{"data":{"id":"us-nj/n.j.-stat.-17b-27a-18.1","jurisdiction":"us-nj","citation":"N.J. Stat. § 17B:27A-18.1","heading":"Provision of benefits to subscriber's child under small employer policy, contract.","body":"9. a. A policy or contract which provides hospital or medical expense benefits under which dependent coverage is available shall continue to make that coverage available for an adult child until the child turns 26 years of age.  A policy or contract shall not deny coverage for a covered employee's child on the grounds that:\n(1)\tThe child was born out of wedlock;\n(2)\tThe child is not claimed as a dependent on the covered employee's federal tax return;\n(3)\tThe child does not reside with the covered employee or in the carrier's service area, provided that, in the case of a managed care plan, the child complies with the terms and conditions of the policy or contract with respect to the use of specified providers;\n(4)\tThe child is married;\n(5)\tThe child has or adopts a child; or\n(6)\tThe child starts or leaves school.\nb.\tIf a child has coverage through a policy or contract of a noncustodial parent, the carrier shall:\n(1)\tProvide such information to the custodial parent as may be necessary for the child to obtain benefits through the child's noncustodial parent's coverage;\n(2)\tPermit the custodial parent, or the health care provider with the authorization of the custodial parent, to submit claims for covered services without the approval of the noncustodial parent; and\n(3)\tMake payments on claims submitted in accordance with paragraph (2) of this subsection directly to the custodial parent, the health care provider or the Division of Medical Assistance and Health Services in the Department of Human Services which administers the State Medicaid program, as appropriate.\nc.\tWhen a parent who is the covered employee is eligible for dependent coverage and is required by a court or administrative order to provide health insurance coverage for his child, the carrier shall:\n(1)\tPermit the parent to enroll his child as a dependent, without regard to any open enrollment restrictions;\n(2)\tPermit the child's other parent, or the Division of Medical Assistance and Health Services as the State Medicaid agency or the Division of Family Development as the State IV-D agency, in the Department of Human Services, to enroll the child under the policy or contract if the parent who is the covered employee fails to enroll the child; and\n(3)\tNot terminate coverage of the child unless the parent who is the covered employee provides the carrier with satisfactory written evidence that: the court or administrative order is no longer in effect; or the child is or will be enrolled in a comparable health benefits plan whose coverage will be effective on the date of the termination of coverage.\nL.1995, c.288, s.9; amended 2019, c.356, s.7.","path":["TITLE 17B INSURANCE"],"source_url":"https://pub.njleg.state.nj.us/statutes/STATUTES-TEXT.zip","current_through":"P.L.2025, c.405, and J.R.22","vintage":"","retrieved_at":"2026-08-27T17:54:13Z","sha256":"55c4c926dd116ae4bd819954708f4c82838e9f69735e5b6022b1d46db7e483f9","source_id":"us-nj","stale":true,"prev":"us-nj/n.j.-stat.-17b-27a-18","next":"us-nj/n.j.-stat.-17b-27a-18.2"},"notice":"GroundRules: Original legal text. Not legal advice."}