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An Overview on Medical Insurance in New Jersey

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Medical Insurance in New Jersey

Medical Insurance in New Jersey

Introduction: The health insurance condition in New Jersey does not significantly differ from the health insurance condition in most of the American states. In accordance to a survey conducted by The Center for Disease Control, almost 14% of the total New Jersey residents did not get New Jersey medical insurance coverage per year, between 2001 and 2003.

We have provided a useful article to let the New Jersey individuals know the health insurance status of their state. The article contains some important New Jersey medical insurance regulations and information about the New Jersey medical insurance alternative programs.

Important New Jersey Medical Insurance Regulations

To regulate overall New Jersey health insurance market and to monitor the activities of different New Jersey medical insurance companies, the state insurance department has launched some regulations. The regulations are written below:

  • New Jersey is a guaranteed issue state. In New Jersey, health insurance is sold on guaranteed issue basis.
  • All New Jersey people, having access to group New Jersey medical insurance through an employer, can not be refused or restricted access to employers' medical insurance.
  • New Jersey medical insurance companies can not refuse an individual seeking individual New Jersey medical insurance, depending on deciding factors such as age, health condition and gender.
  • To avail the benefits of New Jersey medical insurance and buy individual New Jersey medical insurance, on guaranteed basis, an applicant should meet some residency criteria. He or she should be a resident of New Jersey or otherwise be set to be a New Jersey resident.
  • New Jersey individual, who has no access to the state's medical insurance, is always able to purchase individual New Jersey medical insurance. However, there are some exceptions.
  • Normally, New Jersey residents can access New Jersey medical insurance, all through the year. Nevertheless, in some cases, they have to hang around until the open enrollment period, which is in November.
  • New Jersey medical insurance companies can inflict a waiting period for a pre-existing medical condition; only except HIPAA qualified New Jersey individuals. However, under no circumstance they can implement elimination riders that may keep out a health condition from coverage.
  • As per New Jersey insurance law, a pre-existing medical condition may be defined as an illness for which an individual has been treated or received medical advice or otherwise diagnosed within 6 months, before commencement of new health insurance plan.
  • A New Jersey medical insurance company can inflict a waiting period for a health condition for no more than 1 year. During this time, the individual is not able to get any coverage for that particular health condition.
  • Pregnancy may be considered to be a pre-existing medical condition and thus subject to a waiting period.
  • Continual coverage may be transferred from previous policy to new one for pre-existing health condition waiting period; if and only if there was no breakage in coverage during the term of previous policy.
  • All New Jersey medical insurance companies are required to offer a guaranteed renewability provision to every policy holder and for every insurance policy.
  • Guaranteed renewability provision provides the right to renew an existing New Jersey medical insurance plan.
  • Renewal provision is guaranteed, if the applicant has disbursed all the premiums, in time and provided no fake information, during the entire term of respective health insurance plan.
  • All New Jersey medical insurance companies, which provide individual health insurance coverage, must offer complete standardized plans including PPO plans and HMO plans.
  • New Jersey medical insurance companies are required to offer a Basic and Essential plans, too. This plan does not provide coverage for maternity, prescription drugs and chemotherapy.
  • Rules for Dependant Coverage: New Jersey individuals below 30 years and yet dependant upon their parents are qualified to get covered under their parent's individual New Jersey medical insurance. However, conditions may apply.
  • All newborns and adopted children should get coverage, automatically under their parent's individual New Jersey health insurance policy, for the initial 31 days from the day of birth or adoption. The policy should be modified, accordingly, after the period is over; in order to provide accommodation to the children.
  • In some cases, the disabled and handicapped dependant may get covered under parent's individual New Jersey medical insurance plan that offer dependant coverage; even if the dependant has exceeded the decided upper age limit.
  • Full-time students can get covered under their parent's New Jersey medical insurance plan, up to age 23.
  • New Jersey medical insurance costs cannot be different for individual medical insurance, based on gender, age, occupation, health condition and demographics. Nevertheless, it can vary, depending on dependants.
  • Basic and Essential plan costs however can differ.
  • New Jersey individuals, who are between health insurance policies or jobs, can take advantage of temporary New Jersey medial insurance plans offered by some of the New Jersey medical insurance companies.

New Jersey Medical Insurance Alternative Options

New Jersey state insurance department offers some medical insurance alternative programs to let the New Jersey individuals, who are unable to pay for individual New Jersey medical insurance, access insurance coverage. The programs are as follows:

  • New Jersey Medicaid: This program is available to New Jersey individuals, who meet all the income as well as other health-related criteria.
  • New Jersey FamilyCare: This is basically New Jersey Children's Health Insurance Program or NJCHIP that offer medical insurance to the children below and up to the age of 19. However, children from families those are not able to afford the cost of New Jersey medical insurance or ineligible for New Jersey Medicaid can apply for the program.

New Jersey Department of Banking and Insurance

Mailing address
Department of Banking and Insurance
P. O. Box 325
Trenton, NJ 08625-0325
For telephonic assistance, you can contact at the following numbers, accordingly:
(800) 838-0935 [for individual health coverage program information]
Fax No: (609) 633-2030 [for individual and small employer]

New Jersey Health Maintenance Organizations or HMOs

New Jersey Department of Insurance has provided the following list of active New Jersey HMOs along with their office address. Each of them is licensed to sell New Jersey medical insurance. The list is as follows:

  • 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.
    d/b/a AmeriHealth
    8000 Midlantic Dr., Suite 333, Mt Laurel, NJ 08054
  • Aetna Health, Inc.
    980 Jolly Road, P.O. Box 1109, Blue Bell, PA 19422
  • 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
  • CIGNA HealthCare of New Jersey, Inc.
    499 Washington Boulevard, Jersey City, NJ 07310
  • 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
  • Health Net of New Jersey, Inc.
    3501 State Highway 66, Neptune, NJ 07754
  • University Health Plans, Inc.
    550 Broad Street, Newark, NJ 07102-4599
  • 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


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