CYNTHIA MEEKINS VS. STATE HEALTH BENEFITS COMMISSION (STATE HEALTH BENEFITS COMMISSION) ( 2021 )

NOT FOR PUBLICATION WITHOUT THE
APPROVAL OF THE APPELLATE DIVISION
This opinion shall not "constitute precedent or be binding upon any court ." Although it is posted on the
internet, this opinion is binding only on the parties in the case and its use in other cases is limited. R. 1:36-3.
SUPERIOR COURT OF NEW JERSEY
APPELLATE DIVISION
DOCKET NO. A-3182-19
CYNTHIA MEEKINS,
Petitioner-Appellant,
v.
STATE HEALTH BENEFITS
COMMISSION,
Respondent-Respondent.
_________________________
Argued October 12, 2021 – Decided December 6, 2021
Before Judges Sumners and Vernoia.
On appeal from the State Health Benefits Commission,
Department of the Treasury.
Michael P. DeRose argued the cause for appellant
(Crivelli & Barbati, LLC, attorneys; Michael P.
DeRose, on the briefs).
Matthew Melton, Deputy Attorney General, argued the
cause for respondent (Andre J. Bruck, Acting Attorney
General, attorney; Melissa H. Raksa, Assistant
Attorney General, of counsel; Matthew Melton, on the
brief).
PER CURIAM
Petitioner Cynthia Meekins appeals the final agency decision of State
Health Benefits Commission (Commission) denying her retirement health
insurance benefits under the State Health Benefits Plan (SHBP). The
Commission's decision was based upon its interpretation of the applicable
statutes and regulations, and its finding that because Meekins was not actively
employed by the State of New Jersey or a State entity at the time of her
retirement, she was not a "retired employee" and, therefore, did not qualify for
retiree coverage under SHBP. We affirm.
I.
In 1985, Meekins began her New Jersey public employment career,
working for the Central Regional School District and becoming a member of the
Public Employees Retirement System (PERS). In 2004, Rutgers University
("Rutgers" or "the university") hired her as a Student and Academic Services
Specialist. As a university employee, she was employed by the State of New
Jersey and continued her PERS membership and received health insurance
benefits under the SHBP.
In July 2015, Meekins was notified by the university that she was being
terminated as part of a major lay-off plan. She subsequently met with a Division
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of Pensions and Benefits (Division) counselor to inquire about the impact of the
layoff on her pension contributions. During the meeting, the counselor advised
her that if she delayed her retirement five more years until she was fifty-five
years old her monthly pension benefit would increase by $2,000. According to
Meekins, the counselor never advised her that she would not be eligible for
retiree SHBP coverage if she was not receiving SHBP coverage at the time of
her retirement.
Following a brief layoff, Meekins returned to employment at Rutgers in
February 2016. She worked at the university for another year until she was laid
off again in February 2017. After this second layoff, Meekins continued her
enrollment in SHBP by making monthly COBRA payments.
In June 2017, Meekins accepted a position at Barnard College of
Columbia University. She then cancelled her SHBP coverage because her new
job provided health insurance coverage. Meekins did not return to public
employment in New Jersey.
Two years later, on May 31, 2019, Meekins filed for PERS early
retirement with the Division, effective June 1, 2019, based upon her age of fifty-
five and thirty-one years of service credit. On August 16, the Division sent her
a letter denying her retiree coverage under SHBP "because [she] did not
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maintain [her] . . . health coverage until the date of [her] retirement." Meekins
appealed the decision to the Commission.
On September 11, the Commission heard Meekins's appeal. The
Commission, however, tabled its decision until November 20, "to allow [her]
time to gather information from Rutgers University regarding the termination of
[her] employment in 2017" because she claimed she "received a 'retirement
package' from Rutgers."
On November 20, after considering "all the information submitted," the
Commission denied Meekins's appeal. In a November 25 letter notifying her of
its decision, the Commission explained:
the rules and regulations of the SHBP explicitly state
that there cannot be a gap in health benefits coverage
between active coverage and retired coverage.
[N.J.A.C.] 17:9-6.1 defines a retired employee as:
Retired employees of the State of New
Jersey and of employers defined as State
agencies in N.J.S.A. 52:14-17.26, who
were eligible for coverage as active
employees immediately prior to retirement
and who continued coverage at
retirement[.]
