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Get Part-time Employees Group New Jersey State ... - Nj
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How to fill out the PART-TIME EMPLOYEES GROUP NEW JERSEY STATE ... - Nj online
This guide provides clear and structured instructions on how to complete the PART-TIME EMPLOYEES GROUP NEW JERSEY STATE HEALTH BENEFITS PROGRAM APPLICATION form online. It aims to assist users with varying levels of experience in filling out this important document accurately and efficiently.
Follow the steps to successfully complete your application.
- Click ‘Get Form’ button to obtain the form and open it in your preferred browser or editing tool.
- Complete Section 1, Employee Information, by providing your last name, first name, middle initial, date of birth, gender, street address, city, state, zip code, home telephone number, and social security number. Ensure all details are accurate and legible.
- Navigate to Section 2, Medical Coverage. Choose between NJ PLUS coverage and the Prescription Drug Plan by checking the appropriate box. Additionally, enter your NJ PLUS Primary Care Physician's ID number if selecting that option.
- In Section 2b, select the level of coverage you wish to have under NJ PLUS. This may include options such as single, member and spouse, or family coverage.
- If opting for prescription drug coverage, proceed to Section 2c and indicate the desired level of coverage.
- Move to Section 4, Dependent Information. List all eligible dependents, including their names, dates of birth, genders, and social security numbers. Ensure to include NJ PLUS Primary Care Physician ID numbers for these dependents.
- If you need to make any changes or updates regarding coverage, complete Section 5, Type of Activity, as applicable. This may involve adding or deleting dependents or indicating any other changes.
- Read through Section 6, Employee Certification, carefully. Sign and date the form to affirm that all information provided is accurate to the best of your knowledge.
- Lastly, submit the completed form to the employer for certification. Once your employer has filled out the necessary sections and confirmed eligibility, you may then submit it to the appropriate health benefits program.
Complete your application for health benefits online now.
“Minimum number of expected work hours” means the minimum number of hours an employee will be assigned to work on a weekly or monthly basis. “Part time employee” means an employee who works fewer than 30 hours per week on average during any one month period. S109 - New Jersey Legislature njleg.gov https://pub.njleg.gov › bills njleg.gov https://pub.njleg.gov › bills
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