Below are excerpts directly from the text of the highlights of the NJ Small Employer Health Program Readoption effective 1/1/2017. If you are looking for 126 pages of fun, there are links to the full text below!

The Definition of a Small Employer
"Small employer" means in connection with a group health plan with respect to a calendar year and a plan year, an employer with a business location in the State of New Jersey who employed an average of at least one but not more than 50 employees on business days during the preceding calendar year;
and who employs at least one employee on the first day of the plan year.
Any person treated as a single employer under subsection (b), (c), (m), or (o) of section 414 of the Internal Revenue Code of 1986 (26 U.S.C. § 414) shall be treated as one employer.

Additionally, small employer includes an employer that employs more than 50 full-time employees if the employer's workforce exceeds 50 full-time employees for no more than 120 days during the calendar year and the employees in excess of 50 who were employed during such 120-day or fewer period were seasonal workers. As used in the definition of small employer full-time means an employee works 30 or more hours per week.
-A small employer carrier shall add the number of full-time employees (where full-time means 30 or more hours per week for purposes of the determination of small employer status) to the number that results from the part-time employee calculation in below, and if the sum is at least one but not more than 50, the employer shall be considered to be a small employer.

-Employees working 30 or more hours per week are full-time employees and each full-time employee counts as one.
-Employees working fewer than 30 hours per week are part-time and counted as the sum of the hours each part-time employee works per week multiplied by four and the product divided by 120 and rounded down to the nearest whole number.
-Small employer carriers shall not include an individual and his or her spouse when the business is owned by the individual or by the individual and his or her spouse, sole proprietors, partners of partnerships, or two percent or more owners of Subchapter S corporations, or their immediate family members as employees, even if such persons will be covered under the employer's plan.
-At the time of application, the determination of whether an employer is a small employer shall be based upon the small employer's completed New Jersey Small Employer Certification form.
-If an employer qualifies as a small employer in the immediately preceding calendar year, the employer shall be considered a small employer regardless of the status of the employer on the date of application or the effective date of coverage, so long as it employs at least one employee on the first day of the plan year
-If an employer did not qualify as a small employer in the immediately preceding calendar year, the employer shall not be considered a small employer, regardless of the status of the employer on the date of application or the proposed effective date of coverage, if any.

The Board on Removing The "A" Definition -
-"When the SEH Board initially amended its rules to accommodate both the Federal and State law, the Board believed it was appropriate to retain aspects of the New Jersey definition of eligible employee and to modify the definition of small employer, creating a two-part definition.
-Following careful analysis the Board believes it is not necessary to retain either the definition of eligible employee which is more restrictive than the Federal law or a two-part definition of small employer in order to effectuate both the Federal and State law. Further, the Board believes that maintaining the definition of eligible employee and a two-part definition of small employer is inefficient and has proven to be confusing for anyone engaged in the administration of the group health plans for small employers. Not merely is it an issue in determining whether an employer is eligible to be offered a small employer health benefits plan, but it becomes problematic for carriers in trying to determine how to address continuation requirements under the Federal Consolidated Omnibus Budget Reconciliation Act (COBRA), Federal Medicare as Secondary Payor requirements and other Federal laws, and there are tax implications as well for the employers who may find themselves classified as small employers for some purposes and large employers for others. Consequently, the Board is proposing to delete the definition of eligible employee, and references to the term throughout the rules (replacing it with the term employee or full-time employee, as appropriate), and the Board is proposing to delete the first part of the definition of small employer. In turn, the Board proposes to amend the definition of "employee" to remove reference to that part of the small employer definition proposed to be deleted."
-IMPORTANT NOTE: ERISA establishes that a group only exists if there are employees covered under the plan, and specifies that an individual and his or her spouse, and partners in a partnership are not considered employees for this purpose if the business is wholly owned by the spouse(s) or the partners. (Owners can be covered under the plan, but if they are the only people covered, the plan is not a group health plan.)

Deleting the term "Eligible Employee"
-The SEH Board proposes to delete the term "eligible employee," and to amend the definitions of "employee" and "small employer" in order to better align New Jersey's rules with Federal law. Employee is defined using common law principles based on the employer-employee relationship
-ERISA establishes that a group only exists if there are employees covered under the plan, and specifies that an individual and his or her spouse, and partners in a partnership are not considered employees for this purpose if the business is wholly owned by the spouse(s) or the partners. (Owners can be covered under the plan, but if they are the only people covered, the plan is not a group health plan.)
-The SEH Board proposes to add a new definition of "full-time employee" that would be used to determine eligibility for coverage under a small employer plan and to calculate participation requirements. For these purposes, full-time means 25 or more hours per week. The SEH Board notes that the 25-hour requirement is consistent with the hourly requirement established in the definition of eligible employee.
Group Health Plan & Full-Time Employee Definition
-"Group health plan" means an employee welfare benefit plan to the extent that the plan provides medical care and including items and services paid for as medical care to employees or their dependents directly or through insurance, reimbursement or otherwise.
-"Full-time employee" as used to determine eligibility for coverage under a small employer health benefits plan and satisfaction of participation requirements means an employee who works a normal work week of 25 hours or more hours per week. Note that the determination of small employer status uses a different definition of full-time employee (30 hours worked per week).
Required Pediatric Dental Verification
-"A small employer carrier that does not embed pediatric dental benefits in the health benefits plans offered to small employers shall obtain a reasonable assurance that the small employer has purchased a stand-alone pediatric dental benefit plan from a carrier that offers a qualified pediatric dental benefit plan."
Amending the definition of "dependent"
-The SEH Board proposes an amendment to the definition of "dependent" to clarify that legal spouse includes a civil union partner for purposes of dependent eligibility but not for purposes of determining employee status. The SEH Board affirms that an employee may cover a civil union partner as a dependent under the plan. The SEH Board notes that if a business owner has a civil union partner and such civil union partner works as an employee in the business the civil union partner should be considered as an employee.
Allowed Charges and Out-Of-Network Reimbursement
-The board is deleting the defined term "allowed charge" and repealing the requirement that carriers use an out-of-network reimbursement standard (80th percent of HIAA) that has not been updated since 2010.
-NOTE: New Jersey law precludes payment of benefits at the out of network level in emergency situations and while the member is an inpatient with respect to services provided during the hospitalization such as anesthesia and radiology
-The SEH Board refers to the small percent of claims to which out of network reimbursement is applied as voluntary out of network claims to distinguish them from out of network claims that are processed subject to New Jersey law cited above such that the member is held harmless.
-Although small employers and their employees prefer plans with out of network benefits, many do not buy them because they are more expensive than EPO and HMO plans. The SEH Board believes that allowing carriers to use an appropriate basis to determine the allowed charge would help bring the premiums closer to the premiums for comparable EPO and HMO plans and expand employer choice.
-It is worth noting that New Jersey has been unique as compared to other states in terms of regulating the basis for the determination of the allowed charge for voluntary out of network claims. As a result, carriers offering plans in the small employer market have been required to use a basis that is specific to the New Jersey small employer market for that small segment of business whereas in the large group market in New Jersey as well as all markets in which the carriers offer plans in other states, have used the basis the carrier determined to be best suited for voluntary out of network claims.
-Further, the Board will require carriers to specifically identify the standard for the determination of allowed charges within the definition of allowed charge contained in the standard plans. The SEH Board is proposing that the standard used by a carrier must allow consumers the opportunity to learn the allowed charge amount for any given service or supply.