— Overview —
Healthcare costs and quality can vary enormously from hospital to hospital, physician to physician, and area to area. Consumer-friendly comparative information can be difficult to find. This Fast Fact is intended to steer NJBIA members to reliable sources of information.
The Individual Health Benefits Program provides New Jersey residents access to healthcare coverage. This Fast Fact briefly explains the basics of the individual health benefits market. For more information on health insurance options in New Jersey, visit Get Covered NJ.
— 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. 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 and 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. Some insurance carriers allow dependent children to stay on health plans through the end of the month the dependent turns 26, or until the end of the billing cycle or calendar year. It is important to check with insurance carriers to determine coverage end dates. 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?
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 greater benefits. The new plan becomes effective the following January 1.
— Individual Health Benefits Program Carriers —
Contact the carriers directly to request an application
|Carrier Name and Web Addresses
|AmeriHealth HMO Inc. and AmeriHealth Ins. Co.
|WellCare Health Plans Inc. (Beginning in 2022)
|Horizon Blue Cross Blue Shield of NJ and
Horizon HealthCare of NJ
|Oscar Insurance Corporation (NJ)
|Oxford Health Insurance (NJ) Inc.
For more information on how to contact the health insurance carriers participating in the New Jersey Individual Health Benefits Program Carriers, please visit Individual Health Coverage Program – Health Insurance Carriers
— 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.
— For More Information —
If you need additional information, please contact NJBIA’s Member Action Center at 1-800-499-4419, ext. 3 or email@example.com.