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Health Insurance Program - NJ Protect |
Enrollment Suspension |
Effective March 1, 2013, New Jersey must suspend accepting new applications for NJ Protect. This means new applications must be received no later than 5 p.m. on Friday March 1, 2013. All applications received after 5 p.m. on Friday March 1, 2013 must be rejected.
The decision to suspend enrollment was made by the federal government. NJ Protect operates with federal funding and thus New Jersey is suspending enrollment in NJ Protect as required by the federal government.
New Jersey residents covered by NJ Protect are not affected by the enrollment suspension. |
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Introducing NJ Protect - A new, more affordable health insurance option
NJ Protect is a new health insurance option for uninsured New Jerseyans with pre-existing medical conditions. Coverage through NJ Protect will generally cost less than comparable individual health insurance and offer superior benefits. Because the program is federally subsidized, treatment for pre-existing medical conditions will be covered as of the day a policy goes into effect, and preventive care will be covered at no out-of-pocket cost to the policyholder.
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Who is eligible? |
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The eligibility requirements are established by Federal law. To be eligible for NJ Protect:
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You must be a U.S. citizen or national or lawfully present in the United States AND |
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You must be a New Jersey resident AND |
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You must have been without any creditable coverage for at least 6 months AND |
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You must have a pre-existing condition. |
You must be able to provide documentation for each of the above requirements. The questions below provide guidance as to how you would go about proving these eligibility requirements. |
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How do I prove I am a citizen? |
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Documentation would be a copy of your birth certificate or your passport information, or a certificate of citizenship, or a copy of your naturalization certificate. |
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How do I prove I am a non-citizen national? |
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Documentation would be a copy of a U.S. passport that shows your national status. |
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If I am not a citizen or a non-citizen national, how do I prove I am lawfully present in the United States?  |
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Documentation would be a copy of your immigration documents, one of which has your Alien Registration Number or I-94 Number. This could include the following:
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I-327 (Reentry Permit) |
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I-551 (Permanent Resident Card) |
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I-571 (Refugee Travel Document) |
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I-766 (Employment Authorization Document) |
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a machine-readable Immigrant Visa with Temporary I-551 Language affixed to an unexpired foreign passport |
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a Temporary I-551 Stamp affixed to an I-94 |
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an I-94 (Arrival/Departure Record) with an unexpired foreign passport |
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an unexpired Foreign Passport for Visa Waiver Program travelers |
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an I-20 (Certificate of Eligibility for Nonimmigrant (F-1) Student Status) with an I-94 on an unexpired foreign passport |
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a DS2019 (Certificate of Eligibility for Exchange Visitor (J-1) Status) with an I-94 and an unexpired foreign passport |
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How do I prove I am a New Jersey resident? |
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Documentation would be a New Jersey driver’s license, mortgage or rent bills, utility bills, and bank statements. |
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What is creditable coverage? |
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Creditable coverage is most forms of health coverage that is offered through a public or private employer or that you can buy on your own in New Jersey or another State. Creditable coverage also includes health coverage through Medicaid, a State Children’s Health Insurance Program (like NJ FamilyCare) or Medicare. It also includes coverage from a foreign country. Some very limited health policies (for instance, vision-only policies) and dental coverage are not considered to be creditable coverage. Worker’s compensation is not creditable coverage. |
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I did not have any of those things in the past 6 months. How do I go about proving I did not have something? |
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The enrollment form asks a series of questions geared toward whether you had creditable coverage within the past 6 months. Answer the questions.
In addition, New Jersey is planning to contract with a company that has a massive database with information concerning health coverage. Using that database, insurance companies will be able to verify whether or not you have had creditable coverage within the past 6 months. |
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The requirement that a person must have been uninsured for at least 6 months seems terribly harsh. Can it be waived for a very compelling reason? |
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Sorry, but no. The eligibility requirements are set in the Federal law. New Jersey does not have the ability to waive the requirement that a person must have been uninsured for at least 6 months. |
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What is a pre-existing condition? |
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For purposes of NJ Protect a pre-existing condition is defined as a medical condition clinically present prior to the date of coverage, whether or not symptomatic or treated, and whether or not currently symptomatic or in a state of remission, for which treatment has been or will be medically necessary and appropriate.
New Jersey does not allow carriers to deny coverage because of pre-existing conditions, but carriers can exclude benefits for treatment of a pre-existing condition for a period of time. So, if the medical condition is one that a carrier would have excluded from coverage under a health plan other than NJ Protect, then the medical condition is probably a pre-existing condition for purposes of NJ Protect,
too. |
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How do I prove that I have a pre-existing condition? |
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You will be required to identify the condition on the enrollment form, and provide a note from your doctor verifying the diagnosis and/or treatment.
To make sure the note from the doctor contains all of the required information you can give your doctor the NJ Protect Practitioner Form to complete or to use as a guide for the note he or she will write. Whether your doctor uses the NJ Protect Practitioner Form or writes a separate note including the same information the form requests, the form or the note must contain an original signature. |
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What health care services does NJ Protect cover?  |
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NJ Protect is issued by insurance companies that currently issue coverage in the New Jersey individual market. In fact, the NJ Protect plans being offered are the same plans you could buy on your own in the individual market. The plans provide coverage for health care services such as:
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office visits |
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durable medical equipment |
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hospital care including emergency room |
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prosthetics and orthotic appliances |
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care and treatment of injury and illness by surgical and non-surgical means |
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biologically based mental illness and alcoholism services |
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transplant benefits |
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certain non-biologically based mental illness and substance abuse services |
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prenatal and maternity care |
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home health care |
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immunizations and well-child care |
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hospice care |
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screenings, including mammograms, pap smears and prostate examinations |
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rehabilitation services |
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x-ray and laboratory services |
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therapy services (physical, occupational, speech etc.) |
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blood and blood products |
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prescription drugs |
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anesthesia |
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certain infant formulas |
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ambulance service |
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The cost sharing (copayment, deductible and coinsurance) varies based on the specific plan you may select. All of the plans feature a $5,000 maximum out of pocket which is the most you will need to pay per year for copayment, deductible and coinsurance for in-network services.
