State RegulationsNJ specificDifficulty 2/5
Under a New Jersey employer's group health policy, what document do enrolled employees receive, and what does it do?
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
In the group structure governed by N.J.S.A. 17B:27-26 et seq., the master policy is held by the group policyholder, and each enrolled member receives a certificate of insurance. The certificate summarizes the member's coverage, benefits, and rights under the master policy without conveying ownership of the contract itself. The New Jersey Department of Banking and Insurance regulates the form and content of these documents in carriers' group health business.
Why the other options are wrong
- B) Members do not receive the master policy itself, and no individual member can amend the group contract with the carrier.
- C) Enrollment as a member conveys no licensing authority of any kind.
- D) A waiver evidences declined coverage; an enrolled employee receives a certificate describing the coverage in force.
Memory hook
Master policy to the employer, certificate to the member — summary, not ownership.