Department of Health and Senior Services
The Office of Managed Care in the New Jersey Department of Health and
Senior Services monitors the compliance of managed health care plans
with New Jersey rules through annual examinations and in-depth reviews
of each plan conducted every three years. The office investigates consumer
complaints and oversees the Independent Health Care Appeals Program (IHCAP).
For information, call the Office of Managed Care toll-free at (888) 393-1062
or visit the web site: www.state.nj.us/health.
Department of Banking and Insurance
The New Jersey Department of Banking and Insurance (DOBI) publishes
Buyer’s Guides for individual and small employer coverage. You
may obtain a copy of the Buyer’s Guide for individuals at (800)
838-0935 and for small employers at (800) 263-5912. These are also
available at DOBI’s web site: www.njdobi.org.
DOBI also posts information on enrollment by county and line of business, premiums, net worth and profitability for all New Jersey
HMOs, as well as summary information on other managed care companies.
This information is available on the DOBI managed care web site: www.njdobi.org/managed.htm.
Medicare
For information on managed care options for Medicare in New Jersey, call
the New Jersey Department of Health and Senior Services, Division of
Aging and Community Services, State Health Insurance Assistance Program
(SHIP) at (800) 792-8820, or call (800) MEDICARE. You can also visit www.medicare.gov.
If you have a complaint about a Medicare managed care plan, refer to
your member services handbook for detailed information about where
to submit your complaint based on the type of complaint you have.
Medicaid
For information on Medicaid HMO options, quality information and complaints,
call the New Jersey Department of Human Services at (800) 356-1561
or visit www.state.nj.us/humanservices.
Physicians
For information on New Jersey physicians, including disciplinary actions,
call the New Jersey State Board of Medical Examiners at (609) 826-7100
or visit www.state.nj.us/lps/ca/medical/bme.htm.
Self-Insured Plans
Large employers and unions often assume financial responsibility for
employee health benefits instead of buying insurance. Employers may
contract with outside organizations to administer their self-insured
health benefits plans. These plans are not bound by our state’s
statutory or regulatory requirements, but rather by federal rules.
Roughly half of all New Jerseyans getting health benefits through their
employers are in self-insured plans. Questions or complaints about
these self-insured plans can only be addressed by the federal Department
of Labor’s Employee Benefits Security Administration. The main
number is: (866) 275-7922. The web site is: www.dol.gov/ebsa.
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