Health Insurance in New Jersey

Health Insurance in New Jersey
New Jersey has witnessed a good improvement in its health system as it stands at 18th spot in the 2008 Healthiest States List of United Health Foundation. In 2007, the state was at 21th position and 14th position in 2006. The major strengths of New Jersey include low percentage of children in poverty, better access to primary health care services and good public health funding. The state, having the population of more than eight million people, offers both private-market and public health insurance alternatives. The private-market health insurance consists of various types of health plans including family, Medicare supplemental, short-term, student, group and dental. In addition, the state and federal government sponsored programs provide subsidized health coverage to the uninsurable residents of New Jersey who meet specific eligibility requirements.

The New Jersey Department of Banking and Insurance protects the insurance consumers against unfair practices by regulating all kinds of insurance sold through private-market health insurers as well as public health coverage programs. However, 15.6% uninsured residents continue to be a major concern for the state’s lawmakers. Approximately, 41.1% uninsured New Jersey citizens come under the above 200% FPL bracket, according to the Censor Bureau’s 2007 and 2008 Current Population Survey.

Health insurance is one thing that you cannot afford to survive without. When purchasing health coverage, it is prudent to contact a licensed health insurance agent/broker to avail the benefits of health insurance alternatives.

Individual/Family Health Insurance

Below is the guidelines for applying for and obtaining individual health insurance in the state of New Jersey. These regulations apply to all insurance companies offering individual or family health insurance in New Jersey:

Medical Underwriting
Yes
Pre-Existing Condition Exclusion Period
12 months
Look Back Period
6 months
Look Back Standard
Prudent person
Mandatory Benefits
Cancer screening for women including breast cancer screening and cervical cancer screening, reconstructive surgery after mastectomy, eating disorder parity, maternity care
Market Rate Restrictions
Yes
Guaranteed Issue Options
None
Small Group Health Insurance

Below is the guidelines for small group health insurance in the state of New Jersey. These regulations apply to all insurance companies offering small group health insurance in New Jersey.

Small Group Size
2-50
Employee Qualifications
Two employees must work for at least 6 months out of the year, and work 25 hours per week
Guaranteed Issue
Yes
Premium Rating Factors
Adjusted Community Rating
Rate Adjustment Factors
Modified Community Rate
Look-Back Period
6 months
Pre-existing condition exclusionary period
6 months
Mandatory Benefits
Same as individual
State Cobra Variations for Small Groups

Below are the COBRA guidelines for small groups in the state of New Jersey. For employer groups of more than 20 employees, refer to the federal COBRA guidelines:

Mini-Cobra Option
Yes
Eligible Group Sizes
2-19
Extension of Benefits Period – Standard
18 months
Extension of Benefits Period – Disabled
29 months
Maximum Premium Increase
102%
State Legislation Reference
Regulation Chapter 17B, Section 27-60
Additional Notes
The employee should elect the mini-cobra coverage within 30 days
State Sponsored Health Insurance Programs

There are several state sponsored health insurance programs in the State of New Jersey to assist those without insurance in obtaining adequate coverage.

High-Risk Pools

Some states offer special state sponsored health insurance plans for qualified persons that are not eligible for individual health insurance due to pre-existing medical conditions. However, New Jersey does not have a high risk pool for its residents who are unable to obtain private health insurance due to pre-existing health conditions.

Children’s Health Insurance Program

Through shared funding from the federal government, the State of New Jersey provides health insurance for uninsured children that meet certain eligibility guidelines. A summary of this program is outlined in the chart below:

Program Name
NJ Family Care
Website
https://www.njfamilycare.org/
Phone Number
800-701-0710
Apply Online
Yes
Age Limits
Under 18
Insurance Carrier
Amerigroup, Americhoice, HealthNet, Horizon Blue Cross Blue Shield of New Jersey, University Health Plan New Jersey
Length of Coverage
Occasional Eligibility Review
Residency Requirements
New Jersey resident and U.S. citizen, qualified immigrant
Other Eligibility Requirements
Applicants will be eligible for NJ FamilyCare only if they have been uninsured for a period of three months or more.
Pre-Existing Condition Exclusions
None
Cost
For many families, NJ FamilyCare will be free. Other families will pay a monthly premium based on their income and small co-payments for some services.
Medicaid

Medicaid is a state program partially funded through the federal government. Qualification guidelines, as well as the types of people that are eligible, will vary by state. The chart below provides a summary of the Medicaid programs in the State of New Jersey

Governing Agency
Department of Human Services
Website
https://www.nj.gov/humanservices/index.shtml
Phone Number
800-356-1561
Residency Requirements
New Jersey resident and U.S. citizen
Federal Poverty Line Income Limits
Infants (5ages 0-1): 200% FPL (5mother is enrolled in Medicaid at the time of birth. If not, infants with family incomes of 185% FPL)
Children (5ages 1-19): 133% FPL
Pregnant Women: 185% FPL (5Expanded coverage for women with incomes between 186% and 200% may also be available)
Qualified Parents: 100% FPL
Medically Needy Individual: 51% FPL
Medically Needy Couple: 45% FPL
SSI Recipients: 74% FPL
Aged, Blind and Disabled: 100% FPL
Additional Resources

New Jersey Health Care Options Matrix™ Guide
Provided by the Foundation for Health Coverage Education, the guide is a quick reference guide prepared by the non-profit Foundation for Health Coverage Education that outlines New Jersey’s public and private health care choices for individuals and groups with various demographic profiles.
Family Health Insurance Guide by HealthInsuranceFinders.com
The guide created by HealthInsuranceFinders.com provides useful information regarding health insurance coverage such as individual/family health insurance, group health insurance, separate child health insurance and state-sponsored programs that are available for low to middle income families.
New Jersey: At-A-Glance
Provides exclusive health data of the New Jersey state. Statehealthfacts.org, a project of the Henry J. Kaiser Family Foundation, is designed to provide free, up-to-date, and easy-to-use health data on all 50 states.