Dependent Coverage
Pompton Lakes School District

  

Eligible dependents are your spouse, civil union partner, eligible same-sex domestic partner, or your eligible children (this can include natural children under age 26 regardless of marital, student, or financial dependency status, stepchildren, foster children, and those in a guardian ward relationship). Supporting documention is required for enrollment.

 

The Affordable Care Act and Your Dependent
The Affordable Care Act allows for medical and prescription drug coverage for eligible dependents until the end of the month in which he/she turns age 26.   Note that your child is eligible for District dental plan coverage either through 1) the end of the year in which he/she turns age 19 or 2) the end of the year in which he/she turns age 23 if a full-time student.

When your child is about to age out of the medical, prescription, or dental plans, it is important that you notify the Business Office to learn about continuing coverage options like COBRA or New Jersey Chapter 375 coverage.

Note that dependents over age 26 but under age 31 may be eligible for health and prescription coverage under the New Jersey <31 dependent law or COBRA (dental coverage is available through COBRA as well).  However, you must notify the District that your dependent is no longer eligible for coverage or he/she could forfeit rights to continued coverage.

The New Jersey Chapter 375 Dependent Plan
The New Jersey Chapter 375 law gives eligible adults to age 31 the choice to elect health and prescription coverage under a parent's group health plan.


Who is eligible for the plan?
The following conditions must be met to be eligible for Chapter 375:

* Aging-out of a group health plan
* Younger than 31 years old
* New Jersey resident or full-time-student
* Not married; not a parent
* No other health coverage
* Not entitled to Medicare coverage
* Parent is in group health coverage

   

What is the cost for the plan?  Premium costs for your dependent plan are based on the District's current Single-tier plan. Your dependent is fully responsible for these premiums.  The carrier bills and collects premiums directly from your dependent.  

Your dependent is enrolled as a standalone member; his/her expenses do not impact plan cost-sharing requirements or limits (e.g. family deductibles, plan maximums).  


How does my dependent enroll? Those who are eligible to continue coverage under New Jersey Chapter 375 must enroll within 30 days prior to losing coverage due to aging out. Others who meet eligibility at a later time (e.g., an out-of-state dependent moves back to New Jersey) may be eligible to enroll within 30 days after the event.  If the 30-day timeframe is missed, he/she must wait until the next Open Enrollment period. 

How long is my dependent eligible? Eligiblity for coverage ends upon one of the below:

* His/her 31st birthday
* Marriage or becoming a parent
* No longer a full-time student or New Jersey resident
* Acquires other health coverage
* Required premiums are not paid
* The parent's plan coverage ends or the plan ends dependent coverage

If a dependent loses eligibility but meets requirements at a later date, he/she can again elect coverage.