dependent is incapable of employment due to mental retardation or physical handicap and chiefly dependent on the insured. (New Jersey Stat. Ann. Sections 17:48-6, 6.1, 48A-7.1, 48E-22, 17B:27-30.)

 

Home Health Care: Group health insurance policies covering inpatient hospital care or skilled nursing facility care also must cover home health care. (New Jersey Stat. Ann. Section 17B:27-51.4.)

 

Lead Poisoning and Screening and Treatment: Insurers must provide children age 6 and under with coverage for lead screening in accordance with State Department of Health policy; medical evaluation and treatment or any such diagnosed condition also must be provided. (S1014, 1996) (New Jersey Stat. Ann. Section 1014, 316.)

 

Mammography Screening: Group and individual health insurance contracts, group and individual hospital service corporation contracts, group and individual health service corporation contracts, and HMOs must provide a baseline mammogram for women at least 35 but less than 40 years of age; a mammogram every two years, or more frequently if recommended by a physician, for women at least 40 but less than 50 years of age; and an annual mammogram for women age 50 and older. Benefits must be provided to the same extent as any other sickness under the policy. (New Jersey Stat. Ann. Sections 17:48-6g, 17:48-A7f, 17:48E-35.4, 17B:27-46.1f, 26:2J-4.4.)

 

Maternity Benefits: Policies must cover maternity care without regard to marital status to the same extent as the hospitalization benefit is provided for any other illness. (New Jersey Stat. Ann. Sections 17:48-6c, 48-A-7c, 17B:27-46.1b.) Individual and group policies providing maternity benefits must supply benefits for a minimum of 48 hours of inpatient care in a licensed health care facility following a vaginal delivery and for a minimum of 96 hours of inpatient care following a Caesarean section. However the extended care must be determined to be medically necessary by the attending physician or requested by the mother. (AB2224, 1995.)

 

Newborns: Policies must cover newborn children from the moment of birth for injury or sickness including treatment of medically diagnosed congenital defects and abnormalities. (New Jersey Stat. Ann. Sections 17:48-6 - 6.1, 17:48A-7.1, 48E-20 - 28, 17B:27-30.)

 

Pap Smears: Coverage for pap smears must be provided by insurers and HMOs covering groups of 50 or more people. (A2231, 1996) (New Jersey Stat. Ann. Section 96-415.)

 

Prostate Cancer Screening: Group insurers (HMOs included) with greater than 49 participants must cover annual diagnostic examinations including, but not limited to, a digital rectal examination and a prostate specific antigen test for men 50 and over who are a symptomatic and for men age 40 and over with a family history of prostate cancer or other prostate cancer risk factors. (S1077, 1996) (New Jersey Rev. Stat. Section 17-26.)

 

Providers: Chiropractors, podiatrists, bio-analytical laboratories, dentists, optometrists, psychologists, physical therapists, chiropractors, certified midwives, and registered professional nurses: Costs for services must be covered if the provider is licensed, the service is within the provider's scope of services, and the service is covered by the policy. (New Jersey Stat. Ann. Section 17:48A-26 - 32, 17:48E-12, 17B:27-50 - 51.9.)

 

Second Opinion: Medical or health service corporation individual contracts covering inpatient surgical services must cover second surgical opinions for elective inpatient surgical procedures (coverage is optional for group contracts.) If the second opinion does not confirm medical advisability, a third opinion must be covered. (New Jersey Stat. Ann. Sections 17:48A-6.2 - 6.4, 17:48E-33, 17B:27-46.4.)

 

Standard Plans: Insurers must offer all five specific standard plans to individuals or small groups. Premiums must be established using community rating (taking into account limited factors) and exclusions for pre-existing conditions are limited. Plans differ in deductibles and co-payments. Large employers must be offered the standard plans, and by July 1, 1999, coverage through the standard plans will be universal. (New Jersey Stat. Ann. Sections 17B:27A-19 - 39.) An association, multiple employer arrangement, or out of state trust must offer health benefits to all eligible employees and their dependents. Only certain factors may be used in determining rage differentials charged to small employers. (New Jersey Stat. Ann. Section 17B:27A-17.) Eligibility to purchase small employer health insurance is expanded. (S866, 1995.)

 

NEW JERSEY - GROUP HEALTH FOR SMALL EMPLOYERS

For insurance plans offered to small employers:

NEW JERSEY - GROUP LIFE CODE ADDITIONS

Employer required to pay part of premium: Yes.

 

Percent of employees who must elect coverage (if employees pay part of premium): 75%.

