SEHBP and SHBP members must provide documentation

The School Employees’ Health Benefits Program (SEHBP) and the State Health Benefits Program (SHBP), will be conducting a Dependent Eligibility Verification Audit (DEVA) to ensure that only eligible employees, retirees, and their dependents are receiving health care coverage under the respective programs. This will require all subscribers to provide legal documentation for all dependents covered under programs. This documentation must prove the dependent’s relationship to the member. Dependents who do not have proper legal documentation will be terminated from the coverage at the end of the audit.

Because the state believes that ineligible dependents are one reason health care costs are increasing, it is looking to verify that those listed as dependents in the programs meet the definition of “dependent” as defined in the law.

The SHBP/SEHBP has retained Alight, a subcontractor of Aon Consulting, to perform the DEVA. Each employee/retiree who covers a dependent under their SEHBP/SHBP health plan will receive a letter from the state introducing Alight as the DEVA vendor. Letters started going out in December, so you may have already received it. This letter will be followed up with a letter from Alight introducing the required audit program.

Members will be asked to submit verification documents confirming that their dependents are eligible for coverage under the programs. These documents could include copies of marriage certificates, birth certificates, federal tax returns or custody agreements. Alight will encourage members to upload the documents to a secure portal, where they can track the verification process. They will also accept documents via secure fax and regular mail.

Although Alight will not be asking for verification documentation until early 2019, NJEA encourages members to start locating these documents, and if necessary, start the process of obtaining them from the appropriate body or agency.

Key definitions

The definition of dependent and children for both the SEHBP and the SHBP is:

o Child (or children) means a subscriber’s child until age 26, regardless of the child’s marital, student, or financial dependency status—even if the young adult no longer lives with his or her parents. This includes a stepchild, foster child, legally adopted child, or any child in a guardian-ward relationship upon submitting required supporting documentation.

o Dependent means an employee’s spouse, eligible domestic or civil union partner. Dependent also means unmarried children and those not in a domestic partnership or civil union, covered by their parents under the SHBP/SEHBP prior to the attainment of age 26, who:

    • Are incapable of self-sustaining employment by reason of mental or physical disabilities.

    • Became incapable prior to attament of age 26.

    • Are substantially dependent upon such employees for support and maintenance while the insurance of the employees remains in force and the dependents remain in such conditions.

You may contact Alight’s Dependent Verification Center at 1-833-372-8748 with questions.

Amnesty period for ineligible dependents

Providing ineligible dependents with health care coverage is not always intentional. For this reason, as part of the DEVA, the state is allowing an amnesty period during which subscribers will have the opportunity to voluntarily identify any ineligible dependents and avoid any penalties or other legal action. After the close of the amnesty period, there may be legal consequences for anyone found to have knowingly enrolled or attempted to enroll ineligible dependents. Should a member know or discover that they are covering an ineligible dependent, they can remove them immediately by contacting the New Jersey Division of Pensions and Benefits.

It is important to remember that any enrollee who does not submit the appropriate documentation to Alight, prior to the conclusion of the DEVA, will have their unverified dependents removed from the SEHBP/SHBP.

You may contact Alight’s Dependent Verification Center at 1-833-372-8748 with questions.

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