Key Features of the Individual New Jersey Health Insurance Coverage Program

Key Features of the Individual Health Coverage Program

The Individual Health Coverage Program requires each carrier to:

• guarantee coverage and renewability for all eligible people regardless of health, subject to the pre-existing conditions provision, as applicable;
• establish modified community rates -- which are rates that apply to all people who purchase the same standard IHC plan and do not vary based on an individual person's gender, occupation, geographic location or health status, but may vary based on age. Carriers may use modified community rates for the Basic and Essential Plan (B&E Plan) where rates may vary based on age, gender and geographic location. Health status is not a permissible rating factor for any plan. Please note that while carriers may vary standard plan rates based on age, not all carriers were doing so as of the date such rating was first permitted. Refer to the rate comparison pages for information as to which carriers are using age as a factor for rating standard plans.
• offer at least three of the standardized individual plans (referred to as Plans A/50,B,C D and/or an HMO Plan) to make it easier for you to compare benefits and costs among the many participating carriers offering coverage. Plans A/50, B, C and D can be offered as indemnity or traditional plans, or as PPO or as POS plans. Carriers may file riders to increase the benefits under one or more of the standard plans.
• offer a Basic and Essential Plan (B&E Plan). The B&E plan is not a standard plan and provides only limited coverage. Carriers may file riders to enhance the limited coverage. As mentioned above, carriers may vary the rates for the B&E plan based on age, gender and geographic location. The rate comparison pages identify which factors each carrier uses for B&E rates.

Guaranteed Coverage and Guaranteed Renewability

Provided you satisfy the eligibility requirements described in the Eligibility Section, you cannot be denied coverage for any reason including your past or current health condition. However, the "pre-existing conditions" provision may limit coverage during the first 12 months. You are guaranteed that your policy will be renewed provided you remain a resident of New Jersey and your premium is paid in a timely fashion and you do not commit fraud.