New Jersey Health Insurance (NJ)

New Jersey (NJ)
Individual Health Insurance Regulations

Learn more about New Jersey Individual Health Insurance

To purchase individual health insurance in New Jersey you must have resided in the state for a period of 6 months or have recently moved to the state with the intent of staying 6 months or longer. Medical underwriting is not permitted for individual health plans in New Jersey. This restricts the insurance companies from declining to provide health insurance to a person based on their past or current health status. New Jersey health insurance carriers are required to offer five standardized individual health products that must include a basic health plan. The insurance carrier is allowed a 6 month look back period and a 12 month exclusionary period for pre-existing health conditions. The maximum exclusionary period is 12 months and elimination riders are not permitted. Premium rates are community based and may vary depending upon the age, gender and location of applicant. You are not eligible to buy individual health insurance in New Jersey if you have access to group health insurance.

New Jersey (NJ)
Small Group Health Insurance Regulations

New Jersey law defines a small group as any company with 2-50 employees. Group health insurance coverage for groups of this size is guarantee issue which prohibits the health insurance carrier from declining coverage based upon the health status of the group. Insurance companies require that an employer provide proof of eligibility for each employee and must prove that the employee wishing to enroll in the group health plan work for the company at least 25 hours per week. Employers may impose a waiting period upon newly hired employees before allowing them to join the employer-sponsored health plan. The waiting period must be enforced consistently and may not vary. New Jersey law allows for groups of 5 or less to a have a 6 month exclusionary period on pre-existing conditions for any plan member that does not have prior creditable coverage. In determining rates, the insurance company may only consider the age, gender and family status of the group. Groups may not be charged higher rates for poor health status of employees. Insurance companies that offer small group health insurance in New Jersey must offer five standardized plans and one HMO plan with benefits and coverage limits defined by state regulations. Other plans may be offered by each insurance carrier, but these standardized plans must be made available to allow small business owners the ability to compare rates on like plans from various insurance companies.

New Jersey COBRA and Continuation Coverage

New Jersey has its own state mini-COBRA regulation which applies to small group health plans within the state. COBRA is a continuation of coverage under the small group health plan, which may be elected upon the occurrence of a specific qualifying event. This allows the employee to remain on the group health plan and receive the same level of coverage for a specific period of time. Under New Jersey law, the period of time you may remain on the plan is dependent upon the qualifying event, with maximums of 18, 29 and 36 months. Election for continuation coverage must be made in writing within 30 days of the qualifying event and must be made available to any employee that has had a reduction in hours to less than 25, or has lost their job for a reason other than just cause. New Jersey does not have a conversion option for persons leaving a group health plan because New Jersey is a guaranteed issue state for the individual health market.

Additional New Jersey Resources

• New Jersey Family Care
  A state run program offering free or low-cost health care coverage to children and certain low-income parents.
• Medical Assistance & Health Services
  The largest state run social service program, the New Jersey Medicaid program offers financial assistance for health care benefits to the needy throughout the state.
• New Jersey Health & Social Services
  Provides links to many health care related sites, HMO performance reports and Medicare and social services information.
• New Jersey Department of Health and Senior Services
  Offers assistance to the elder population of New Jersey in understanding their Medicare rights and helping them choose the right Medicare plan.

NJ Medical Insurance Statistics

Total Population: 8,725,000
With Health Insurance: 7,401,000 / 84.8%
Without Health Insurance: 1,324,000 / 15.2%
*According to 2005 CPS Reports / U.S. Census Bureau

Note: The percentage of New Jersey residents without health insurance has decreased by .1% since 2004.

New Jersey Department of Banking and Insurance
Phone: 800-838-0935
The Department of Banking and Insurance regulates the insurance industry within the State of New Jersey, handling consumer complaints and offering helpful consumer links and information.

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