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NJ State Health Insurance Exchange: Implementation and Reforms Overview

New Jersey Department of Banking and Insurance is taking steps towards establishing a temporary high-risk pool within the state's individual health coverage market. By January 1, 2014, an operational Health Insurance Exchange must be in place, offering Bronze, Silver, Gold, and Platinum packages determined by the Secretary. Other reforms include Medicaid expansion, insurance market reforms, and premium reviews. This comprehensive guide provides insights into the state's efforts to enhance healthcare accessibility and quality through various initiatives.

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NJ State Health Insurance Exchange: Implementation and Reforms Overview

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  1. State Implementation • Temporary High-Risk Pool • NJ DOBI filed a letter of intent to Secretary Sebelius to use the state’s individual health coverage market as its temporary high-risk pool. • NJ already has “guaranteed issue,” meaning high-risk pool will have little overall effect on coverage. • Health Insurance Exchange • By Jan. 1, 2014, states must have an operational health insurance exchange run independently by the state, or in conjunction with other states. Federal start-up funds become available next year for states. • Secretary shall determine benefits, but broken up into Bronze, Silver, Gold and Platinum packages. • Reinsurance Pool – Health Care Choice Compacts

  2. State Implementation, cont’d • Insurance Reform • Market Reforms – coverage for dependent children, ban on pre-existing conditions, guarantee issue etc. • Premium Review – NJ eligible for $1 million this year • Medicaid Expansion • Beginning Jan. 1, 2014, Medicaid coverage will be expanded to 133% of the federal poverty level for non-elderly individuals • States will receive greater federal match for cost of expansion • Early expansion option

  3. Tax Exempt Status • Community needs assessment • Financial assistance policy / charge limits • Debt collection • Reporting disclosure • State legislation – conflicts of interest, quarterly public meetings, charge limitations etc.

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