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Effective Date: April 1, 2009

Approval Date: ____________ 45

For families with gross income above 200% and at or below 250% of the federal poverty level before the applicable disregards, the monthly premium will be $37.50 per family. For families with gross income above 250% and at or below 300% of the federal poverty level before the applicable disregards, the monthly premium will be $74.50 per family. For families with gross income above 300% and at or below 350% of the federal poverty level before the applicable disregards, the monthly premium will be $125.00 per family.

The premiums required above will be adjusted in accordance with the change in the Federal Poverty Level (FPL) for a family of 2 at 100% FPL, as compared to the previous year. In other words, as income increases with the increase in the FPL, premiums will increase by the same percentage. For example, if the income amount changes by 2%, the premium amount will also change by 2%. A notice of administrative change regarding the revised premiums will be published in the New Jersey Register, as a legal notice in the newspapers of widest circulation in cities of 50,000 or more within the State, placed on the agency's web site, distributed to the State House Press Bureau, and sent to any person who requests to be placed on a list of interested parties in regard to such changes. Each family affected by the change in premiums will receive an individual notice of the change.

Families will be granted a 30 day grace period before coverage is canceled for non-payment of premium. Given that the mechanism for determining when a family has exceeded the cost-sharing cap anticipates payment of the monthly premium for the entire year, this will not be an issue in determining when a premium payment is due.

Premiums for families participating in the State's premium assistance program are set lower than the premiums in the NJFC program, to assist in achieving the goal of encouraging families to participate in the premium assistance program.

NJ FamilyCare Premium Payments Effective July 1, 2007 Premiums for Children

Plan C 18.50 Plan D (over 200% FPL up to and including 250% FPL) 37.50 Plan D (over 250% FPL up to and including 300% FPL) 74.50 Plan D (over 300% FPL up to and including 350% FPL) 125.00

NJ FamilyCare Premium Assistance Premium Payments Effective July 1, 2007 Premiums for Children

Plan C 8.50 Plan D (over 200% FPL up to and including 250% FPL) 27.50