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New Jersey State Health Insurance Laws

Many states struggle with health insurance as a policy issue and New Jersey is no different. The state has laws governing the relationship between citizens and isurers and what insurance companies can and can't do when operating in state borders. Ensuring the good health of citizens decreases future health outlays from the state budget.

  1. Individual Health Coverage Program

    • This program ensures that individuals who are not covered by employer- or government-provided health insurance can buy individual coverage from competing private insurers. The law was passed in 1992, before which most people without insurance had limited options to buy from private insurance companies, particularly if they had chronic illnesses. Carriers offering insurance under the program must offer a standard application form and many will require payment with the application so that coverage can start upon acceptance. The state provides a rate-comparison chart so that those seeking coverage can compare the competing companies and rates to determine what is most economical for them. As long as residents meet basic requirements, they cannot be denied coverage by an insurer.

    Small Employer Health Benefits Program

    • The Small Employer Health Benefits (SEH) Program was passed in 1994 to ensure that small businesses can purchase and renew small group health insurance plans regardless of the job duties of the employees or their health status. To qualify as a small business, the business must have more than two but fewer than 50 employees and to qualify, a majority of eligible employees must work within the state. Carriers are allowed to deny coverage for services determined to be unnecessary. Insured people can appeal these decisions, and New Jersey law requires the carrier to have a two-stage appeal process.

    Dependent Under 31 Law

    • New Jersey seeks to expand insurance coverage with its coverage of young adults under 31 years of age. This law says that people under 31 can continue on a parent's group health plan or become covered under such a plan so long as he has had coverage under that plan in the past. Coverage for the young adult will end should the young adult becomes a parent, gets married, or if the parent for some reason becomes no longer covered under his or her group plan.

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