 

Percent of employees who must be covered if employer pays all of premium: 100%.

 

Minimum number of employees in group plan: 10.

 

Employer prohibited as beneficiary: Yes.

 

Grace period (days): 31.

 

Mandatory conversion: Yes.

 

Other provisions: None.

 

(New Jersey Rev. Stat. Sections 17B:27-2, 17B:27-11, 17B:27-19)

 

NEW JERSEY - HOLIDAYS

January 1, Washington's Birthday (or 3rd Monday in February), Memorial Day (or last Monday in May), July 4, Labor Day (or 1st Monday in September), Veterans Day, and December 25 are state holidays in all 50 states and in the District of Columbia. Other holidays under State law include: Martin Luther King's birthday (or 3rd Monday in January), Lincoln's Birthday, Columbus Day (or 2nd Monday in October), Thanksgiving. Other: Any day ordered or recommended by Governor or President. If holiday falls on Sunday, following Monday is a holiday; if holiday falls on Saturday, preceding Friday is a holiday for state employees. (New Jersey Stat. Ann. Sections. 36:1-1, 39:1-1-2, 36:1-8, 36:1-9, 36:2-3, 36:2-6, 36:2-7, 36:2-9, 36:2-10, 36:2-11, 36:2-16, 36:2-18 through 36:2-34)

 

NEW JERSEY - IMMIGRATION (PREVAILING WAGE POLICY)

See U.S. Federal General Administrative Letter 1-2000

 

NEW JERSEY - JURY DUTY & WITNESS TIME OFF

Employer Restriction For Discharging Employee For Taking Leave For Jury Service: Yes.

 

Remedies and Penalties: Employee may bring civil action within 30 days of discharge for damages, reinstatement, and reasonable attorney fees.

 

Other Requirements: Full time employees are entitled to usual compensation less amount of per diem fee for each day of service. (New Jersey Stat. Ann. Section 2B:20-16.)

 

Employer Restriction For Discharging Employee For Taking Leave to be a Witness: State reports no statutory requirements.

 

Remedies and Penalties: State reports no statutory requirements.

 

Other Requirements: State reports no statutory requirements.

 

NEW JERSEY - LEAVES OF ABSENCE

Employers Subject to Leave Laws: Employers with 50 or more employees.

 

Criteria for Eligibility: Must be employed for 1,000 hours for at least 1 year.

 

Maximum length of leave: 12 weeks in a 24 month period.

 

Paid Leave: Employer discretion.

 

Acceptable Reasons for Leave: Birth/adoption of child and serious health condition of child, parent, or spouse.

 

Employment Guarantees After Leave: Entitled to reinstatement in the position held prior to the leave or equivalent position, unless a layoff during the leave would have applied to the employee.

 

Use of Vacation or other Time-off Benefits: State reports no statutory requirements.

 

Certification Required: Employer may require certification of illness if leave is taken to care for ill child, parent, or spouse; certification of birth or adoption may also be required. Employer may require a second or third opinion at the employer's expense.

 

Effect Of Leave on Other Benefits: All benefits continue in effect while on leave.

 

Effect of Seniority Accrual During Leave: Benefits do not accrue while on leave.

 

 

Minimum Requirements for Notification to Employer: Prior notice, if possible, is required.

Conditions for Denial of a Request For Leave: Leave may be denied if employee is salaried and among highest 5% of employees; leave may also be denied if it will cause substantial economic injury to employer.

 

(New Jersey Rev. Stat. Sections 34:11B-3 - 34:11B-13.)

 

See U.S. Federal Family and Medical Leave Act

 

NEW JERSEY - LONG TERM DISABILITY CODE ADDITIONS

State does not require employer to provide long term disability benefits; although many employers do in order to remain competitive in hiring/retention of employees.

 

See LEAVES OF ABSENCE (above), WORKERS' COMPENSATION (below) and U.S. Federal Americans With Disabilities Act

 

NEW JERSEY - MANDATED PROVIDERS

Optometrists, chiropractors, dentists, and psychologists. Mandatory coverage for professional registered nurses, audiologists, and speech pathologists. (New Jersey Rev. Stat. Sections 17B27:46.1s, 17B:27-50, 17B:27-51, 17B27-51.1, 17B27-51.1a, 17B27-51.8)

 

NEW JERSEY - MENTAL HEALTH CARE

State reports no statutory requirements.

 

NEW JERSEY - MINIMUM WAGE

Refer to the Federal minimum wage: $5.15 per hour (effective September 1, 1997).

