New Jersey Health Insurance

New Jersey (NJ)

Individual Health Insurance Regulations

Medical insurance is the logical answer to your family's healthcare needs. In the event of medical mishaps, suitable health coverage can save you from unanticipated medical bills. Shopping for a policy is tedious and needs evaluation of family's medical needs and finances. If you are a New Jersey resident, you can choose from wide range of coverage alternatives. The New Jersey Department of Banking and Insurance regulates the laws under which the New Jersey health insurers can sell private health plans to individuals and families.
To purchase individual medical 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 coverage to a person based on their past or current health status. New Jersey 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 medical insurance in New Jersey if you have access to group health insurance.
Search for plans and the costs associated with them using the search box above. We provide individual, family, Medicare supplemental, group and student health plan quotes for you to compare on all states and zip codes. Remember that having coverage leads to a healthier lifestyle as you are able to get regular doctor checkups and therefore a low-cost premium.

New Jersey (NJ)

Small Group Health Insurance Regulations

New Jersey law defines a small group as any company with 2-50 employees. Group health coverage for groups of this size is guarantee issue which prohibits the 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 look-back and 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 medical 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

Groups with 20 or more employees must follow federal COBRA regulations which state that a departing employee is entitled to remain on the group health plan for a period of 18 months, provided that group health plan remains in existence. An employee who has left work on his own or was terminated from the job is eligible to be covered by COBRA. The one exception to this is if the former employer was fired for gross misconduct. COBRA provides health coverage to individuals and their beneficiaries, spouses and dependents. The COBRA recipient will be responsible for the payment of the entire the insurance premium that the employer was paying for his coverage as well as 2% administrative costs.
New Jersey has its own state mini-COBRA regulation enacted through Regulation Chapter 17B, Section 27-60 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.