New Jersey Health Insurance
Independent Health Care Appeals Program for New Jersey
The State of New Jersey follows strict health insurance regulations that is not only in place to benefit you medically but exists to help protect your overall security as a policy holder. Understanding the state laws and plans for health insurance in New Jersey will help with recognizing which arrangements are good for you and/or your family.
If you are covered through a group health plan, most likely through your employer, then you are not eligible for the individual New Jersey health insurance policy. The reason behind this is because if you could receive similar coverage options through your group plan, then you cannot be qualified for the individual medical plan.
There are 2 types of individual medical coverage in New Jersey, the Comprehensive Standardized Policy and the Basic and Essential Plan.
Comprehensive Standardized Plan
This policy allows you to choose from 2 standard indemnity policies: HMO or PPO
Basic and Essential Plan
This policy provides much less coverage, offering just the essential protection package
New Jersey Individual Medical Insurance Coverage Terms:
- Non-discrimination: You cannot be denied coverage by an individual insurer due to the status of your health
- October Enrollment Period: You can only enroll for individual medical coverage in October
- Policy Rates: Costs of medical plans are typically determined by community ratings
- Look-Back Period: Insurance companies can review your medical history from the past 6 months for information on any pre-existing conditions
- Exclusion Period: Unless you are HIPAA-eligible, if you have a pre-existing condition, you can be given an exclusion period of up to 12 months. However, insurance companies in New Jersey may not attach exclusion riders to your policy
New Jersey is not a high-risk pool state, which means that it does not have non-profit organizations like other states that offer health insurance to those who have either lost their coverage plan or have pre-existing conditions that prevented them from obtaining any medical insurance.
The most important regulations to know regarding pre-existing health conditions are:
- Creditable Coverage: This is credit individuals receive 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 pre-existing conditions who are switching health insurance providers that may have a waiting period for the coverage. The waiting period is generally 12 months
- Portability: The waiting period for pre-existing conditions is void as long as previous coverage does not lapse between the new coverage and the old coverage
- Pre-existing Exclusions: Health insurance companies have the right to refuse coverage due to certain pre-existing 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 pre-existing health condition in New Jersey, but if you have any complications with the pregnancy, then it will be covered
Learning New Jersey terms and regulations for health insurance helps you as the policy holder. With more understanding, your personal requirements for medical insurance may now have changed. This is a positive revolution because now you have more control over your health decisions. By finding out what different insurance providers in New Jersey offer, acquire insurance quotes from them.
Enter your zip code below to begin with the process. Afterward, see which packages benefit you the most in terms of coverage options and affordability. Once you’ve determined which provider you want to go with, make the switch.