New Jersey Group health insurance quotes
Provided you satisfy the eligibility requirements described in the Eligibility Section, you cannot be denied coverage for any reason including your past or current health condition. However, the "pre-existing conditions" provision may limit coverage during the first 12 months. You also are guaranteed renewal of your policy, provided you remain a resident of New Jersey and do not become eligible for coverage under a group plan, your premium is paid in a timely fashion and you do not commit fraud.
Health Maintenance Organization (HMO) plans are network-based forms of managed care. An HMO consists of a network of physicians, hospitals and other health care professionals which provides members with medical treatment and care. You choose a Primary Care Provider or Primary Care Physician (PCP) from those participating in the HMO network. That PCP coordinates your health care, referring you to specialists in the network, when necessary. Services not provided by or referred by a PCP are not covered, except for emergency medical care. You are responsible for a copayment for specified services, for example, a $15 copayment for a physician visit or a $150 per day copayment for hospitalization. There are no calendar year deductibles. There is generally no coinsurance requirement except that carriers have the option to provide prescription drug benefits subject to either 50 percent coinsurance or a $15 copayment per prescription or refill. The rate comparison sheets list the election made by each HMO carrier. There are two ways an HMO may provide access to services and supplies -- through a fully staffed health center or through a physician who is a member of the network. An HMO is not required to offer coverage to persons who do not reside in its approved service area.
Preferred Provider Organization (PPO) plans are network-based forms of managed care which allow you to seek medical care and treatment either from within a network of physicians, hospitals and other health care professionals or from physicians, hospitals and other health care professionals that are outside of the PPO network. If you seek medical care and treatment from network providers, you generally will be eligible for a richer level of benefits. If you seek care and treatment from providers that are outside of the network, you will be eligible for a lower level of benefits. The network benefits under the plan may be subject to copayments, just as is the case with HMO coverage. Non-network benefits will always be subject to a deductible and coinsurance. Carriers are not required to sell PPO plans. Carriers that do offer PPO plans are identified on the rate comparison sheets. Contact the carriers directly for information concerning their PPO plan designs.