Medical Insurance Overview

In 1992, the New Jersey Legislature created the Individual Health Coverage (IHC) Program to ensure that people without access to employer or government sponsored health care programs could purchase health coverage for themselves and their families from a variety of private carriers. You are eligible to purchase an individual plan if you are:

  1. A resident of New Jersey
  2. Not eligible for coverage on Medicare

Annual Open Enrollment Period

Beginning in 2014, and for each year after that, there will be an Annual Open Enrollment Period.  During the Annual Open Enrollment Period, people can buy individual insurance.  It does not matter whether you are buying your very first individual plan, or replacing individual coverage that you already have.  For 2015, the Annual Open Enrollment Period starts November 15, 2014 and continues through February 15, 2015. Coverage applied for during the Annual Open Enrollment Period by December 31 will begin January 1 of the next year.  When the Annual Open Enrollment Period extends beyond December 31 – as it will for 2015 – coverage applied for after December 31 will be effective on the first day of the month following the month the application is received (so, an application received January 10 will have a coverage effective date of February 1). Some carriers allow effective dates on the 15th of the month (in which case, an application received January 10 could have an effective date of January 15.) Applications must be received during the Annual Open Enrollment Period to be considered.

Special Enrollment Period

When certain events happen in your life, you have the right to buy an individual policy or change your current coverage without waiting for the Annual Open Enrollment Period.  These “triggering” events create 60-day Special Enrollment Periods.  The 60-day period starts on the date of the triggering event.

Triggering Events

Generally, a triggering event is one that results in a change in your family, a change in your location, or one that results in a loss of minimum essential coverage for a family member.  It can also include a change in your eligibility for coverage.  It does NOT include a loss of coverage because you failed to pay premiums, or misrepresented material facts, or committed fraud.  If you lose coverage contact the carrier that issued the coverage you lost to ask if the loss of coverage is considered to be a triggering event. When there is a change in your family, such as birth or marriage, or if you move your primary residence, contact your current carrier and ask if the event entitles you to a special enrollment period.

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Click here for Link to the NJ Individual Buyer’s Guide