New Jersey Health Insurance Guide

Types of plans offered in New Jersey include major medical health insurance coverage such as Personal Health Quotes, Family Health, and Group Health. Start your search for low-cost health insurance today!

Health Insurance Resources for NJ State Residents

New Jersey has guaranteed access to health coverage to all resident individuals and small employers. In New Jersey no one can be denied health coverage because of health status, age, claims history or any other risk factor.

Individual Health Insurance in New Jersey
• The Individual Health Coverage Program (IHC) is available to any New Jersey resident who does not have access to employer-provided group insurance or government-sponsored health care such as Medicare.
• The IHC provisions assure that individuals are guaranteed renewable health care coverage for themselves and their families either under the standard individual health benefits plans (SIHB) or the Basic and Essential plans (B&E) sold by any company licensed to sell health care insurance in New Jersey.
• Both B&E and SIHB plans are available for an individual, two adults, a family or an adult with one or more children.
• SIHB plans are sold as traditional, fee-for-service plans, also called indemnity plans or as managed care plans, which include network-based plans through Health Maintenance Organizations (HMOs) and carrier plans using a Preferred Provider Organization (PPO). Under New Jersey health insurance laws, all standard plans, regardless of whether they are issues as indemnity, PPO, or HMO must provide comprehensive medical care that includes office visits, hospitalization, prenatal and maternity care, immunizations and well-child care, prescription drugs, preventive screening such as mammograms, pap smears and prostate exams, x-ray and lab services and biologically-based mental illness services, certain non-biologically-based mental illness and substance abuse services.
• B&E plans are limited-benefit, network-based plans purchased from insurance carriers using an Exclusive Provider Organization (EPO), although some B&E plans are offered as indemnity policies and let you select your providers. B&E plans do not provide the comprehensive coverage mandated for SIHB plans. For instance, B&E only covers 90 days per year for hospitalization, $600 per year for wellness services, $700 per year for doctor office visits for injury or illness, $500 per year for out-of-hospital tests and limited benefits for mental health, substance abuse treatment and physical therapy. However, different carriers can, if they choose, add enhanced benefits to their B&E plans or offer enhanced benefit riders.

Small employer insurance in New Jersey
• New Jersey’s Small Employer Health Benefits Program (SEH) permits any business with between two and 50 full-time employees to offer any SIHB plan sold by the state’s licensed carriers. In certain cases, a small business can choose to buy or renew non-standard plans that were available prior to New Jersey’s 1992 health insurance reforms.

Privileges and Limitations

• Under New Jersey law, you have 30 days to review any policy you purchase and return it for a full premium refund (minus any claims paid or services provided). No individual or small business employer insurance plan offered can impose a benefit limit that violates New Jersey law. However, if the law doesn’t mandate coverage for a specific service or supply, a plan has the option of limiting benefits.


Low-Income Coverage
• New Jersey FamilyCare (NJFC) is a federal and state funded health insurance program. It helps provide affordable health coverage for the state’s uninsured children and certain low-income parents and guardians who do not have access to affordable employer-provided health insurance and cannot afford individual coverage. Services covered by NJFC include doctor visits, hospitalization, x-ray and lab tests, prescription drugs, mental health services, eyeglasses and dental (for most children).
  Each New Jersey county has three to five HMOs that will help you obtain NJFC services. Certain services may be limited depending on your annual income.

New Jersey health insurance regulatory agencies
• The Department of Banking and Insurance regulates individual and small business insurance sold in New Jersey. It also jointly regulates the state’s HMOs along with the Department of Health and Senior Services, which is responsible for issues of quality and care, including the process for appealing denial of care.

Get access to New Jersey health insurance quotes at based on your coverage needs and individual health circumstances.

State of New Jersey Department of Banking and Insurance
www.state.nj.us/dobi/index.html
www.state.nj.us/dobi/aboutdobi.htm
Consumer Inquiry
P.O. Box 471, Trenton, NJ 08625-0471
Consumer Inquiries and Complaints
Phone: 609-292-7272 or 1-800-446-7467

Individual Health Coverage Program (IHC)
P.O. Box 325
Trenton, NJ 08625-0325
Phone: 609-633-1882
Fax: 609-633-2030
www.state.nj.us/dobi/division_insurance/ihcseh/ihcmain.htm

Small Employer Health Benefits Program (SEH)
P.O. Box 325
Trenton, NJ 08625-0325
Phone: 609-633-1882
Fax: 609-633-2030
www.state.nj.us/dobi/division_insurance/ihcseh/sehmain.htm

(NAIC) National Association of Insurance Commissioners
The National Association of Insurance Commissioners (NAIC) is the organization of insurance regulators from the 50 states, the District of Columbia and the five U.S. territories. The NAIC provides a forum for the development of uniform policy when uniformity is appropriate. NAIC members are the elected or appointed state government officials who along with their departments and staff regulate the conduct of insurance companies and agents in their respective state or territory.
www.naic.org