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Part III - Covered Individuals Subtask

The Part III - Covered Individuals subtask lists any covered individuals which can either be an employee or a dependent.

Note:

Part III data is not applicable for non-self-insured employer plans unless the reporting state is New Jersey.

Contents

Field	Description
Exclude from Part III in Federal Filing	This checkbox displays if the Part III data will be included in the federal filing. A Part III record is created for New Jersey employees with a non-self-insured employer plan. This data is reported to New Jersey but should not be included in the federal filing.
Individual Type	These options indicate whether the covered individual type is an Employee or a Dependent.
Dependent Name	If this record is used to indicate a covered dependent, this field displays the selected dependent.
Social Security Number (SSN)	If this record is for covered dependent and a Social Security Number is assigned to the dependent , then this field will be populated with the dependent’s SSN Otherwise, if the Individual Type is Employee, then this field will be populated with the employee’s SSN. If SSN Suppression is selected for the logged-in user, then only the last four digits of the SSN will be displayed. The other values will be shown as x. For example, xxx-xx-1234.
Date of Birth	If this record is for a covered dependent and a Social Security Number is not assigned to the dependent, this field loads the dependent’s date of birth. If the individual type is Employee, then this field will not be populated since the Social Security Number (SNN) field will always display a value for employees.
Covered All 12 Months	These checkbox indicates whether the individual (employee or dependent) was covered under employer provided self-insured coverage for the entire calendar year.
Months of Coverage (January - December)	The checkboxes to indicate whether the individual (employee or dependent) was covered under employer provided self-insured coverage for specific months, if the individual was not covered for the entire year.

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Part III - Covered Individuals Subtask

The Part III - Covered Individuals subtask lists any covered individuals which can either be an employee or a dependent.

Note:

Part III data is not applicable for non-self-insured employer plans unless the reporting state is New Jersey.

Contents

Field	Description
Exclude from Part III in Federal Filing	This checkbox displays if the Part III data will be included in the federal filing. A Part III record is created for New Jersey employees with a non-self-insured employer plan. This data is reported to New Jersey but should not be included in the federal filing.
Individual Type	These options indicate whether the covered individual type is an Employee or a Dependent.
Dependent Name	If this record is used to indicate a covered dependent, this field displays the selected dependent.
Social Security Number (SSN)	If this record is for covered dependent and a Social Security Number is assigned to the dependent , then this field will be populated with the dependent’s SSN Otherwise, if the Individual Type is Employee, then this field will be populated with the employee’s SSN. If SSN Suppression is selected for the logged-in user, then only the last four digits of the SSN will be displayed. The other values will be shown as x. For example, xxx-xx-1234.
Date of Birth	If this record is for a covered dependent and a Social Security Number is not assigned to the dependent, this field loads the dependent’s date of birth. If the individual type is Employee, then this field will not be populated since the Social Security Number (SNN) field will always display a value for employees.
Covered All 12 Months	These checkbox indicates whether the individual (employee or dependent) was covered under employer provided self-insured coverage for the entire calendar year.
Months of Coverage (January - December)	The checkboxes to indicate whether the individual (employee or dependent) was covered under employer provided self-insured coverage for specific months, if the individual was not covered for the entire year.