New Jersey individual health insurance

TA | April 9, 2009

Q: I am helping a friend who was just dropped from his company's health insurance for "costing too much" (he has kidney disease). NJ does not have a High Risk Pool, and BCBS is the insurer that dropped him.

A: If your information can from this friend, then perhaps part of the detail was lost in translation. The reason that New Jersey does not have a high risk plan is that all health plans - including individual or group insurance - offer guaranteed acceptance and takeover of pre-existing conditions for those who follow prescribed application procedures. The problem your friend describes is more likely to be caused by the inability to pay for insurance rather than being "dropped". As a practical matter, New Jersey law does not allow a person who has been covered by a group health plan to be made ineligible for major medical insurance.

Their are, however, specific details and strict procedures that must be considered to change from one type of policy to another. If your friend has not been in touch with the employer's benefits administrator or NJ Blue Cross, then she should do so immediately. There are specific procedures that must be followed by both employers and individuals to ensure this guaranteed eligibility for major medical insurance with "takeover benefits". Do not assume that you can circumvent this procedure and find a better deal for your friend by surfing the Internet.

In most similar cases in New Jersey, the underlying limiting issue is the cost of insurance rather than availability of coverage. In other words, insurance coverage is available but many cannot afford to pay for it. The state's insurance laws passed in the 1992 have forced the cost of health coverage higher than many individuals and companies can afford. There are no low cost health insurance plans in New Jersey and none of the nation's most popular limited benefit health insurance plans are currently available in New Jersey. Keep looking here, however, because we expect to announce that the state has offered some legislative relief from these insurance restrictions in the near future.  


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