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COVID-19 and Health Insurance FAQS

Will my insurance cover testing for COVID-19?
The State of New Jersey has instructed state-regulated health insurance companies to waive consumer cost-sharing (co-payments, deductibles or co-insurance) for medically necessary COVID-19 testing. This means that consumers may not be charged out of pockets costs for medically necessary COVID-19 testing.

This waiver covers emergency room, urgent care, and office visits related to COVID-19 testing for the following groups:

  • the state’s individual, small and large group markets;
  • the State Health Benefits and School Employee Health Benefits Plans;
  • NJ FamilyCare populations; and
  • those eligible for the Charity Care program. 

Additionally, to ensure that individuals who are uninsured have access to testing for COVID-19, the Murphy Administration required hospitals and Federally Qualified Health Centers (FQHCs) to waive patient fees for testing and related diagnostic services for those who lack health insurance.

What do I do if my health insurance is a self-funded plan, a federal health plan (military or veteran), or a health-sharing ministry?
The Department does not regulate self-funded plans, federal health plans or health-sharing ministries. However, note that the Families First Coronavirus Response Act establishes requirements for providing coronavirus diagnostic testing at no cost to consumers in certain plans not regulated by the Department.  Contact your employer or health insurer to find out what is covered by your health plan.

What should I do if I don't have health insurance or if I lose coverage?
As part of the state's aggressive response to the COVID-19 pandemic, Governor Murphy has requested the federal government open a Special Enrollment Period (SEP) in New Jersey to allow uninsured and underinsured residents to enroll in health coverage through the federal health insurance exchange. The press release announcing the request for an SEP may be found here.

If you do not have health insurance, or lose coverage, you may be eligible for free or low-cost coverage (www.njfamilycare.org) through NJ FamilyCare, New Jersey's publicly funded health insurance program. NJ Family Care includes CHIP, Medicaid and Medicaid expansion populations and covers doctor visits, prescriptions, vision, dental care, mental health and substance use services and even hospitalization.

If you have experienced a life-changing event, such as losing job-based health coverage, you may qualify for a Special Enrollment Period that would allow you to presently enroll in health coverage. If you or anyone in your household lost qualifying health coverage in the past 60 days OR expects to lose coverage in the next 60 days, you may qualify for a Special Enrollment Period.

Visit GetCoveredNJ (www.getcovered.nj.gov) to see if you qualify or go directly to www.healthcare.gov to enroll in coverage.

Note: State and federal law also require that most employees and dependents who lose health coverage under an employer’s group health plan be given the opportunity to continue coverage for a period of time. Under the federal law (COBRA) and state law, the person electing to continue coverage can be required to pay the full premium plus a 2% administrative fee. You can contact your employer or benefits administrator for more information.

Who should I contact if I need assistance with information about my health coverage options?
Health insurance can be confusing, and sometimes it’s hard to choose between all the plans that are available. Trained professionals are available to help with enrollment. You can reach a trained navigator by phone, by calling the Center for Family Services Statewide Navigator Enrollment Hotline at 1-877-9-NAVIG8 (1-877-962-8448).

Who should I contact about my health insurance complaints?
Residents who have questions or concerns about insurance or any entity regulated by the Department may contact the our Consumer Hotline at 1-800-446-7467 (8:30 am to 5:00 pm EST Monday-Friday), or go to the department website and click on Consumer Assistance - Inquiries/Complaints, at https://www.dobi.nj.gov

Where can I go to learn more about the spread of COVID-19 and the measures I can take to protect myself and my family?
Residents should visit the New Jersey Department of Health website (www.nj.gov/health) for COVID-19 updates and information on how to prevent the spread of the virus. Information about available resources may be found on the Official Site of the State of New Jersey (www.nj.gov).

 
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New Jersey Department of Banking and Insurance