Health Insurance Carriers in New Jersey (NJ)
New Jersey has a variety of rules particular to the state concerning health insurance. Because navigating the twists and turns of the plans and providers available is no easy task, we have gathered together the information you need to make a well informed decision.
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Health Insurance Providers in New Jersey
Assurant Health (Formerly Fortis)
Guardian / Health Net
Horizon Blue Cross Blue Shield of New Jersey
Oxford Health Plans
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Group Health Insurance in New Jersey
- Qualified people may not be denied or charged more for coverage due to a health problem.
- Employers and HMOs can impose a waiting period on new coverage.
- Life changes regarding family and job loss may provide for opportunities in group health coverage.
- Providers may review medical history for the six months previous to coverage to assess the status of a pre-existing condition.
- In the case of a pre-existing condition, providers may apply an exclusion period, the length of which varies according to type of coverage.
- If continuous coverage of a pre-existing condition was maintained with no breaks over 63 days, creditable coverage is available.
- Contact employers for more information.
Small Business Health Insurance in New Jersey
- Small businesses with fewer than 50 employees may not be denied small group insurance or cancelled due to sickness in the insured group.
- Premium costs are set by the modified community rating.
- Providers must offer standardized plans.
Self-Employed Health Insurance in New Jersey
- Self-employed individuals may not buy group health insurance.
- There are business associations which offer group health insurance to their members. Check with the New Jersey Department of Banking and Insurance for regulations.
New Jersey Department of Banking and Insurance
P.O. Box 325
Trenton, NJ 08625
Individual Health Insurance in New Jersey
- Providers may not deny coverage because of a health problem.
- Enrollment for individual coverage is only in October.
- HIPAA eligible residents are guaranteed the right to coverage.
- Coverage may not be cancelled because of illness.
- Providers must offer two types of individual plans: comprehensive standardized policies and the Basic and Essential Plan.
- In reference to pre-existing conditions, insurance providers may review medical records for the six months previous to coverage.
- If a pre-existing condition is found, an exclusion period up to 12 months may be applied.
- Those who are HIPAA eligible are not subject to pre-existing exclusion periods.
- Providers may not attach exclusion riders to policies for pre-existing conditions.
- Pregnancy is considered a pre-existing condition, but any complications will be covered.
- Most individual policies rates are based on community ratings.
New Jersey Health Care Programs
Assistance is available to low income residents through Medicaid and New Jersey Family Care.
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