Frequently Asked Questions About New Jersey Health Insurance Eligibility

Frequently Asked Questions About Eligibility and Dependent Eligibility

Question 1: May I purchase an individual plan if I live in another state during part of the year?

Yes, provided New Jersey is your primary residence and you are present in New Jersey for at least six months of the year. The policyholder is required to be a New Jersey resident. These residency requirements do not apply to dependents. Although, for coverage under an HMO, everyone intended to be covered must live in the HMO's service area. Also, as explained in the section on residency, the requirement to be present in New Jersey for at least six months of the year does not apply to a federally defined eligible individual.

Question 2: My parents are coming to visit me from abroad. They will be staying with me for about 4 months. May I buy a plan to cover them while they are in New Jersey?

No, visitors do not generally satisfy the residency requirement and should investigate coverages available where they reside.

Question 3: I just moved to New Jersey, may I purchase an individual plan?

Yes, if you relocate to New Jersey with the intention of being present in New Jersey for at least 6 months of the year, and meet all other eligibility requirements, you may purchase individual coverage.

Question 4: May I keep my New Jersey individual plan if I move out of state?

No. However, your carrier may offer a plan with similar benefits in other states. You should check with your insurance company or HMO regarding a plan termination date before you move.

Question 5: May I keep my New Jersey individual plan if I become eligible for Medicare?

Yes. However, the individual plan will not act like a Medicare Supplement Plan and it will not replace Medicare coverage. The benefits for which you are eligible under Medicare will be coordinated with the benefits of the individual plan whether or not you actually enroll in Medicare. Medicare would pay benefits first, and then the individual plan would pay benefits as the secondary payor. In addition, the only individual plan you may be covered under once you become eligible for Medicare is the plan you are covered under at the time you become eligible for Medicare. You may not elect another individual plan or plan option or switch to another carrier.

Question 6: I need family coverage, not just individual coverage. How do I get coverage for my family?

It is called individual coverage because you are buying it on your own rather than getting the coverage through an employer group plan. If the members of your family qualify as dependents, they can also be covered under your individual plan.

Question 7: My son will be graduating from college in May. He is covered under the group plan I have from my employer until he graduates. May I purchase a short-term policy to cover him until he finds a job that offers group health coverage?

No. There are no "short-term" plans available in New Jersey. However, you may purchase an individual plan for him and decide to keep it only until he becomes covered under a group plan. Another option to cover him would be COBRA or New Jersey group continuation. You should check with your employer to find out whether the employer is subject to the requirements of COBRA or New Jersey group continuation. Under both of these continuation laws, your son could elect to continue coverage under your group plan for up to 36 months. Another option is coverage for certain dependents who are under 31 years old under P.L. 2005, c. 375. You can find lots of information about coverage under this law on the Department of Banking and Insurance website: www.state.nj.us/dobi/division_consumers/du31.html