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.

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

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

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:

	I-327 (Reentry Permit)
	I-551 (Permanent Resident Card)
	I-571 (Refugee Travel Document)
	I-766 (Employment Authorization Document)
	a machine-readable Immigrant Visa with Temporary I-551 Language affixed to an unexpired foreign passport
	a Temporary I-551 Stamp affixed to an I-94
	an I-94 (Arrival/Departure Record) with an unexpired foreign passport
	an unexpired Foreign Passport for Visa Waiver Program travelers
	an I-20 (Certificate of Eligibility for Nonimmigrant (F-1) Student Status) with an I-94 on an unexpired foreign passport
	a DS2019 (Certificate of Eligibility for Exchange Visitor (J-1) Status) with an I-94 and an unexpired foreign passport

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. 

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.

What health care services does NJ Protect cover?

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:

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

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?