Benefits Law

The federal Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 requires that most employers sponsoring group health plans offer employees and their eligible dependents the opportunity to temporarily extend their group health coverage in certain instances where coverage under the plan would otherwise end. For State Health Benefits Program (SHBP) participants, COBRA is not a separate health program; it is a continuation of SHBP coverage under the provisions of the federal law.
Click here for more information about COBRA.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law that includes important new protections for millions of working Americans and their families who have preexisting medical conditions, or might suffer discrimination in health coverage based on a factor that relates to an individual’s health. This Act requires health plans, such as the SHBP, to maintain the privacy of any personal information relating to its members’ physical or mental health.
Click here for more information about HIPAA.

The Mental Health Parity Act of 1996 requires that the dollar limitations on mental health benefits are not lower than those of medical or surgical benefits. All SHBP health plans meet or exceed the federal requirements, with the exception of mental health parity for the Traditional Plan and NJ PLUS. Maximum annual and lifetime dollar limits for mental health benefits are outlined in the Traditional Plan and NJ PLUS Member Handbooks and the SHBP Summary Program Description.

The Newborns’ and Mothers’ Health Protection Act of 1996 requires that health plans provide a minimum level of coverage for newborns and mothers, generally 48 hours for a vaginal delivery and 96 hours for a cesarean delivery.

The Federal Family and Medical Leave Act (FMLA) of 1993 is enforced by the Department of Labor. Eligible employees have to work a minimum of 1,250 hours during the 12 months prior to the start of the FMLA Leave. Passed in 1993 the Federal Act provides:

  • Up to 12 work weeks of paid leave:
    • For the birth of a son or daughter, and to care for the newborn child;
    • For the placement with an employee of a child for adoption or foster care, and to care for the newly placed child;
    • To care for an immediate family member (spouse, child, or parent-but not a parent ‘in-law’) with a serious health condition; and
    • When an employee is unable to work because of a serious health condition.
  • Job protection for the duration of the leave
  • Maintenance of pre-existing health benefits.

The New Jersey Family Leave Act (NJFLA) is enforced by the Division of New Jersey of Civil Rights. Eligible employees must have been employed for at least (12) months and; must have worked 1,000 base hours in the preceding twelve (12) months. Passed in 1990, the State Act provides:

  • Up to 12 weeks during a 24-month period of unpaid leave:
    • For birth or adoption.
    • For serious health condition of parent, parent of spouse, child or spouse.
  • NJFLA does not cover employee’s own serious health condition.
  • Job protection for the duration of the leave
  • Employee has a right to reinstatement from a NJFLA leave.
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