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Numerous state and federal laws make it easier for people with pre-existing conditions to get or keep health insurance, or to change from one health plan to another. A federal law, known as the Health Insurance Portability and Accountability Act (HIPAA) sets national standards for all health plans. In addition, states can pass different reforms for the health plans they regulate (fully insured group health plans and individual health plans), so your protections may vary if you leave New Jersey. New Jersey has enacted comprehensive reforms to expand its residents’access to health insurance and to guarantee fair pricing of policies. Neither federal nor state laws protect your access to health insurance in all circumstances. So please read this guide carefully.

The following information summarizes how federal and state laws do – or do not – protect you as a New Jersey resident.

How am I protected?
In New Jersey, your health insurance options do not depend on your health status.

• Coverage under your group health plan (if your employer offers one) cannot be denied or limited, nor can you be required to pay more, because of your health status. This is called nondiscrimination.

• All health plans in New Jersey must limit exclusion of pre-existing conditions. There are rules about what counts as a pre-existing condition and how long you must wait before a new health plan will begin to pay for care for that condition. Generally, if you join a new plan your old coverage will be credited toward the pre-existing condition exclusion period, provided you did not have a long break in coverage.

• Your coverage cannot be canceled because you get sick. This is called guaranteed renewability. You have this protection provided that you pay the premiums, do not defraud the company, and, in the case of managed care plans, continue to live in the plan service area. Your insurance company also can refuse to renew your individual health plan if that company decides to stop selling all individual health insurance in New Jersey.

• If you leave your job, you may be able to remain in your old group health plan for a certain length of time. This is called COBRA continuation coverage or state continuation coverage. It can help when you are between jobs or waiting for a new health plan to cover your pre-existing condition. There are limits on what you can be charged for this coverage.

• If you have coverage through an employer's fully insured group health plan and you lose eligibility to that coverage because of divorce, you can buy a conversion policy. This is an individual policy you buy from the company that insured your employer's group plan.

• If you are a small employer buying a group health plan, you cannot be charged more due to the health status or claims experience of people in your group. However, your premiums will vary within limits based on age, gender, and family size of those in your group and will vary based on where you are located. This is called modified community rating.

• If you are a small employer buying a group health plan, you cannot be turned down because of the health status, age, or any factor that might predict the use of health services of those in your group. This is called guaranteed issue.

• You cannot be turned down for an individual health plan because of your health status, age, or any other factor that might predict your use of health services. All individual health insurance policies must be sold on a guaranteed issue basis.

• If you are buying an individual health insurance policy, besides the Basic and Standard Plan, you cannot be charged more for your health insurance due to health status, age, gender, or occupation. Also, your premiums do not vary based on where you live. This is called community rating.

• If you have low or modest household income, you may be eligible for free or subsidized health coverage for yourself or members of your family. The New Jersey Medicaid program offers free health coverage for pregnant women, families with children, elderly and disabled individuals with very low-incomes. In addition, some women who are diagnosed with breast or cervical cancer may be eligible for medical care through Medicaid.

• Your child may be eligible for free or inexpensive health insurance through the NJ FamilyCare Program if they are 18 years old or younger, uninsured and your family income is modest or low.

• If you have lost your health insurance and are receiving benefits from the Trade Adjustment Assistance (TAA) Program then you may be eligible for a federal income tax credit to help pay for new health coverage. This credit is called the Health Coverage Tax Credit (HCTC), and it is equal to 65% of the cost of qualified health coverage, including COBRA and state continuation coverage.

• If you are a retiree aged 55-65 and receiving pension benefits from Pension Benefit Guarantee Corporation (PBGC), then you may also be eligible for the HCTC .