 

Exemptions: Certain domestics, outside sales. Students, apprentices, and handicapped workers in special environments may be exempt by special certificate. (New Jersey Rev. Stat. Ann. Sections 34:11-56a4, 34:11-56a17)

 

See U.S. Minimum Wage

 

NEW JERSEY - NEW HIRE REPORTING

Who is required to report: All employers.

 

Who must be reported: All employees and rehires.

 

Exempt from reporting: No exemptions.

 

Form(s) to file: W-4 form or equivalent including required information.

 

Filing deadline: Within 20 days of hire.

 

Employer information to be included: Name, address, and federal EIN.

 

Employee information to be included: Name, address, SSN, and date of birth.

 

Penalty for failure to report: Fine of $25 per employee not reported. $500 if failure results from conspiracy between employer and employee.

 

(N.J. Stat. Ann. Section 2A:17-56.61)

 

NEW JERSEY - NEWBORN CARE MANDATE

Mandated coverage.

 

Preventive care for children: Yes, immunizations and lead screening. (New Jersey Rev. Stat. Sections 17B:30, 17B:27-46.1 et seq.)

 

NEW JERSEY - PARENTAL LEAVE

See U.S. Federal Family and Medical Leave Act

 

NEW JERSEY - PRE-EXISTING CONDITIONS

For insurance plans offered to small employers, no plan shall contain pre-existing condition provisions excepts as apply to late enrollees. (New Jersey Rev. Stat. Sections 17B:27A - 17 et seq.)

 

See U.S. Federal Health Insurance Portability & Accountability Act

 

NEW JERSEY - PROTECTED CLASSIFICATIONS

Age: Yes, age 40 and over.

Race: Yes.

Color: Yes.

National Origin:  Yes.

Ancestry: Yes.

Religion:  Yes.

Sex:  Yes.

Pregnancy: Yes.

Sexual Harassment: Yes.

 

(N.J. Stat. Ann. Sections 10:3-1, 10:5-3, 10:5-4, 10:5-12; Gilchrist v. Board of Educ., 155 N.J. Super. 358 (1978)..)

 

NEW JERSEY - SALARY SURVEY

ERI's Relocation Assessor™ is a recommended source for U.S./Canadian wages & salaries (covering 3,000 positions).

 

NEW JERSEY - SHORT TERM DISABILITY CODE ADDITIONS

Covered Employers: Employers with 1 or more employees that have paid in more than $1,000 or more in a calendar year.

 

Employer Contribution: 0.5% of first $18,000 earned during first 3 years; then 0.1-0.75% of first $18,000 (depending on experience rating).

 

Covered Employees: Earning $400 or more in wages in base period, been employed at least 14 weeks, and earned wages for 20 hours or more.

 

Employee Contribution: 0.5% of first taxable $18,600 in wages for temporary disability insurance.

 

Weekly Benefit Amount: $339 (1996); $350 (1997).

 

Waiting Period: 7 days.

 

Coordinated with Workers' Compensation: Yes.

 

Responsible Agency:

Disability Insurance Services

DN 387

Trenton, NJ 08625

 

NEW JERSEY - TERMINATION & SEVERANCE PAY

Date pay is due if employee is discharged: Payday.

 

Date due if employee resigns: Payday.

 

Wages: Yes. (Wages defined to include commissions, but not bonuses or profit-sharing arrangements.)

 

Vacation Pay: No.

 

Holiday: No.

 

Sick leave: No.

 

Severance: No.

 

( New Jersey Rev. Stat. Sections 34:11-4.1, 34:11-4.3)

 

NEW JERSEY - UNEMPLOYMENT TAX

Employer Contributions:

 

 

Voluntary Contribution Provision: Yes. Within 30 days of mailing notice, extended to 60 days for good cause, but not exceeding 120 days after start of contribution year.

 

(New Jersey Stat. Ann. Sections 43:21-7, 43:21-14, 43:21-16, 43:21-52.)

 

NEW JERSEY - VACATION PAY

State reports no statutory requirements.

 

NEW JERSEY - VOTING TIME OFF

State reports no statutory requirements.

 

NEW JERSEY - WORKERS' COMPENSATION

Private Employers: Statutory presumption of election of all employees.

 

Public Employers: Mandatory coverage to all public employments.

 

Exceptions: Casual workers, maritime workers, and railroad workers engaged in interstate commerce.

 

Special Coverage Provisions: None reported.

 

(U.S. Chamber of Commerce, 1994 Analysis of Workers' Compensation Laws.)