Your employment with Rutgers University ended
February 4, 2017. You carried COBRA from March 1,
2017[,] through July l, 2017. You retired on an early
retirement effective for June 1, 2019. Retiree coverage
would have begun on July 1, 2019. However, since
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there was a lapse in coverage from July 1, 2017[,]
through July 1, 2019[,] you are not eligible for retired
coverage.
On December 17, Meekins appealed "the Commission's determination in
both law and fact" and "request[ed] that the matter be declared a contested case
and transmitted to the Office of Administrative Law for the appropriate
hearing." Her request was subsequently denied.
On March 11, 2020, the Commission issued its final agency decision,
denying Meekins's request for a contested case hearing and her enrollment into
SHBP as a retiree. Applying essentially the same reasoning as it set forth in its
November 25 letter, but in greater detail, the Commission stated:
The health care benefits coverage under the SHBP of
any employee shall cease upon the discontinuance of
employment, subject to such regulations as may be
prescribed by the Commission for continuance of
coverage after retirement. N.J.S.A. 52:14-17.32.
To be eligible to enroll in the SHBP in retirement an
individual must be a "retired employee" as defined by
N.J.A.C. 17:9-6.1. A "retired employee" includes
"[r]etired employees of the State of New Jersey and of
employers defined as State agencies in N.J.S.A. 52:14-
17.26, who were eligible for coverage as active
employees immediately prior to retirement and who
continued coverage at retirement." N.J.A.C. 17:9-
6.l(b)(l). For prospective retirants, continuity of
coverage may be extended until the application for
retirement is formally approved or denied by the Board
of Trustees of the retirement system paying the benefit.
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N.J.A.C. 17:9-6.2(a). However, the coverage must be
continuous for coverage to be extended under N.J.A.C.
17:9-6.2(a).
To be eligible for retiree health benefits there must be
coverage under the SHBP immediately prior to
retirement and continued at retirement. Continuity of
coverage can only be extended under N.J.A.C. 17:9-
6.2(a) only if there is continuous coverage. []Meekins's
active health benefits coverage terminated on June 30,
2017, but her retirement did not become effective until
July 1, 2019. []Meekins had a two[-]year lapse in
coverage and without continuous coverage, she is not
eligible for retiree health benefits.
(first alteration in original).
In addition, the Commission rejected Meekins's contention "that a
Division counselor gave her inaccurate and incomplete information in 2015
when her employment with Rutgers was first terminated." Because Meekins did
not retire at that time and "returned to employment at Rutgers in February 2016,"
the Commission determined "she did not rely on the alleged statements of the
Division counselor when she decid[ed] not to retire in 2015."
The Commission also rejected Meekins's assertions that: (1) "a Division
counselor gave her inaccurate and incomplete information in 2015 when her
employment with Rutgers was first terminated"; and (2) the Division failed to
advise her after her second lay-off in 2017 "that she would become ineligible
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for retiree health benefits if she did not file for retirement when she left
employment." The Commission stated:
this information was provided to []Meekins by her
employer in the retirement package, which included
Fact Sheet #11, a document that is also publicly
available, that explains to be eligible for retired group
health benefits coverage a member "must have been
eligible for health insurance coverage until their
retirement date." During her presentation to the
Commission on November 25, 2019, []Meekins
admitted that she did not intend to retire in 2017. [Her]
incorrect belief that pension benefits and health
benefits are tied together, cannot displace the eligibility
requirements [f]or retiree health benefits.
Finally, the Commission determined there was no need for a contested
hearing because it was "able to reach its findings of fact and conclusions of law,
based on . . . undisputed facts and . . . [its] conclusions of law."
II.
Meekins now appeals the Commission's final agency decision, presenting
the same unsuccessful arguments she raised in the administrative proceeding.
