The Individual Health Coverage Program provides guaranteed health insurance to New Jersey residents.
Individual health insurance options within the state of New Jersey provide for the insurance needs of persons deemed ineligible for health coverage. Income limitations or pre-existing medical conditions can result in an ineligibility status in the eyes of insurance companies. But plans offered through New Jersey's Individual Health Coverage Program guarantee standard coverages and have guaranteed renewal.
Identification
Within the state of New Jersey, the Individual Health Coverage (IHC) Program ensures all eligible persons have access to some form of health insurance. According to the State of New Jersey Department of Banking & Insurance, coverage is available for a family, two adults, one adult with children, and an individual person. Persons can choose from an assortment of insurance carriers with different types of plans available to choose from. The IHC program requires guaranteed coverage and renewal, which means individuals cannot be denied coverage based on pre-existing conditions or current health status.
Function
The Individual Health Coverage program provides coverage for individuals unable to obtain access to employer-sponsored or government-sponsored coverage. According to the State of New Jersey Department of Banking & Insurance, plan types come in the form of fee-for service plans, HMOs, PPOs and POSs. One other plan, called the Basic and Essential Health Plan (B&E Plan), falls under plans offered by EPOs or Exclusive Provider Organizations. Standardized plan coverages include hospital care, office visits, tests and screenings, prescription drugs, along with other necessary services.
Eligibility
According to the State of New Jersey Department of Banking & Insurance, New Jersey residents may be eligible for individual health insurance as long as they reside within the state and are ineligible for any employer, government or church group plans or Medicare coverage. In order to be considered a resident of the state, individuals must reside there at least six months out of the calendar year. Exceptions to this requirement include those defined as a federally eligible individual. Federal eligibility applies when a person has had coverage for a minimum of 18 months and shows no breaks in coverage longer than 63 days at a time.
Coverage Requirements
New Jersey’s Individual Health Insurance Program requires insurance carriers to set standard community rates or costs for coverage plans. According to the State of New Jersey Department of Banking & Insurance, standard community rates apply regardless of a person’s health status, gender, location or occupation, though rates may differ on the basis of age. Participating carriers must offer a base of different plan coverages so consumers can compare benefits and costs from different carriers. Insurance carriers must also offer a Basic and Essential Plan, which provides limited health insurance coverage.
Pre-Existing Conditions
Under New Jersey’s Individual Health Insurance Program, any illness or injury that first appears six months prior to enrollment in a health plan falls under the definition of a pre-existing condition. Individuals who’ve had no prior insurance as of 31 days prior to enrollment must undergo a waiting period of 12 months before receiving coverage for a pre-existing condition, according to the State of New Jersey Department of Banking & Insurance. During the waiting period, coverage applies only to conditions not related to the pre-existing condition. Exceptions to this rule include federally defined eligibility, where no waiting period is required for a pre-existing condition.
Tags: Banking Insurance, Department Banking, Department Banking Insurance, Jersey Department, Jersey Department Banking, State Jersey Department