In addition to the above, NJ Protect provides first dollar coverage for preventive services up to the stated maximum benefits. This means preventive care is covered without any copayment, deductible or coinsurance. The 50% prescription drug coinsurance accumulates toward the $5,000 maximum out of pocket amount for in-network services if the prescriptions are obtained at an in-network pharmacy. Prescriptions obtained at an out-of-network pharmacy accumulate toward the out of network maximum out-of-pocket. Most importantly, NJ Protect covers pre-existing conditions from day one. |
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How much does NJ Protect cost? |
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The monthly premiums for NJ Protect will vary based on which plan you buy, and what your age is. See the chart comparing rates and plans. You will notice that the monthly rates are lower than the rates you may have seen on the Individual Health Coverage Program web site. You may wonder – how can this be? The coverage is slightly better and the cost is lower! The lower rates are possible because of funding made available by the Federal government.
We realize these monthly rates may be more than some people can afford. Unfortunately there is no assistance available to help pay premiums for NJ Protect.
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How do I apply? |
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Enrollment Suspension |
Effective March 1, 2013, New Jersey must suspend accepting new applications for NJ Protect. This means new applications must be received no later than 5 p.m. on Friday March 1, 2013. All applications received after 5 p.m. on Friday March 1, 2013 must be rejected.
Since NJ Protect applications must be accompanied by the required documentation and check for the first premium payment all applications are submitted by mail. An application put in the mail during the last week of February may or may not be received by March 1. Next day delivery mail service is an option that some consumers already use and would promise delivery by March 1 if mailed by February 28.
During the final week of applications for NJ Protect we will allow a FAX option as well. The application and documentation may be sent via FAX. The faxed application and documentation must be received no later than 5 p.m. on Friday March 1, 2013. Applicants who use the FAX option must mail the hard copy of the application, supporting documentation as well as the check for the first premium no later than March 2, 2013 in order for the application to be processed. The date the faxed application and documentation are received will be used as the date the application is received.
NJ Protect applications with documentation may be sent via FAX to:
AmeriHealth: 609-662-2566
Horizon: 973-274-2226
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NJ Protect is offered by two carriers: AmeriHealth of New Jersey and Horizon Blue Cross and Blue Shield of NJ. Contact one of these companies about enrolling in NJ Protect. Please be sure to explain you are asking about NJ Protect so the customer service representative can quickly provide information for the NJ Protect options.
AmeriHealth of New Jersey |
Web site |
Telephone:
1-866-681-7368 |
Mailing address:
259 Prospect Plains Road, Bldg. M
Cranbury, NJ 08512 |
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Horizon Blue Cross Blue Shield of NJ |
Web site |
Telephone:
1-888-551-2130 |
Mailing address:
PO Box 1330 Newark, NJ 07101-1330 |
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Product information and monthly rates are provided further below.
Your coverage will become effective on the 1st or the 15th of the month, whichever first occurs on or after the 10th day following our receipt of your completed application, required documentation and premium payment. You may request a later effective date however, the date must occur on the 1st or 15th of the month. For example, if your application, required documentation and premium are received on the 2nd of the month coverage will be effective the 15th of the month. |
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How do I know if my doctor will take this plan? |
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All of the plans that are offered have in-network and out-of-network benefits. To find out if your doctor is in the network you can check the provider directory on Horizon's web site or the provider directory on AmeriHealth's web site. You can also ask the office manager at your doctor's office whether the doctor participates in the network. |
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If one person in a family is eligible for NJ Protect, can the other family members also be covered under NJ Protect? |
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NJ Protect is designed to cover applicants on an individual basis only. If two or more members of a family are eligible for NJ Protect, then each person would apply separately, and would be covered under separate NJ Protect policies. |
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May children be covered under NJ Protect? |
Yes, children may be covered under their own NJ Protect policy if eligible. However, a parent or guardian may find more cost-effective options for coverage for a NJ Protect-eligible child under NJ FamilyCare instead. |
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Can I lose coverage under NJ Protect? |
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NJ Protect coverage is intended to remain in place until December 31, 2013. However, there are reasons it would end earlier, as explained below.
NJ Protect coverage will end if you do not pay the monthly premiums when due. There is a 31 day grace period for each premium payment, but if the premium is not paid by the end of the grace period the coverage will be retroactively terminated to the last day for which premium was paid. There is no opportunity to reinstate the coverage so be sure to pay your premiums on time!
NJ Protect will end when you become covered under Medicare or under a group plan.
The Federal dollars that are helping reduce the cost of coverage for NJ Protect are expected to allow the coverage to continue until December 31, 2013. However, it is possible the money available for NJ Protect will be used up before December 31, 2013. Persons covered under NJ Protect will be given as much advance notice as possible if the NJ Protect coverage will end before December 31, 2013.
Although new enrollments will be suspended March 1, 2013, policies already in effect are not affected by the enrollment suspension.
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Can my insurance agent help me get NJ Protect? |
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Your agent may tell you about the coverage if he or she thinks it might be a good option for you. Because of the special eligibility requirements for NJ Protect agents will not have copies of the applications and will not be submitting the applications to the insurance companies. For the most part you will be dealing directly with the insurance company. |
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