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.
Resources:
- » A Table of Standardized Medigap Plans
- » Deciding on The Right Medigap Plan for You
- » What Medigap Programs Don't Cover Compared to Medicare
- » Summary of Medigap and Secondary Health Insurance Policies
- » Introductory Information to Medicare HMO's
Articles:
- » Specialized Rules and Features for Medicare HMO's
- » Comparing the Traditional Medicare Plan and Medicare HMO's
- » Choosing A Specific Medicare or Medicare HMO Plan for You
New Jersey Health Guide Pages:
- » Introduction to The New Jersey Individual Health Coverage Program Buyer's Guide
- » Obtaining New Jersey Health Insurance Coverage
- » New Jersey Health Insurance Coverage Eligibility
- » New Jersey Health Insurance Coverage Dependent Eligibility
- » Frequently Asked Questions About New Jersey Health Insurance Eligibility
- » More Questions Regarding New Jersey Health Insurance Eligibility
- » Key Features of the Individual New Jersey Health Insurance Coverage Program
- » Pre-existing Conditions and Portability Regarding New Jersey Health Insurance Coverage
- » New Jersey Individual Health Insurance Ratings & Rate Changes
- » Questions Regarding New Jersey Health Insurance Plans, Features & Rates
- » New Jersey Health Insurance Delivery Systems
- » Managed Health Insurance & Health Care Plans
- » Frequently Asked Questions About New Jersey Health Insurance Delivery Systems
- » New Jersey Health Insurance Coverage Benefits
- » More Types of New Jersey Health Insurance Coverage Benefits
- » Frequently Asked Questions About New Jersey Health Insurance Benefits
- » Alternatives to Individual New Jersey Health Insurance Coverage
- » Individual New Jersey Health Insurance Plans Summary
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