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Home > Insurance Division > Health Insurance Programs > NJ Protect
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.  


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.


 
 
Who is eligible?line  

The eligibility requirements are established by Federal law.  To be eligible for NJ Protect:

check You must be a U.S. citizen or national or lawfully present in the United States AND
check You must be a New Jersey resident AND
check You must have been without any creditable coverage for at least 6 months AND
check 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. 

 
 
How do I prove I am a citizen?line  
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.  
 
How do I prove I am a non-citizen national?line  
Documentation would be a copy of a U.S. passport that shows your national status.
 
If I am not a citizen or a non-citizen national, how do I prove I am lawfully present in the United States? line  

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:

check I-327 (Reentry Permit)
check I-551 (Permanent Resident Card)
check I-571 (Refugee Travel Document)
check I-766 (Employment Authorization Document)
check a machine-readable Immigrant Visa with Temporary I-551 Language affixed to an unexpired foreign passport
check a Temporary I-551 Stamp affixed to an I-94
check an I-94 (Arrival/Departure Record) with an unexpired foreign passport
check an unexpired Foreign Passport for Visa Waiver Program travelers
check an I-20 (Certificate of Eligibility for Nonimmigrant (F-1) Student Status) with an I-94 on an unexpired foreign passport
check a DS2019 (Certificate of Eligibility for Exchange Visitor (J-1) Status) with an I-94 and an unexpired foreign passport
 
 
How do I prove I am a New Jersey resident?line  
Documentation would be a New Jersey driver’s license, mortgage or rent bills, utility bills, and bank statements.  
 
What is creditable coverage?line  
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.  
 
I did not have any of those things in the past 6 months.  How do I go about proving I did not have something?line  

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. 

 
 
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?line  
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.   
 
What is a pre-existing condition?line  

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.

 
 
How do I prove that I have a pre-existing condition?line  

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.    

 
 

What health care services does NJ Protect cover? line

 

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:

check office visits check durable medical equipment
check hospital care including emergency room check prosthetics and orthotic appliances
check care and treatment of injury and illness by surgical and non-surgical means check biologically based mental illness and alcoholism services
check transplant benefits check certain non-biologically based mental illness and substance abuse services
check prenatal and maternity care check home health care
check immunizations and well-child care check hospice care
check screenings, including mammograms, pap smears and prostate examinations check rehabilitation services
check x-ray and laboratory services check therapy services (physical, occupational, speech etc.)
check blood and blood products check prescription drugs
check anesthesia check certain infant formulas
check ambulance service    

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. 

 
 

How much does NJ Protect cost?line

 

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.


 
 

How do I apply?line

 
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

 

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

Horizon Blue Cross Blue Shield of NJ

Web site

Telephone:
1-888-551-2130

Mailing address:
P.O. Box 1330 Newark, NJ 07101-1330

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.

 
 
How do I know if my doctor will take this plan?line  
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.  
   
If one person in a family is eligible for NJ Protect, can the other family members also be covered under NJ Protect?line  
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.  
 

May children be covered under NJ Protect?line

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 or NJ FamilyCare Advantage instead.

 
 
Can I lose coverage under NJ Protect?line  

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.

 
 

Can my insurance agent help me get NJ Protect?line

 

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. 

 
     
Monthly Ratesline
NJ Protect Monthly Rates are for coverage effective beginning August 1, 2012
All rates are for coverage of one person

Carriers and Plan Choices

Under 25 years old 25 to 29 years old 30 to 34 years old 35 to 39 years old 40 to 44 years old 45 to 49 years old 50 to 54 years old

55 to 59 years old

60 to 64 years old 65 years and older
Horizon BCBSNJ Plan C + NJ Protect Rider 80%/70%, $2500/$5000
$245.18
$274.51
$324.35
$348.50
$357.94
$369.90
$418.84
$479.03
$566.55
$659.40
Plan C + NJ Protect Rider 100%/70%, $0/$7500
$351.95
$394.04
$465.63
$500.26
$513.84
$530.99
$601.27
$687.63
$813.30
$946.60

AmeriHealth

Plan C + NJ Protect Rider $30, 90/70%
$250.61
$283.21
$338.45
$366.62
$380.36
$398.98
$455.78
$526.37
$629.20
$629.20
 
Plan C + NJ Protect Rider provides coverage of the following services: office visits (preventative and treatment-related, including most medically-necessary specialist's care), hospital care, prenatal and maternity care, immunizations and well-child care, screenings (including mammograms, pap smears and prostate exams), x-ray and lab services, treatment for mental illness and substance abuse, many therapy services, and prescription drugs.  These are plans with both "in-network" and "out-of-network" benefits, so you may choose to obtain healthcare services through the carrier's network of health care providers, or may go outside of the network.  You will pay more to go out-of-network because of greater cost-sharing requirements, plus health care providers may charge more than what the carrier considers reasonable and customary.  In-network providers charge a negotiated rate.  
Remember, to be eligible for NJ Protect, you:
  • must be a U.S. citizen, U.S. national, or lawfully present in the U.S.;

  • must be a New Jersey resident;

  • must be uninsured for at least 6 months;

  • must have a pre-existing (prior) medical condition.
In addition, you MUST submit documentation that supports each requirement!
Horizon's Plan C 80%/70% requires you to pay the first $2500 of covered charges in-network ($5000 out-of-network) before Horizon pays charges (however, the carrier pays for preventive services up to the maximum benefit even if the deductible has not been met).  Then, Horizon pays 80% of the covered charges in-network (70% out-of-network).  After you have paid a total of $5,000 in covered charges in-network, Horizon will cover all of your in-network charges. 

Horizon's Plan C 100%/70% has copayment requirements in-network ($30 for most services, $50 for specialist visits), but no deductible or coinsurance requirement.  For out-of-network services, you pay the first $7500 of covered charges, then 30% of additional covered charges until you have paid a total of $22,500 in covered charges; after that, Horizon will pay all of the out-of-network covered charges.

AmeriHealth's Plan C $30, 90/70% requires you to pay the first $2500 of covered charges in-network ($5000 out-of-network) before AmeriHealth pays charges; however, the carrier pays for preventive services even if the deductible has not been met, and physician visits are subject to copayment requirements of $30 for primary care and $50 for specialist visits. After the deductible is satisfied, AmeriHealth pays 90% of the covered charges in-network (except for the physician visits subject to copayments), and 70% of the covered charges out-of-network.
     
   

Questions not answered here?line

 

The insurance companies issuing NJ Protect coverage will be the best place to ask coverage-specific questions.  The carriers will also be the best place to follow-up after you have submitted an application.  Remember to allow at least 15 days before making a follow-up call.

You may also contact the New Jersey Individual Health Coverage Program via e-mail: Ellen.derosa@dobi.state.nj.us

 
   
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