Are you a small New Jersey employer with less than 50 employees? Have you tried to navigate the labyrinth of bureaucracy to get health care insurance for your employees? If you did, you may have noticed that there are a number of websites and information governing health insurance in New Jersey. Honestly, it can be confusing for anyone to understand where to start. So, let us help you make some sense over this puzzle.
First let’s put some historical perspective on health insurance in New Jersey. The NJ Department of Banking and Insurance regulates health insurance in New Jersey. All policies must comply with both US federal and the NJ Department of Banking and Insurance (NJ DOBI) regulations. In 1992, NJ DOBI established the Small Employer Health (SEH) Program. All NJ small business health insurance plans are regulated by the SEH. In addition, the 2010 US Affordable Care Act (ACA) is one of the primary governing federal regulations for US health insurance. The ACA established marketplace exchanges (essentially on-line portals) to buy health insurance.
Insurance language can definitely be complex, so before we go further, let’s establish some base terminology for this article:
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IHC is the Individual Health Benefits Program (not explicitly discussed in this article).
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SEH is the Small Employer Health Benefits Program for New Jersey.
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Get Covered New Jersey (GetCoveredNJ) is New Jersey’s state-based Exchange (SBE) through which qualified individuals may purchase some QHPs and SADPs (Stand Alone Dental Plans) with financial help (premium tax credits, cost-sharing reductions, and/or the New Jersey premium state subsidy) depending upon a person’s eligibility. All health benefits plans offered through GetCoveredNJ are also offered outside of GetCoveredNJ, but financial help is ONLY available through GetCoveredNJ.
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Qualified Health Plan (QHP) refers to health benefits plans providing medical services and supplies (with or without a defined set of pediatric dental services embedded in the health benefits plan). All standard health benefit plans available in the individual and small employer markets (see below) are QHPs.
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Small Employers in NJ are any employer that has 2-50 full time equivalent (FTE) employees.
Now, what have we learned through those definitions:
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In NJ, the SEH regulates small employer health plans.
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GetCoveredNJ is the state-based Exchange (SBE) specific to New Jersey.
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If you want to purchase a QHP as a small business, you can use GetCoveredNJ–Small Employers/SHOP.
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If you believe you qualify for a tax credit or subsidy, you must either contact an insurance carrier directly or a SHOP registered agent/broker.
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There are small employer plans available outside of GetCoveredNJ that are regulated by SEH. Most small employers will approach their healthcare from this perspective.
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If you want, you can use the SEH websites to contact health insurance carriers directly.
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Alternatively, if you want a health insurance broker to work on your behalf, they can contact the carriers and provide plan options for you.
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Here at Rue Insurance, we know how to navigate through this layered system, and we highly recommend that you choose a broker to work on your behalf. The regulation and rules in the healthcare system are constantly changing as new state and federal laws are passed, and with this, we are constantly tackling new ideas / preparing ourselves to help out in any way we can. We understand how confusing this process can be and are eager to aid you through your own process of choosing the right healthcare plan for your employees. Give us a call at 609-586-7474. And remember to always…”Be Ready with Rue.”
Image by Antoni Shkraba Studio on Pexels.
About the Authors
Anthony DePalo is a Risk Management Sales Intern at Rue Insurance. He is a rising senior at Loyola Maryland and will graduate with a bachelor’s degree in Business Economics. During his internship he will be focusing on the Employee Benefits side of insurance.
Garrett Grega joined Rue in 2023 as the Director of Marketing & Communications, bringing over 2 decades of marketing experience from various Fortune 500 companies. He holds a license for property, casulaty, life and health in New Jersey. Garrett is responsible for developing the external communications platform consistent with the strategic direction, strategic vision, mission, and values for Rue Insurance.