She asserts she qualifies for retiree SHBP coverage based on her thirty-one years
of public service and contributions to PERS. She relies upon N.J.A.C. 17:9-
6.1(a), which states in part that, "'retired employee' means 'a person who is
eligible for coverage under the SHBP's retiree group.'" Citing Barron v. State
Health Benefits Com'n, 343 N.J. Super. 583 (App. Div. 2001), she insists the
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legislative intent of N.J.S.A. 52:14-17.32(c)(1) 1 is to provide health benefits to
retirees who accrue at least twenty-five years of service credit. She also
reiterates her equitable estoppel argument that she is entitled to retiree health
insurance benefits because she was not advised by the Division that a failure to
be enrolled in SHBP at the time of her retirement would disqualify her for
coverage. We disagree and affirm substantially for the reasons set forth in the
Commission's final agency decision. We add the following comments.
A.
This court's review of administrative agency decisions is generally
limited. In re Stallworth, 208 N.J. 182, 194 (2011). "We will ordinarily defer
to the decision of a State administrative agency unless the appellant establishes
that the agency's decision was arbitrary, capricious, or unreasonable, or that it
was unsupported by sufficient credible, competent evidence in the record."
Green v. State Health Benefits Com'n, 373 N.J. Super. 408, 414 (App. Div.
2004).
1
The statute is part of the New Jersey Health Benefits Program Act, N.J.S.A.
52:14-17.24 to .45.
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It is also well established that "[c]ourts afford an agency great deference
in reviewing its interpretation of statutes within its scope of authority." N.J.
Ass'n of Sch. Adm'rs v. Schundler, 211 N.J. 535, 549 (2012) (citations omitted).
The same applies to an agency's interpretation of its own regulations. R.S. v.
Div. of Med. Assistance & Health Servs., 434 N.J. Super. 250, 261 (App. Div.
2014) (quoting I.L. v. N.J. Dep't of Human Servs., Div. of Med. Assistance &
Health Servs., 389 N.J. Super. 354, 364 (App. Div. 2006)). Courts defer to the
interpretation of legislation by the administrative agency to whom its
enforcement is entrusted, but only if that interpretation "is not plainly
unreasonable." Merin v. Maglaki, 126 N.J. 430, 437 (1992); accord Matturri v.
Bd. of Trs. of the Judicial Ret. Sys., 173 N.J. 368, 382 (2002). Nonetheless,
"when an agency's decision is based on the 'agency's interpretation of a statute
or its determination of a strictly legal issue,' we are not bound by the agency's
interpretation. Statutory interpretation involves the examination of legal issues
and is, therefore, a question of law subject to de novo review." Saccone v. Bd.
of Trs. of Police & Firemen's Ret. Sys., 219 N.J. 369, 380 (2014) (quoting Russo
v. Bd. of Trs., Police & Firemen's Ret. Sys., 206 N.J. 14, 27 (2011)).
"When assessing a regulation's intent, '[t]he same rules of construction
that apply to the interpretation of statutes guide our interpretation of
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regulations.'" J.H. v. R & M Tagliareni, LLC, 239 N.J. 198, 216 (2019)
(alteration in original) (quoting Headen v. Jersey City Bd. of Educ., 212 N.J.
437, 451 (2012)). The first step in interpreting the statute is to look "to the plain
language of the statute," and "ascribe to the statutory language its ordinary
meaning." D'Annunzio v. Prudential Ins. Co. of Am., 192 N.J. 110, 119-20
(2007) (citations omitted). Our "goal in the interpretation of a statute is always
to determine the Legislature's intent." Id. at 119 (citing Wollen v. Borough of
Fort Lee, 27 N.J. 408, 418 (1958)). "Where a statute is clear and unambiguous
on its face and admits of only one interpretation, a court must infer the
Legislature's intent from the statute's plain meaning." O'Connell v. State, 171
N.J. 484, 488 (2002) (citing V.C. v. M.J.B., 163 N.J. 200, 217 (2000)). When a
statute's plain language lends to only one interpretation, a court should not
consider "extrinsic interpretative aids." DiProspero v. Penn, 183 N.J. 477, 492
(2005) (quoting Lozano v. Frank DeLuca Const., 178 N.J. 513, 522 (2004)).
"On the other hand, if there is ambiguity in the statutory language that leads to
more than one plausible interpretation, we may turn to extrinsic evidence,
'including legislative history, committee reports, and contemporaneous
construction.'" Id. at 492-93 (quoting Cherry Hill Manor Assocs. v. Faugno,
182 N.J. 64, 75 (2004)).
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B.
