(a) The term “State” means the State of New Jersey.

(b) The term “commission” means the State Health Benefits Commission, created by section 3 of P.L.1961, c.49 (C. 52:14-17.27).

(c) (1) The term “employee” means an appointive or elective officer, a full-time employee of the State of New Jersey, or a full-time employee of an employer other than the State who appears on a regular payroll and receives a salary or wages for an average of the number of hours per week as prescribed by the governing body of the participating employer which number of hours worked shall be considered full-time, determined by resolution, and not less than 20.

(2) After the effective date of P.L.2010, c.2, the term “employee” means: (i) a full-time appointive or elective officer whose hours of work are fixed at 35 or more per week, a full-time employee of the State, or a full-time employee of an employer other than the State who appears on a regular payroll and receives a salary or wages for an average of the number of hours per week as prescribed by the governing body of the participating employer which number of hours worked shall be considered full-time, determined by resolution, and not less than 25; (ii) an appointive or elective officer, an employee of the State, or an employee of an employer other than the State who has or is eligible for health benefits coverage provided under P.L.1961, c.49 (C. 52:14-17.25 et seq.) or sections 31 through 41 of P.L.2007, c.103 (C. 52:14-17.46.1 et seq.) on that effective date and continuously thereafter, provided the officer or employee is covered by the definition in paragraph (1) of this subsection; or (iii) every commissioner appointed to the New Jersey Maritime Pilot and Docking Pilot Commission pursuant to R.S.12:8-1. Any hour or part thereof, during which an employee does not work due to the employee’s participation in a voluntary or mandatory furlough program shall not be deducted in determining if a person‘s hours of work are fixed at fewer than 35 or 32 per week, as appropriate, for the purpose of eligibility for health benefits coverage provided under P.L.1961, c.49 (C. 52:14-17.25 et seq.), provided the employee continues to pay contributions for coverage during the period of furlough. If the pay of a furloughed employee is insufficient to withhold the entirety of the employee’s contribution, then the employee shall remit the portion of the contribution not withheld from the employee’s pay to the Division of Pensions and Benefits in the Department of the Treasury in a manner determined by the division, except that no deduction for the payment of such contributions shall be made from the unemployment compensation benefits of the employee. For the purposes of this act, an employee of Rutgers, The State University of New Jersey, shall be deemed to be an employee of the State, and an employee of the New Jersey Institute of Technology shall be considered to be an employee of the State during such time as the Trustees of the Institute are party to a contractual agreement with the State Treasurer for the provision of educational services. The term “employee” shall further mean, for purposes of this act, a former employee of the South Jersey Port Corporation, who is employed by a subsidiary corporation or other corporation, which has been established by the Delaware River Port Authority pursuant to subdivision (m) of Article I of the compact creating the Delaware River Port Authority (R.S.32:3-2), as defined in section 3 of P.L.1997, c.150 (C. 34:1B-146), and who is eligible for continued membership in the Public Employees’ Retirement System pursuant to subsection j. of section 7 of P.L.1954, c.84 (C. 43:15A-7).

For the purposes of this act the term “employee” shall not include persons employed on a short-term, seasonal, intermittent or emergency basis, persons compensated on a fee basis, persons having less than two months of continuous service or persons whose compensation from the State is limited to reimbursement of necessary expenses actually incurred in the discharge of their official duties, provided, however, that the term “employee” shall include persons employed on an intermittent basis to whom the State has agreed to provide coverage under P.L.1961, c.49 (C. 52:14-17.25 et seq.) in accordance with a binding collective negotiations agreement. An employee paid on a 10-month basis, pursuant to an annual contract, will be deemed to have satisfied the two-month waiting period if the employee begins employment at the beginning of the contract year. The term “employee” shall also not include retired persons who are otherwise eligible for benefits under this act but who, although they meet the age or disability eligibility requirement of Medicare, are not covered by Medicare Hospital Insurance, also known as Medicare Part A, and Medicare Medical Insurance, also known as Medicare Part B. A determination by the commission that a person is an eligible employee within the meaning of this act shall be final and shall be binding on all parties.

(d) (1) The term “dependents” means an employee’s spouse, partner in a civil union couple or an employee’s domestic partner as defined in section 3 of P.L.2003, c.246 (C. 26:8A-3), and the employee’s unmarried children under the age of 23 years who live with the employee in a regular parent-child relationship. “Children” shall include stepchildren, legally adopted children and children placed by the Division of Child Protection and Permanency in the Department of Children and Families, provided they are reported for coverage and are wholly dependent upon the employee for support and maintenance. A spouse, partner in a civil union couple, domestic partner or child enlisting or inducted into military service shall not be considered a dependent during the military service. The term “dependents” shall not include spouses, partners in a civil union couple or domestic partners of retired persons who are otherwise eligible for the benefits under this act but who, although they meet the age or disability eligibility requirement of Medicare, are not covered by Medicare Hospital Insurance, also known as Medicare Part A, and Medicare Medical Insurance, also known as Medicare Part B.

