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—Overview—

The Individual Health Benefits Program provides New Jersey residents access to healthcare coverage. This Fast Facts briefly explains the basics of the individual health benefits market.

—Background—

The Individual Health Benefits Program created standard health benefits plans that insurance companies are required to offer. Carriers must offer these plans on a guaranteed issue/guaranteed renewal basis, so that an eligible individual can never be denied coverage or renewal.

Health benefits plans are available for a single person, and may also cover eligible dependents such as a spouse and child(ren). Rate comparison sheets are available on the program’s website and are updated periodically. http://www.state.nj.us/dobi/division_insurance/ihcseh/ihcmain.htm. For more current information, contact each insurance company directly.

—Eligibility Rules and Requirements—

Who is eligible to purchase an individual health plan in New Jersey?
A resident of New Jersey who is not eligible for a group health plan or Medicare may purchase health insurance in the individual market.

If I become eligible for Medicare while I am covered by an individual plan, must I terminate my coverage?
No. You are only disqualified if you are eligible for Medicare before you try to obtain individual coverage. However, comparing the cost & benefits is suggested if turning 65.

If I cover my dependent children, how long will they remain eligible?
Your children are eligible until their 26th birthday. Dependents, who are incapacitated may be covered indefinitely, provided documentation is supplied to the carrier and your plan remains in effect.

May I purchase an individual plan if I am eligible for COBRA?
Yes.

How long do I have to pay premiums? If I don’t pay, when will my coverage end?
There is a 31-day grace period and coverage remains in place during that time. If you do not pay by the end of the grace period, your coverage ends the last day of the month of your last premium payment. If you incur charges during the grace period and submit a claim to the carrier, your claim will be denied unless the premium is paid before the end of the grace period.

What if I want to change health plans?
An open enrollment period is held annually if you want to buy a more expensive plan with more benefits. The new plan becomes effective the following January 1.

—Individual Health Benefits Program Carriers—
Aetna Health, Inc. and Aetna Life Ins. Co.
1-800-234-8454
AmeriHealth HMO Inc. and AmeriHealth Ins. Co.
1-866-681-7368
Cigna HealthCare of NJ
1-866-438-2446
Health Republic Ins. of New Jersey
1-888-990-5706
Horizon Blue Cross Blue Shield of NJ and

Horizon HealthCare of NJ
1-800-224-1234
Oscar Insurance Corporation of NJ
1-855-OSCAR-88
Oxford Health Ins. (NJ), Inc. and

Oxford Health Plans (NJ), Inc.
1-800-216-0778

For more information on how to contact the health insurance carriers participating in the New Jersey Individual Health Benefits Program review http://www.state.nj.us/dobi/division_insurance/ihcseh/ihcrates2016.htm#HealthCarrierContactInformation

—Buyer’s Guide Available—

For more information on the New Jersey Individual Health Benefits Program, review the Buyer’s Guide prepared by the NJ Department of Banking & Insurance. http://www.state.nj.us/dobi/division_insurance/ihcseh/ihcguide2016/index.html

—For More Information—

Visit NJBIA’s website to download a copy of Buying Health Insurance for Your Business – How to be a Savvy Purchaser, Fast Fact.

Visit https://njbia.org/resources/fastfacts  to view all NJBIA Fast Facts.

If you need additional information, please contact Chrissy Buteas at cbuteas@njbia.org or 609-858-9510.

Updated: October 3, 2016

Prepared by Eileen Shrem, RHU, LUTCF, CLTC. For additional information on this topic you may contact Ms. Shrem at 732-988-7256 or EMShrem@verizon.com www.your-friend-in-insurance.com.

This information should not be construed as constituting specific legal advice. It is intended to provide general information about this subject and general compliance strategies. For specific legal advice, NJBIA strongly recommends members consult with their attorney.