New Jersey Individual Health Insurance
In the wake of rising healthcare costs, health insurance is a crucial protection that no person or family should be without. For those considering New Jersey individual health insurance, the possibilities are endless, as there are often literally hundreds of plans to choose from. Since you are considering individual health insurance in New Jersey, you may want to know more about the laws regulating individual policies.
Eligibility: How Am I Evaluated?
New Jersey individual health insurance applications are reviewed based on residency requirements. Insurers are not allowed to use criteria such as age, past medical history, and lifestyle habits to determine whether or not to approve or deny an applicant. New Jersey law requires private insurers to accept all residents who meet certain residency standards and provide a certain number of standardized policies for them to choose from.
In accordance with HIPPA Group-to-Individual Portability Coverage regulations, New Jersey guarantees issuance of health insurance through any private health insurance provider to all HIPPA eligible consumers.
New Jersey Guaranteed Benefits & Pre-Existing Conditions
The state of New Jersey does require insurers to carry certain standardized policies that are guaranteed issue. These policies include:
- Four comprehensive indemnity policies
- A comprehensive HMO policy
- A comprehensive PPO policy
- A non-comprehensive 'Basic and Essentials Plan'
HIPPA eligible consumers cannot have exclusion periods imposed on their policy. Pre-existing conditions can be included in an exclusionary period of up to 12 months for up non-HIPPA customers. To determine what is a pre-existing condition, insurers can look back in your medical files up to 6 months prior to your application. Any condition that you did or should have sought medical advice or treatment for can be considered a pre-existing condition. Elimination riders cannot be imposed on policies in the state.
New Jersey Individual Health Insurance Premiums
For most policies, insurers cannot give you a premium based on individual factors such as age, gender, and health. The policies cost must be based on the benefits offered with the plan. The exception is with a 'Basic and Essentials Plan';, which can have a premium based on factors such as age, gender and/or geographic location, but not based on health status. However, your policy cannot be cancelled because of a change in your health status, even when it is time to renew and you won't be charged a higher premium in order to keep the plan. In effect, your health insurer may choose to raise your premiums.
It is important to remember that even basic protection is better than no protection at all when one is suddenly hit with high medical expenses and large bills. Individual health insurance can be a life preserver in these situations. Get in touch with a licensed health insurance broker/agent to choose health coverage that suits your and your family's medical needs.
