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New Jersey Health Insurance
According to the Center for Disease Control, an average of 13.7% of New Jersey residents went uninsured for New Jersey health insurance each year from 2001 to 2003.
New Jersey Health Insurance Regulations
New Jersey residents who have access to group health insurance under an employer cannot be denied or limited access to the employer’s health insurance. New Jersey health insurance companies cannot turn down an applicant for individual health insurance on the basis of health, status, age, gender or other factors. Individuals must meet certain residency standards and must be a resident or intend to be a resident in New Jersey in order to purchase individual health insurance on a guaranteed basis.
With some exceptions, an individual can only purchase individual New Jersey health insurance if that individual does not already have health insurance in the state. In general, individual health insurance is available year round, but, under certain circumstances, an individual may have to wait until the open enrollment period in November.
Individuals under 30 and still dependent upon parents, may still qualify to be covered under the parent’s health insurance plan. Newborns, adopted children, and children placed under adoption are automatically covered for the first 31 days under the parent’s health insurance plan if the plan already covers dependents. Policy changes may need to be made after this period. Under some circumstances disabled children may continue to be covered under the parent’s health insurance plan even if they have passed the age at which dependent coverage usually ends. Full-time students can remain under a parent’s health insurance until the age of 23.
All New Jersey health insurance is guaranteed renewable which means that every individual has the right to renew an existing New Jersey health insurance policy provided the individual has paid all premiums and has not provided false information. All individual health insurers are required to sell comprehensive standardized policies which include HMO policies or PPO policies. Insurers are also required to offer a Basic and Essential Plan which does not include coverage for services such as chemotherapy, prescription drugs and maternity.
Although HIPPA eligible individuals do not face any limitations for pre-existing conditions, other individuals may need to wait for coverage for certain medical conditions. Any medical condition for which an individual received advice, treatment, or diagnosis during the 6 months prior to the beginning of coverage can be considered a pre-existing condition. An insurance company can withhold coverage for this condition for up to 12 months. Continuous health insurance coverage may credit pre-existing policies. Pregnancy can be considered a pre-existing condition. No New Jersey health insurance provider can impose an elimination rider which is designed to permanently exclude a medical condition from policy coverage.
New Jersey health insurance rates cannot vary for individual health insurance due to age, gender, health, occupation or location. They can, however vary for dependents and the Basic and Essential Plan rates can also vary.
For individuals who are between health insurance plans or employers, some New Jersey health insurance companies sell temporary medical insurance.
Alternative New Jersey Health Insurance Options
For individuals who cannot afford individual New Jersey medical insurance, there are some state programs which may help.
- New Jersey Medicaid is available to qualifying individuals who meet the eligibility criteria
- NJ FamilyCare is the State’s Children’s Health Insurance Program that is designed to provide health insurance for children under 19 whose families may not qualify for Medicaid and who also may not be able to afford New Jersey medical insurance.
New Jersey Department of Banking and Insurance
Department of Banking and Insurance
P. O. Box 325
Trenton, NJ 08625-0325
For Individual Health Coverage Program Information: (800) 838-0935
Fax: Health (Individual/Small Employer) (609) 633-2030
According to the New Jersey Department of Insurance, the following is a list of HMO providers authorized to sell insurance in New Jersey:
Aetna Health, Inc.
980 Jolly Road, P.O. Box 1109, Blue Bell, PA 19422
AmeriChoice of New Jersey, Inc.
2 Gateway Center, 13th Floor, Newark, NJ 07102
AMERIGROUP New Jersey, Inc.
d/b/a Americaid Community Care
4425 Corporation Lane, Suite 100, Virginia Beach, VA 23462
AmeriHealth HMO, Inc.
8000 Midlantic Dr., Suite 333, Mt Laurel, NJ 08054
CIGNA HealthCare of New Jersey, Inc.
499 Washington Boulevard, Jersey City, NJ 07310
Coventry Health Care of Delaware, Inc.
2751 Centerville Road, Suite 400, Wilmington, DE 19808
Empire HealthChoice HMO, Inc.
d/b/a WellChoice HMO of New Jersey
P.O. Box 3509, Church Street Station, New York, NY 10008-3509
Health Net of New Jersey, Inc.
3501 State Highway 66, Neptune, NJ 07754
Horizon HealthCare Plan of New Jersey
d/b/a Horizon HMO
(formerly called HMO Blue, is a subsidiary of Horizon Blue Cross Blue Shield of New Jersey)
3 Penn Plaza East, Newark, NJ 07102
Oxford Health Plans (NJ), Inc.
48 Monroe Turnpike, Trumbull, CT 06611
UnitedHealthCare of New Jersey, Inc.
2 Penn Plaza, 7th Floor, New York, NY 10121
University Health Plans, Inc.
550 Broad Street, Newark, NJ 07102-4599
For other New Jersey Insurance Resources, See:
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