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New Jersey

New Jersey Health Insurance

New Jersey has strict health insurance regulationswhich both protect and benefit policy holders, like you. However, to make these rules really work for you, you first need to know what they are. Before we really get into the important details of New Jersey health insurance regulations, though, you should know that in order to be eligible to purchase an individual New Jersey health insurance policy, you must be ineligible receive similar coverage through a group health plan. So, if you have the opportunity to be covered under a group health insurance plan, then you may not purchase an individual insurance policy with similar coverage and benefits.

This guide:

  • Describes New Jersey health insurance policy regulations

  • Lists rules New Jersey health insurance companies must follow

Health insurance policies are largely regulated by each state's own health insurance laws. New Jersey health insurance companies and policyholders alike must abide by the established health insurance laws.

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Do You Qualify For A Subsidy?


Find out if you qualify for a government subsidy under Obamacare. Millions of Americans will have their insurance rates reduced under the new health care law. Learn how much you could save with our simple calculator.

New Jersey health insurance policy provisions

Some of the most important New Jersey health insurance laws are the ones that specifically influence the health insurance policy itself. New Jersey in unlike most states in that, in addition to the privitized policies available to you, you have six goverment standardized New Jersey health insurance policies from which you may choose the right one for you.

Of sourse, health insurance policies that aren't one of these standardized plans must still follow New Jersey's health insurance regulations. For instance, a guaranteed renewability provision must be included in every policy issued in New Jersey. This provision states that, as long as premiums have been met, your New Jersey health insurance company cannot deny you continued coverage for any reason.

Also, New Jersey health insurance policies can contain a provision excluding a medical condition from your health insurance coverage for a period of 12 months if they are considered “pre-existing” conditions. Usually, a "pre-existing condition" is one that was diagnosed or treated by a doctor.

In New Jersey, conditions are considered to be "pre-existing" if you received medical treatment for or were diagnosed with them 6 months prior to the beginning of the plan. Legally, New Jersey health insurance companies are allowed to include exclusion periods, or periods of time where the new policy won't pay for treating this condition, for any condition that falls under this description.

If you switch New Jersey health insurance companies, you can avoid having a second exclusion period imposed by the second insurance company by making sure your health insurance coverage is continuous. If you have no lapse of your health insurance coverage between policies, your old coverage credits your new plan's exclusion period, so you will get all the care entitled to you without having to wait another 6~12 months.

Regulating New Jersey health insurance companies

The other area of importance in regards to New Jersey health insurance laws is the degree of influence your health insurance company has over your policy and its price.

Although most New Jersey health insurance companies have the option to deny your application for health insurance, Blue Cross Blue Shield is required to offer health insurance to every resident.

However, it is iportant to note that New Jersey health insurance companies cannot deny you health insurance due to your health status, age or other such factors. Additionally, the cost of your New Jersey health insurance premiums cannot be dependent upon your health, occupation, age, or gender, although they can vary with family size.

Finally, New Jersey health insurance companies must renew your policy upon your request unless you have violated a part of the contract.

More NJ health insurance help

If you want more help getting the best health insurance policy for you individual needs, read our guide to health insurance.

Also see the guide to New Jersey small business health insurance.


To find out more about NJ health insurance laws and regulations, visit the official website of the New Jersey Department of Banking and Insurance.





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This internet site provides information of a general nature for educational purposes only and is not intended to be legal advice. We make no guarantees as to the validity of the information presented. Your particular facts and circumstances, and changes in the law, must be considered when applying insurance law. You should always consult with a competent insurance professional licensed in your state with respect to your particular situation.