New Jersey Individual Health Insurance Regulations

In the state of New Jersey, you are qualified to receive health insurance if you have lived in the state for 6 months or if you have moved to the state recently with the intention to stay 6 months or longer. For individual health plans in New Jersey, medical underwriting is not acceptable. This process prevents the insurance companies from refusing health insurance coverage to a person because of their health history or current health status. Health insurance companies in New Jersey are required to offer a basic health plan that has five different standardized individual health options. The insurance company can perform a 6 month health history check and an exclusionary period of 12 months for any pre-existing health conditions. Elimination riders are not allowed in the state and exclusionary periods can be no more than 12 months. Premium rates may vary depending upon the applicant's age, gender and location, and rates are community based. If you have an employer with group health insurance then you are not eligible to purchase individual health insurance in New Jersey.

NJ Small Group Health Insurance Regulations

In New Jersey, if a company has 2 to 50 employees then it is defined as a small group, and all small groups are given group health insurance coverage on a guarantee issue basis. This prevents the health insurance company from refusing health coverage to a group because of the group's health status. Employers must give proof of eligibility for every employee and they must document that the employee that wants health coverage under the group health insurance plan has been working for the company for at least 25 hours per week. Also, some employers can impose a waiting period to every employee before they are eligible to join the group health plan. The length of the waiting period must be the same for every employee. For groups of 5 or less, New Jersey law permits a 6 month exclusionary period on pre-existing conditions. This exclusionary period applies to any plan member that has not health insurance coverage in the past. When setting insurance rates, the insurance company can only take into account the age, gender and family status of the group. If the group has a poor health status, the insurance company cannot charge higher rates to employees. If a New Jersey insurance company offers small group health insurance then they must make certain plans available. There are 5 standardized plans plus one HMO plan with benefits that New Jersey insurance companies must offer and all coverage limits are regulated by the state. Each insurance carrier can offer other plans, but these standardized health insurance plans must be made available so small business owners can compare plan rates among different insurance companies.

New Jersey COBRA and Continuation Coverage

For small group health insuance plans in New Jersey there are mini-COBRA laws put in place. Under COBRA law, continuation of health insurance coverage must be available to individuals who have dropped their group health coverage due to a qualifying event. An employee can stay on the group health plan and obtain the same level of health coverage for a certain length of time, depending on the type of qualifying event The maximum time spans are 18, 29 and 36 months. Within 30 days of the qualifying event, the applicant must send in their choice for continuation of coverage and have it documented in writing. This documentation must be accessible to any employee that has had their hours reduced to less than 25, or to any employee that has lost their job for any reason other than a just cause. Additionally, for anyone that leaves a group health plan, there are no conversion options because New Jersey is a guaranteed issue state.

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