(2) Notwithstanding the provisions of paragraph (1) of this subsection to the contrary and subject to the provisions of paragraph (3) of this subsection, for the purposes of an employer other than the State that is participating in the State Health Benefits Program pursuant to section 3 of P.L.1964, c.125 (C. 52:14-17.34), the term “dependents” means an employee’s spouse or partner in a civil union couple and the employee’s unmarried children under the age of 23 years who live with the employee in a regular parent-child relationship. “Children” shall include stepchildren, legally adopted children and children placed by the Division of Child Protection and Permanency in the Department of Children and Families provided they are reported for coverage and are wholly dependent upon the employee for support and maintenance. A spouse, partner in a civil union couple or child enlisting or inducted into military service shall not be considered a dependent during the military service. The term “dependents” shall not include spouses or partners in a civil union couple of retired persons who are otherwise eligible for benefits under P.L.1961, c.49 (C. 52:14-17.25 et seq.) but who, although they meet the age or disability eligibility requirement of Medicare, are not covered by Medicare Hospital Insurance, also known as Medicare Part A, and Medicare Medical Insurance, also known as Medicare Part B.

(3) An employer other than the State that is participating in the State Health Benefits Program pursuant to section 3 of P.L.1964, c.125 (C. 52:14-17.34) may adopt a resolution providing that the term “dependents” as defined in paragraph (2) of this subsection shall include domestic partners as provided in paragraph (1) of this subsection.

(e) The term “carrier” means a voluntary association, corporation or other organization, including a health maintenance organization as defined in section 2 of the “Health Maintenance Organizations Act,” P.L.1973, c.337 (C. 26:2J-2), which is lawfully engaged in providing or paying for or reimbursing the cost of personal health services, including hospitalization, medical and surgical services, under insurance policies or contracts, membership or subscription contracts, or the like, in consideration of premiums or other periodic charges payable to the carrier.

(f) The term “hospital” means (1) an institution operated pursuant to law which is primarily engaged in providing on its own premises, for compensation from its patients, medical diagnostic and major surgical facilities for the care and treatment of sick and injured persons on an inpatient basis, and which provides such facilities under the supervision of a staff of physicians and with 24-hour-a-day nursing service by registered graduate nurses, or (2) an institution not meeting all of the requirements of (1) but which is accredited as a hospital by the Joint Commission on Accreditation of Hospitals. In no event shall the term “hospital” include a convalescent nursing home or any institution or part thereof which is used principally as a convalescent facility, residential center for the treatment and education of children with mental disorders, rest facility, nursing facility or facility for the aged or for the care of persons with substance use disorder.

(g) The term “State-managed care plan” means a health care plan under which comprehensive health care services and supplies are provided to eligible employees, retirees, and dependents: (1) through a group of doctors and other providers employed by the plan; or (2) through an individual practice association, preferred provider organization, or point of service plan under which services and supplies are furnished to plan participants through a network of doctors and other providers under contracts or agreements with the plan on a prepayment or reimbursement basis and which may provide for payment or reimbursement for services and supplies obtained outside the network. The plan may be provided on an insured basis through contracts with carriers or on a self-insured basis, and may be operated and administered by the State or by carriers under contracts with the State.

(h) The term “Medicare” means the program established by the “Health Insurance for the Aged Act,” Title XVIII of the “Social Security Act,” Pub.L.89-97 (42 U.S.C. § 1395 et seq.), as amended, or its successor plan or plans.

(i) The term “traditional plan” means a health care plan which provides basic benefits, extended basic benefits and major medical expense benefits as set forth in section 5 of P.L.1961, c.49 (C. 52:14-17.29) by indemnifying eligible employees, retirees, and dependents for expenses for covered health care services and supplies through payments to providers or reimbursements to participants.

(j) The term “successor plan” means a State-managed care plan that shall replace the traditional plan and that shall provide benefits as set forth in subsection (B) of section 5 of P.L.1961, c.49 (C. 52:14-17.29) with provisions regarding reimbursements and payments as set forth in paragraph (1) of subsection (C) of section 5 of P.L.1961, c.49 (C. 52:14-17.29).

L.1961, c.49, s.2; amended 1966, c.191, s.1; 1970, c.231, s.1; 1972, c.75, s.2; 1979, c.90; 1994, c.48, s.298; 1996, c.8, s.1; 1997, c.150, s.25; 2003, c.246, s.41; 2004, c.130, s.118; 2006, c.47, s.190; 2007, c.103, s.19; 2008, c.89, s.15; 2010, c.2, s.9; 2012, c.16, s.137; 2020, c.57, s.9; 2021, c.418, s.4; 2023, c.177, s.122.