New Jersey Health Insurance Laws

Unlike in most states, an individual’s age and health status cannot play a role in a New Jersey health insurance company’s decision whether or not to offer an applicant a policy. In order to qualify for an individual New Jersey health insurance policy, you must merely be a New Jersey resident and not eligible for Medicare coverage. New Jersey health insurance companies offer an open enrollment period of October of every year during which time you can enroll in an insurance plan.

New Jersey health insurance coverage has guaranteed renew ability. This means that a New Jersey health insurance policy cannot be canceled at the end of a term due to age or health related reasons. The only way a New Jersey health insurance policy can be canceled by the New Jersey health insurance company is if the policyholder does not pay his or her premiums.

When it comes to dependents, New Jersey health insurance companies are required to cover newborns and adopted children for their first thirty-one years. During this period, New Jersey health insurance policyholders must officially enroll the new dependent in the New Jersey health insurance plan in order to prolong coverage past thirty-one days. Disabled children with proof of disability and dependency are allowed to remain on a New Jersey health insurance policyholders plan past the age at which normal coverage would end. New Jersey health insurance policyholders must prove that the dependent is incapable of working or living on his or her own. Adult children that are full-time students are also allowed to remain covered as dependents under New Jersey health insurance law until their twenty-third birthdays.

New Jersey health insurance companies are required to offer individual comprehensive standardized insurance policies. Among these, there are four indemnity New Jersey health insurance policies, on HMO choice and one PPO option. These standardized New Jersey health insurance policies offer full comprehensive coverage for New Jersey health insurance policyholders. New Jersey health insurance companies are also required to offer applicants access to what is called the Basic and Essential Plan. This plan offers less than comprehensive New Jersey health insurance coverage, as it excludes coverage for a lot of major health conditions.

New Jersey health insurance companies can impose up to a twelve-month exclusion period on pre-existing conditions, but New Jersey health insurance companies are not allowed to impose elimination riders. Elimination riders permanently exclude certain pre-existing conditions from being covered throughout the life of a New Jersey health insurance policy. New Jersey health insurance law defines a pre-existing condition as treatment for or diagnosis of any illness during the six months prior to when an individual receives a new New Jersey health insurance policy. New Jersey health insurance companies can regard pregnancy as a pre-existing condition; however, insurance companies are required to cover claims relating to pregnancy complications even if they take place within the exclusion period.

New Jersey health insurance companies cannot base regular premium rates on age, health status, gender or any other risk factor assessments. However, if an individual chooses the Basic and Essential plan, his or her premium will be based on a modified community rating system. This means that the New Jersey health insurance policyholder’s premium rate can within limits be based on age or place of residence, but it cannot be based on his or her current or past health status.

New Jersey Health Insurance Laws

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