COBRA or Small Employer Group Continuation

Both federal and New Jersey law require that most employees and dependents who lose coverage under an employer’s group health plan be given the opportunity to continue coverage under the group health plan for a period of time.  The federal law, usually referred to as COBRA, applies to most employers with 20 or more employees, while the New Jersey Small Employer Group continuation law applies to most employers with 2 to 50 employees.  The two laws are very similar.  Under both COBRA and New Jersey law, the person electing to continue coverage can be required to pay the full premium plus a 2% administrative fee; even so, group rates are often lower than an individual rate for a plan with similar benefits.
 
If you lost coverage under an employer group plan as an employee due to termination of employment or a reduction in hours, you may elect to continue your group coverage for up to 18 months.  Coverage will be the same as you had while covered as an active employee, and any dependents who were covered under your plan may also be covered under your continued coverage.  

If you were covered under a group plan as a dependent and lost that coverage due to death of the employee, divorce, or because you no longer meet the dependent eligibility standards under the plan, you may elect to continue your coverage for up to 36 months.  Your coverage will be the same as you had while covered as a dependent. 

Information regarding New Jersey’s Small Employer Group Continuation is provided in SEH Bulletin 07-SEH-02 and is available at  www.state.nj.us/dobi/division_uinsurance/ihcseh/sehbulletins.htm

Continuation of Coverage for Dependents Under 31

New Jersey law (P.L. 2005, c. 375) permits certain children of people covered under group health benefits plans the opportunity to maintain dependent coverage after reaching the limiting age specified in the group plan.  The law applies to a covered employee’s children who no longer meet the age requirements to be a child dependent under the group health coverage who also: are under 31 years old AND are not married AND have no children AND are either residents of New Jersey or are full-time students if not living in New Jersey AND are not actually covered under any other health benefits plan. 

NJ FamilyCare

NJ FamilyCare is a federal and state funded program created to provide New Jersey's uninsured children 18 years old and younger and certain low-income parents and guardians free or low-cost health coverage. Eligibility is based on a family’s size and monthly income. Most children are required to have been uninsured for 3 months before enrolling in NJ FamilyCare, but there are exceptions based on changed circumstances to a parent’s job, and some other reasons. NJ FamilyCare is under the New Jersey Department of Human Services. 

NJ FamilyCare Advantage - Child-only Coverage

If your family’s income does not meet the requirements for NJ FamilyCare (and your child is not otherwise eligible for Medicaid), then consider NJ FamilyCare Advantage.  NJ FamilyCare Advantage is a child-only program that covers children whose monthly family income is too high for the family to qualify for NJ FamilyCare.  No family can earn too much to qualify for NJ FamilyCare Advantage!  However, there are still eligibility requirements:

	The family must reside in New Jersey AND
	The child must be younger than 19 years old AND
	The child must have been uninsured for at least 6 months, UNLESS the child just lost eligibility for Medicaid, or the child just lost eligibility for NJ FamilyCare, or the parent recently lost employment due to staff reductions AND
	All children in the family eligible for NJ FamilyCare Advantage must be enrolled

For more information about NJ FamilyCare Advantage or to get an application, call 1-800-637-2997 or visit the web site: 
http://www.horizonnjhealth.com/ourplans/njfamilycareadvantage/about-plan-affordable-health-care-your-children (where you can download an application).

NJ Protect (New Jersey's Pre-existing Condition Insurance Plan)

The federal Patient Protection and Affordable Care Act of 2010 (often called PPACA) requires all states to have an individual plan to address the needs of people who have been denied coverage because of a pre-existing condition.  NJ Protect is the plan designed to comply with PPACA.  NJ Protect coverage is based on a standard Plan C offered as a PPO product.

While no one can be denied coverage in New Jersey’s individual market because of health issues, NJ Protect has several special features that make it different from other plans available:

	NJ Protect has no pre-existing condition limitation period, so there is no waiting for coverage of treatment for a pre-existing condition to begin.
	NJ Protect has a rider that limits the cost-sharing requirements for prescription drugs – which means lower out-of-pocket costs for people who use many prescription drugs.
	The federal government provides a subsidy to the states to help lower the cost of the insurance – so the premium for NJ Protect is a little less than other Plan C options in the market.
	NJ Protect only covers individuals – there is no option to cover spouses or families on one policy.
	There are extra eligibility requirements to qualify for NJ Protect, so not only must you be a New Jersey resident who is not eligible for a group health plan or Medicare, but you must also: Be a citizen or national or an alien legally present in the United States, Be able to prove that you have a pre-existing condition, AND Be without any creditable coverage for at least 6 months.

For more information or to download an application, go to the Department of Banking and Insurance’s website at www.state.nj.us/dobi/division_insurance/njprotect/index.htm, or call Horizon Blue Cross and Blue Shield of New Jersey’s toll-free number: 1-888-551-2130

Federally Qualified Health Centers

Although not health insurance, Health Centers are a way for people without health coverage to access quality medical care.  Located in various parts of the state, Health Centers are staffed with medical providers to enable them to provide a wide range of medical care.  The Health Centers will charge patients for the care provided using a sliding fee scale based on the patient’s income.

As an attachment to the rate comparison sheet we include a list of the Heath Centers with their phone numbers.