Call today for a free quote!* (877) 498-9070

Health Insurance › Region › New Jersey › More Questions Regarding New Jersey Health Insurance Eligibility

More Questions Regarding New Jersey Health Insurance Eligibility

More Frequently Asked Questions About Eligibility and Dependent Eligibility

Question 8: If I cover my children under my individual plan, up to what age will they be covered?

A policyholder's children -- including those for whom you have legal custody or guardianship, as well as those with whom you have a blood or legal relationship, and who depend on you for most of their support and maintenance and live in your household -- are eligible for coverage under your plan until their 19th birthday. Children who are and remain full-time students may be covered until their 23rd birthday. Coverage will end earlier, if the child graduates or is otherwise no longer a full-time student. Dependents who are incapacitated may be covered indefinitely, provided documentation is supplied to the carrier as requested, and your plan remains in effect. Please note that the option to continue coverage for dependents to age 31 under P.L. 2005, c. 375 does not apply to individual coverage.

Question 9: Can I purchase coverage for a child or children only?

Yes. If you wish to purchase coverage for one child, you will be charged the single rate. If you wish to purchase coverage for more than one child, you will be charged the adult and child(ren) rate. Since all plans may be age-rated, resulting in more favorable rates for younger people, you may want to explore coverage options under age-rated plans as described later in this Guide and identified on the rate comparison chart.

Question 10: My grandchildren live with me and I am responsible for their care and support, but I am not their legal guardian. I am covered under an individual plan. May I add them for coverage under my individual plan?

Yes. A dependent child, for the purpose of an individual plan, includes a child related to you by blood, if the child depends on you for most of the child's support and maintenance and resides in your household.

Question 11: If I waive coverage under Medicare, may I purchase an individual plan?

No. Even if you waive or postpone coverage under Medicare, you are considered eligible for Medicare and thus not eligible for IHC coverage. If you are concerned that Medicare may not provide adequate coverage, you may purchase another type of health plan specifically designed to supplement Medicare coverage. You may obtain free information on plans that supplement Medicare by contacting the New Jersey Department of Health and Senior Services, NJ Division of Aging and Community Services at 1-800-792-8820 or visit their website at www.state.nj.us/health/senior/ship.shtml.

Question 12: May I purchase an individual plan if I am eligible for coverage under COBRA or New Jersey State continuation?

Yes. Although COBRA and New Jersey State continuation are a continuation of a group plan, eligibility for coverage under COBRA or New Jersey State continuation does not preclude the purchase of an individual plan. You may choose to continue your coverage under COBRA or New Jersey State continuation for some, all, or none of the permissible continuation period. Once you purchase an individual plan, you may not maintain health coverage under COBRA or New Jersey State continuation, and therefore, you will have to cancel your health coverage under COBRA or New Jersey State continuation. If you are eligible for COBRA you may elect to maintain your dental or vision coverage, if available, since dental and vision coverage is not available with individual plans.

Question 13: May I purchase an individual plan if I am eligible for coverage as a dependent under age 31 under P.L. 2005, c. 375?

Yes. Although over-age dependent coverage is coverage under a group plan, eligibility for such coverage does not preclude you from purchasing an individual plan. For some over-age dependents, a plan using rates that vary by age may be an option worth exploring. You can read about age-rated plans later in this Guide.

Question 14: May I purchase an individual plan if I actually have group coverage?

The law generally prohibits you from purchasing an individual plan if you are covered by or eligible for a group health plan. However, you may be eligible to purchase an individual plan during the Open Enrollment period in November of each year, subject to certain restrictions. You would be required to terminate your coverage under the group plan no later than December 31 since the individual coverage would take effect on January 1.

Please note that, even if you are eligible for an individual plan, you may not purchase an individual plan that provides the same or similar level of coverage as the group plan for which you are eligible.

An insurance producer or carrier representative can help you evaluate your particular circumstances and the options that may be available to you during the Open Enrollment Period which occurs each year during the month of November. The individual plan would not take effect until January 1 following the Open Enrollment Period.

Exception: If you are covered under your parent's group plan as an over-age dependent you may elect to drop that over-age dependent coverage at any time and purchase your own individual plan.