HomeMy Public PortalAboutr 10-265#10 -265 Decarber 2, 2010
HB80 -184 -793
STATE OF NEW JERSEY
DEPARTMENT OF THE TREASURY
DIVISION OF PENSIONS AND BENEFITS
NEW JERSEY STATE HEALTH BENEFITS PROGRAM
PO BOX 299 Trenton, New Jersey 08625 -0299
RESOLUTION
A RESOLUTION to terminate participation under the New Jersey State Health Benefits Program Act of
the State of New Jersey for Prescription Drug Coverage only.
BE IT RESOLVED:
1. The Borou* of Carteret
hereby resolves to terminate its participation in the Local Prescription Drug Program thereby
canceling prescription drug coverage provided by the New Jersey State Health Benefits Program
(N.J.S.A. 52:14 -17.25 at seq.) for all its active employees.
2. We shall notify all active employees of the date of their termination of coverage under the program.
3. We understand that all COBRA participants will be notified by the Division of Pensions and Benefits and
advised to contact our office concerning a possible alternative prescription drug program.
5. We understand that this resolution shall take effect the first of the month following a 60 -day period
beginning with the receipt of the resolution by the State Health Benefits Commission.
i hereby certify that the foregoing is a true and
correct copy of a resolution duly adopted by the
I i It'1 ! � = Nlytlli
Corporate Name of Employer
on the 2 day of DISII4t, 2010
KkURM M. BAM EY Sinnature
nWCIPAL CLEI;K Official Title
G 11 I � • I: It
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Damrbe 2, 2010
HB -80- 185 -793
PLEASE COMPLETE AND COMPLY WITH THE FOLLOWING:
A. Employer New Jersey State Health Benefits Program
Identification Number
B. New Prescription Drug Carrier
C. Reason for termination of the State Prescription Drug Program
D. In accordance with N.J.S.A. 18A:16 -21 and 40A:10 -25, you must file a copy of your new contract with
the State Health Benefits Commission. Please submit a copy of the new contract with this completed
resolution.