Questions and Answers on the Domestic Partnership Act #insurance #for #domestic #partners


1. What does the Act require with respect to health insurance coverage for domestic partners?

The Act requires health insurance carriers to offer policyholders the option to elect coverage for same-gender, domestic partners of covered persons if the policy permits coverage for eligible dependents and is issued or renewed after July 10, 2004.

2. Does the Act prohibit carriers from offering opposite gender domestic partner coverage?

While the Act does not require that opposite gender domestic partner coverage be offered, it does not prohibit carriers from offering domestic partner coverage that is broader in scope than that required by the Act.

3. Must coverage be offered for children of domestic partners?

The intent of the Act is to treat domestic partners of covered persons as spouses for purposes of providing health insurance coverage. Accordingly, if a spouse’s natural, adoptive or stepchildren would be covered, the domestic partner’s children would similarly be covered.

4. When is the Act effective with respect to the offer of health insurance coverage for domestic partners?

The Act applies to new policies issued after July 10, 2004 and to in-force policies as they renew after July 10, 2004.

5. Who is the offer of coverage made to – the employer or the employee?

In the case of employer-sponsored coverage, carriers must make the required offer of coverage to the employer, not to the individual covered employees. Employer-provided coverage includes coverage under a group contract between an insurer and an employer or, where permitted, a multi-employer trust or other multi-employer arrangement. Employer-provided coverage may require the employee to contribute some portion or all of the cost of the coverage.

6. What types of coverages does the Act apply to?

The Act only applies to health insurance, it does not apply to life insurance. With respect to health coverage, the Act applies to policies providing comprehensive or major medical coverage, as well as to stand-alone dental, prescription drug, and vision coverage. It does not apply to accident only, credit, disability income, stop loss or long-term care coverage.

Group student health insurance that provides benefits for both accidents and sickness under which dependent coverage is available must offer dependent coverage to a covered person’s domestic partner. Group student policies that provide accident-only coverage for students and their dependents do not have to offer domestic partner coverage.

Medicare Supplement policies are not typically designed to provide dependent coverage. However, if dependent coverage is provided, a Medicare Supplement policy must offer coverage to a covered person’s domestic partner unless prohibited by federal law. The Act does not apply to health benefits that are self-funded, even if such benefits are administered by an insurance carrier or an affiliate of an insurance carrier.

7. How does a carrier determine whether a domestic partnership exists?

The Department is not regulating what proof carriers may require employees to submit to establish the existence of a domestic partnership. Carriers may, but are not required, to obtain evidence of a domestic partnership. Similarly, the Department does not regulate how insurers determine that two persons are married.

8. Can carriers charge an employer more for domestic partners than for a spouse?

Carriers are prohibited from rating domestic partners differently than spouses in the small employer market (50 or fewer employees). Carriers may charge more for domestic partners in the large employer market.

9. Is it true that my employer can require me to pay for the coverage of my domestic partner?

Yes, the Domestic Partnership Act allows local employers to require the employee to pay for the coverage of his or her domestic partner. In other words, If an employee wants his partner to be covered, he may have to pay for that coverage.

10. Does the Act only apply to insurance carriers domiciled in New Jersey?

No, the Act applies to all companies authorized to transact health insurance in New Jersey, regardless of the state of domicile. However, the Act applies only to policies issued in New Jersey.

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