If you live in New Jersey and have a pre-existing condition, did you know that you are protected by certain federal and state laws? Believe it or not, this is the case all over the country, according to the U.S. Department of Labor.
More specifically, in 1992, the New Jersey Legislature created the Individual Health Coverage Program ("IHC") and the Small Employer Health Benefits Program ("SEH") to prevent you from being dropped or charged more from your insurance because your unfortunate decline in health. The New Jersey Health Access Program ("Access") was also created to provide subsidies for people who can not afford to purchase individual health coverage at all.
First of all, New Jersey health insurance options do not depend on individual current health status, age or any health determining factor. This form of nondiscrimination prevents insurance cancellation and/or denial from your group insurance plan (often issued by your employer) because of something unfavorable about your health. New Jersey health insurance also implements guaranteed renewability. As long as you pay the premiums, don’t swindle the company and continue to live in the plan service area, you cannot be cancelled from your health insurance for being sick.
Even if you have a New Jersey individual health insurance plan separate from your employer, you cannot be charged more for health insurance due to health status, age, gender or occupation, otherwise known as community rating.
On the other hand, if you are a small employer who offers a group New Jersey health insurance plan, premiums can be subjected to modified community rating, which adjusts premiums based on factors like age, gender and the size of your employees’ families, but not on an employee’s health status. Also, you the employer cannot be turned down for a group policy due to the health status, age or any other predictable health factor of an employee. This is what health insurance providers call a guaranteed issue.
While these New Jersey health insurance reforms certainly help protect against unfair treatment, they do have their limitations. For example, you usually cannot take your group health insurance plan with you when you change jobs; you also have to wait a certain period of time before your new health insurance plan begins at your new job.
According to the State of New Jersey, the IHC Program has had successful results in promoting the guaranteed issue of individual health insurance coverage. For example, before the reforms there was only one carrier offering such guarantees. As of 1997 there were 154,000 people covered by 92,000 individual health benefits plans and 22 carriers.
Similarly with SEH, small employers have also seen an increase in the number of employees covered by group plans. At the end of 1997, 847,000 persons were covered under small employer plans, compared to 694,000 at the end of 1994.
For more information about these reforms and their success so far, visit www.state.nj.us. This website also offers information on identifying health insurance scams in New Jersey and an online consumer’s guide.
By Kelley Caner