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11 N.J.A.R. 257

Health Benefits Commission, State; G.B. and R.B. v
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Citation: 11 N.J.A.R. 257
Decision Date: 1986
Agency: STATE HEALTH BENEFITS COMMISSION
Synopsis: The State Health Benefits Commission denied appellants' request for continued health insurance coverage for their son on the basis of his handicapped status. An appeal was filed arid the matter was transmitted to the Office of Administrative Law. Appellants' son was a qualified dependent under the State Health Benefits Program until he reached the age of 23, as provided by the benefits contract. Appellants requested continued coverage because their son is disabled by mental illness, incapable of self-sustaining employment and dependent upon appellants for support and mainten- ance. The request was denied because the benefits contract permits continued coverage only for dependents incapable of self-support because of mental retardation or physical handicap, but does not include mental illness as a reason for continuance. Appellants contend that this restriction contravenes the State Health Benefits Act and violates equal protection guarantees. The administrative law judge assigned to the case denied appellants' claims, concluding that the denial of extended coverage to dependents who are mentally ill is consistent with the authority given the State Health Benefits Commission in the State Health Benefits Act. That law empowered the State Health Benefits Commission to negotiate terms of benefits contracts which the Commission deemed to be in the best interest of the State and its employees. Because the law did not require extended coverage for dependents, the Commission acted within its discretion in negotiating the contract terms applied to ap- pellants. Providing extended coverage for mentally ill dependents G.B.v. State Health Benefits C0m'n would be difficult to administer and would increase costs. These were legitimate factors for the Commission to consider. Accordingly, the denial of extended coverage by respondent was affirmed. Upon review, this initial decision was accepted by the State Health Benefits Commission. The Appellate Division reversed and remanded. G.B. and R.B., appellants, pro se Edward Kopelson, Esq., for N.B., appellant-intervenor (Community Health Law Project, attorneys) Adele C. Baker, Deputy Attorney General, for respondent (W. Cary Edwards, Attorney General of New Jersey, attorney)
Rule(s) Cited: 17:9-2.16 
Statute(s) Cited: 52:14-17.25 et seq. 52:14-17.32 
Citation Tracker adopted-Health Benefits Com'n; reversed & remanded-222 N.J. Super 83 (App. Div. 1988) [Updated through 1991]