A PERS retiree's eligibility for SHBP coverage is governed by N.J.S.A.
52:14-17.32(c)(1), N.J.A.C. 17:9-6.1, and N.J.A.C. 17:9-6.2. The intent of the
statute and regulations is clearly and unambiguously stated: for a PERS retiree
to be eligible for SHBP, he or she must be an employee at the time of retirement.
N.J.S.A. 52:14-17.32(c)(1) provides:
From funds appropriated therefor, the State shall pay
the premium or periodic charges for the benefits
provided to a retired State employee and the
employee’s dependents covered under the program, but
not including survivors, if such employee retired from
one or more State or locally-administered retirement
systems on a benefit or benefits based in the aggregate
on 25 years or more of nonconcurrent service credited
in the retirement systems, excluding service credited
under the Defined Contribution Retirement Program
established pursuant to P.L.2007, c.92 (C.43:15C-1 et
al.), and excepting the employee who elected deferred
retirement, but including the employee who retired on
a disability pension based on fewer years of service
credited in the retirement systems and shall also
reimburse such retired employee for the premium
charges under Part B of the federal Medicare program
covering the retired employee and the employee’s
spouse.
[N.J.S.A. 52:14-17.32(c)(1) (emphasis added).]
In Barron, we held N.J.S.A. 52:14-17.32(c)(1) provides that free medical
coverage shall be provided to any "retired State employee and his [or her]
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dependents covered under [the SHBP] . . . if such employee retired from a State-
administered retirement system on a benefit based on twenty-five years or more
of service credited in such system." 343 N.J. Super. at 586 (second alteration in
original) (emphasis added).
N.J.A.C. 17:9-6.1 provides, in pertinent part:
(a) "Retired employee" means a person who is eligible
for coverage under the SHBP's retiree group. . . .
(b) The definition of "retired employee" also includes
the following classes of retired employees who are
eligible for coverage:
1. Retired employees of the State of New Jersey and of
employers defined as State agencies in N.J.S.A. 52:14-
17.26, who were eligible for coverage as active
employees immediately prior to retirement and who
continued coverage at retirement[.]
In addition, N.J.A.C. 17:9-6.2(a)(2), provides, for prospective retirees,
"continuity of coverage may be extended until such time as the application for
retirement is formally approved or denied by the Board of Trustees of the
retirement system paying the benefit." However, to avoid a lapse of SHBP
coverage, "[t]he retiring employee . . . must submit personal payments to the
[SHBP] in order to continue coverage."
The plain language of these statutory and regulatory guidelines is clear
and unambiguous that, because Meekins was not covered by SHBP at the time
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of her retirement, she was ineligible for SHBP retiree coverage. It is obvious to
us there is no text in either statute or regulation supporting Meekins's claim for
relief. Thus, we do not consider any extrinsic evidence to determine whether
the Commission misapplied the law.
Meekins's equitable estoppel contention is equally unpersuasive. To
sustain such a contention, she must show the Commission or its representatives
"engaged in conduct, either intentionally or under circumstances that induced
reliance, and that [she] acted or changed [her] position to [her] detriment."
Tasca v. Bd. of Trs., Police & Firemen's Ret. Sys., 458 N.J. Super. 47, 59 (App.
Div. 2019) (quoting Knorr v. Smeal, 178 N.J. 169, 178 (2003)). She has not
done so. There is no assertion the Division counselor misadvised Meekins
before her initial lay-off from Rutgers in 2015, which caused her to be ineligible
for SHBP retiree coverage when she eventually retired in 2019. The counselor
did not have an affirmative duty to advise her that she would be ineligible for
SHBP retiree benefits if she was not in the SHBP at the time she retired. Indeed,
Meekins was properly advised through Fact Sheet #11 that she had to be covered
by SHBP upon retirement to receive retiree health insurance benefits.
The Commission's final agency decision is not arbitrary, capricious, nor
unreasonable, and is supported by the credible evidence in the record. R. 2:11-
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3(e)(1)(D). To the extent we have not specifically addressed any of Meekins's
arguments, they lack sufficient merit to warrant discussion in this opinion. R.
2:11-3(e)(1)(E).
Affirmed.
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