The Regulation of Health Insurance in New Jersey
Several private health insurance providers operate in New Jersey, including Horizon Blue Cross and Blue Shield of New Jersey, one of the few remaining non-profit organizations still members of the national Blue Cross Blue Shield federation of private health insurers. Thirteen health maintenance organizations are currently authorized to operate in New Jersey. The State of New Jersey Department of Banking & Insurance’s Division of Insurance oversees the regulation of all private health insurers in New Jersey. The current Commissioner of the Department is Tom Considine.
In New Jersey, a variety of ‘Basic’ and ‘Essential’ plans exist, but are not required to include some of the features many consumers consider just that, basic and essential. In addition, premiums for Basic and Essential policies are permitted to vary on the basis of age, gender and geographical location. This is why it is important to carefully examine the terms and conditions attached to any private health insurance plan under consideration.
New Jersey family health care insurance providers cannot decline to extend coverage to you as part of a group plan on the basis of medical history, genetic information or disability. However, employers may choose who they extend health coverage to on the basis of criteria unrelated to health, for example part time status. Therefore, a company could extend health care coverage including prescription drug coverage to full-time employees only if it wanted to, but could not extend this coverage only to employees with no disabilities.
New Jersey’s family health care laws require insurers to automatically include newborns under their parents’ group health plan/s for the first 31 days after birth as long as the health insurance plan covers dependents. The insurer might require the parents to enrol their child themselves to extend coverage beyond the initial 31 day period. Disabled adult children can also remain on their parents’ group health plan after the person attains the age at which dependent cover is usually terminated, as long as certain requirements are met. The child must be unable to support him or herself due to the disability and must remain dependent on his or her parents. Proof of this requirement being met is required to be provided to the insurer within 31 days of the usual termination date.