The New Jersey health insurance plan, titled NJ Protect, is designed to provide health insurance coverage for individuals with pre-existing health conditions. Before the inception of the NJ Protect plan, people with pre-existing medical conditions were unable to qualify for health insurance or faced extremely high insurance premiums. Under the federally subsidized NJ Protect plan, premiums are significantly lower and coverage is typically superior.
Qualifications
Qualification criteria to purchase health insurance through NJ Protect include: all applicants must reside in New Jersey; must be a U.S. citizen or lawfully in the country; must not have had creditable insurance coverage for at least six months; and a pre-existing condition must present. Proof of each of the criteria must be presented when applying for the NJ Protect coverage. In addition, applicants must not qualify for Medicare or any other group health insurance plan.
Creditable Coverage
Typically, health insurance plans offered by a private employer, public entity or even those purchased on an individual basis qualify for creditable coverage. Also included in the creditable coverage spectrum is coverage provided by Medicare, a state-run children's health insurance policy, such as NJ FamilyCare, and Medicaid. Programs such as vision or dental coverage are not considered creditable coverage for this purpose.
Pre-Existing Conditions
The NJ Protect insurance plan defines a pre-existing medical condition as a chronic conditional present prior to the beginning of the coverage period. The condition may or may not be treated or causing symptoms at the time of application and includes illnesses in remission. Chronic describes a condition that is expected to last long-term, while a short-term condition is referred to as acute. While New Jersey laws prohibit commercial health insurance providers from denying coverage based on a pre-existing condition, it does allow for a plan to exclude treatment of a pre-existing condition for a set period of time.
Covered Treatment
The NJ Protect insurance program is a comprehensive insurance policy that is the same as those available on the consumer market for purchase. The NJ Protect policies cover office visits, hospital care, emergency room visits, medical equipment, surgical treatment, prosthetics, treatment for mental illness and drug dependency, maternity care, organ transplants and primarily all other medical treatments and expenses. Most preventative services, such as blood screenings, mammograms, prostate exams and vaccinations, require no out-of-pocket expense.
Cost of Coverage
Monthly insurance premiums for NJ Protect is based on the coverage provided and age of the subscriber (see Resources). The federal funding for the program enables NJ Protect to extend coverage to individuals who may not otherwise find health insurance at a lower price. The coverage and prices offered by NJ Protect rival the best insurance plans.
Tags: health insurance, creditable coverage, insurance plan, pre-existing condition, applicants must
