New Jersey Health Insurance

The New Jersey laws regulating health insurance are a bit different from those in other states. Whether you are looking for individual or family coverage, it is important to be knowledgeable about how these laws will affect the type of policy you choose. To help you get started, we've created this guide in the hopes that you'll find the plan and carrier that works best for you.

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Getting Individual Medical Coverage in New Jersey (NJ)

In New Jersey, insurance companies are required to offer two types of individual health plans. The first is a comprehensive standardized policy, which will allow you to choose from 4 standard indemnity policies, an HMO, or a PPO. The second is the Basic and Essential Plan, which has fewer benefits. Be sure to read your policy carefully so you know how you will be covered. Below are some important terms to know if you are purchasing an individual health plan in New Jersey:

• Nondiscrimination — You cannot be denied coverage by an individual insurer due to your health status.
• October enrollment period — In New Jersey, enrollment for individual health coverage is ONLY during the month of October.
• Policy rates — In NJ, the costs of medical plans are usually determined by community ratings.
• Look-back period — The past 6 months of your medical history can be reviewed by carriers to look for preexisting conditions.
• Exclusion period — Unless you are HIPAA-eligible, if you have a preexisting condition, you can be given an exclusion period of up to 12 months. However, insurance companies may not attach exclusion riders to your policy.

New Jersey Family Health Plans (NJ)

The regulations concerning family health insurance in New Jersey are similar to those for individual coverage. To review:

• If you are qualified for group health insurance, New Jersey providers may not turn you down or charge you higher rates.
• Certain life changes, such as marriage or the birth of a child, may provide you more opportunities to enroll in health coverage.
• Group insurers may check the past 6 months of your family members' medical history for preexisting conditions. Exclusion periods may be imposed.

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Pre-Existing Conditions and New Jersey (NJ) Health Insurance

If you have a preexisting condition and are looking for health insurance in New Jersey, your search can be quite difficult. This is because unlike in some other states, New Jersey does not have a state high-risk pool. (State high risk pools are non-profit organizations that offer health insurance to those people who have lost their insurance or have preexisting conditions that prevent them from obtaining health insurance). New Jersey has several regulations concerning preexisting health conditions. Some important ones:

• Creditable Coverage — This is credit individuals get for prior coverage under a group health plan, health coverage, Medicaid, Medicare, military-sponsored health care, Peace Corp, foreign country's government health plan, Federal Employee health plan or public health plan.
• Creditable Coverage Option — New Jersey offers the creditable coverage option for those people with preexisting conditions who are changing health insurance providers and may have a waiting period for coverage. The waiting period is generally 12 months before coverage will begin.
• Portability — In New Jersey, portability means that the waiting period for preexisting conditions is void as long as previous coverage does not lapse between the new coverage and the old coverage.
• Preexisting Exclusions — Health insurance companies in New Jersey may include preexisting condition exclusions for their contracts. They have the right to refuse coverage due to certain preexisting conditions and can implement a 12 month waiting period for coverage on others. This is assuming there are no portability issues.
• Pregnancy — Pregnancy is considered a preexisting health condition in New Jersey; however, if you have any complications from pregnancy, they will be covered.

Getting a New Health Plan in New Jersey (NJ)

If you're moving to New Jersey or worried about what to do about your health insurance between jobs, read the information below so you know what to expect from your new policy:

• COBRA — If you have left your job, COBRA can help you retain the benefits you had under your employee health plan, if you are eligible.
• Conversion policies — New Jersey law allows people who have lost an employer's health coverage due to divorce the option of buying a conversion policy. A conversion policy is an individual policy from the same carrier that ensured your employer.
• Government employees — Be aware that public employers may exempt you from certain health insurance protections provided by NJ regulations. Check with your employer if you want to know more about your medical plan.

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