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Burlington Health Insurance

Facts and Figures

  • Insurance
    Carriers
    8
  • Number of
    General Doctors
    3963
  • Number of
    Hospitals
    6

Insurance Carriers

State Government Insurance Programs Offered

Individual Health Coverage (IHC) Program wwww.state.nj.us (Search: Individual Health Coverage)


IHC: Covers office visits, Hospital care, Prenatal and maternity care, Immunizations, Well-child care, Screenings (including mammographies, Pap smears and prostate examinations), X-ray and laboratory services, Certain mental health and substance abuse services, Prescription drugs. Individuals may be subject to a 12-month waiting period. Eligibility: IHC: Must have been a resident of New Jersey for at least 6 months. Not eligible for coverage under a group health plan, governmental plan or church plan. Not eligible for coverage under Medicare. HIPAA-eligible patients are also qualified (no length of residency requirement).

Medicaid www.state.nj.us/ humanservices/dmahs/clients/ medicaid/


Coverage: Inpatient and outpatient hospital treatment, Laboratory tests and x-rays, Early and periodic screening, diagnostic and treatment services, Home health care, Physician services, Nurse- midwife services, Assistance with family planning and any necessary supplies, Nursing facilities for people over 21. Eligibility: Must be a New Jersey resident and a U.S. citizen or legal permanent resident. Income limits: Pregnant women and infants ages 0–1: 185% FPL. Infants ages 0–1 born to Medicaid-enrolled mothers: 200% FPL. Children ages 1–5: 133% FPL. Children ages 6–19: 100% FPL. Parents/caretakers living with children ages 0–18: 133% FPL. Aged, blind, and disabled: Singles and couples up to 100% FPL, with asset limit of $4,000 for singles and $6,000 for couples. Medically-needy: Singles with income of $367 a month and asset limit of $4,000, couples with monthly income of $434 and asset limit of $6,000.

NJ Family Care Program www.njfamilycare.org


Coverage: NJ Family Care: Doctor visits, Eyeglasses, Hospitalization, X-rays & lab tests, Prescriptions, Checkups, Mental health, and Dental (for children). WIC: Nutrition education and services, breastfeeding promotion and education, monthly food prescription of nutritious foods, immunization screenings, and maternal, prenatal and pediatric health- care services. Eligibility: NJ Family Care: Must be New Jersey resident, not covered by health insurance (including Medicaid), and be a U.S. citizen or legal permanent resident for at least 5 years. Eligible children must be under 19 and have family income of up to 350% FPL. Eligible parents/guardians and their children under 19 must have income of up to 133% FPL.

Medicare www.medicare.gov


Medicare offers Part A, inpatient care in hospitals and rehabilitative centers; Part B, doctor and some preventive services and outpatient care; Part C allows Medicare benefits through private insurance (Medicare Advantage); Part C includes Parts A, B, and C not covered by Medicare. Part D covers prescription drugs. Senior Gold is a state funded prescription discount program. Eligibility: Medicare: Must be U.S. citizen or permanent U.S. resident, and: 1) If 65 years or older, you or your spouse worked for at least 10 years in Medicare-covered employment, or 2) You have a disability or end- stage renal disease (permanent kidney failure requiring dialysis or transplant) at any age. Senior Gold: Must be New Jersey resident and be at least 65 years old, or at least 18 years old and receiving Social Security Disability Title II benefits. Must be participating in Medicare Part D. Income limits of $24,432–$34,432 for singles, and $29,956–$39,956 for couples.

VA Medical Benefits Package www.va.gov


Comprehensive preventive and primary care, outpatient and inpatient services. Eligibility: ”Veteran status” = active duty in the U.S. military, naval, or air service and a discharge or release from active military service under other than dishonorable conditions. Certain veterans must have completed 24 continuous months of service.

NJ Protect Federal program run by the state of New Jersey www.PCIP.gov www.state.nj.us (Search: NJ Protect)


NJ Protect: Covers broad range of benefits, including primary and specialty care, hospital care, and prescription drugs. Coverage: You must be a U.S. citizen or national or lawfully present in the United States and a New Jersey resident. Must have been without any creditable coverage for at least 6 months and you must have a pre-existing condition.

Women-Infant- Children (WIC) www.state.nj.us/health/fhs/wic


WIC: Must be New Jersey resident, be a pregnant or recently pregnant woman, or a child up to age 5, and be determined to have a nutritional risk. Must live at or below 185% FPL.

Heath Care Reform

Small business tax credits.  144,000 small businesses in New Jersey could be helped by a new small business tax credit that makes it easier for businesses to provide coverage to their workers and makes premiums more affordable.1  Small businesses pay, on average, 18 percent more than large businesses for the same coverage, and health insurance premiums have gone up three times faster than wages in the past 10 years.  This tax credit is just the first step towards bringing those costs down and making coverage affordable for small businesses.

Closing the Medicare Part D donut hole. Last year, roughly 109,000 Medicare beneficiaries in New Jersey hit the donut hole, or gap in Medicare Part D drug coverage, and received no extra help to defray the cost of their prescription drugs.2 Medicare beneficiaries in New Jersey who hit the gap this year will automatically be mailed a one-time $250 rebate check. These checks will begin to be mailed to beneficiaries in mid-June and will be mailed monthly throughout the year as new beneficiaries hit the donut hole. The new law continues to provide additional discounts for seniors on Medicare in the years ahead and completely closes the donut hole by 2020. 

Support for health coverage for early retirees. An estimated 117,000 people from New Jersey retired before they were eligible for Medicare and have health coverage through their former employers. Unfortunately, the number of firms that provide health coverage to their retirees has decreased over time.3  Beginning June 1, 2010, a $5 billion temporary early retiree reinsurance program will help stabilize early retiree coverage and help ensure that firms continue to provide health coverage to their early retirees. Companies, unions, and state and local governments are eligible for these benefits.

New consumer protections in the insurance market beginning on or after September 23, 2010.

Insurance companies will no longer be able to place lifetime limits on the coverage they provide, ensuring that the 5.3 million New Jersey residents with private insurance coverage never have to worry about their coverage running out and facing catastrophic out-of-pocket costs.

Insurance companies will be banned from dropping people from coverage when they get sick, protecting the 326,000 individuals who purchase insurance in the individual market from dishonest insurance practices.

Insurance companies will not be able to exclude children from coverage because of a pre-existing condition, giving parents across New Jersey peace of mind.

Insurance plans’ use of annual limits will be tightly regulated to ensure access to needed care.  This will protect the 5 million residents of New Jersey with health insurance from their employer, along with anyone who signs up with a new insurance plan in New Jersey.

Health insurers offering new plans will have to develop an appeals process to make it easy for enrollees to dispute the denial of a medical claim.

Patients’ choice of doctors will be protected by allowing plan members in new plans to pick any participating primary care provider, prohibiting insurers from requiring prior authorization before a woman sees an ob-gyn, and ensuring access to emergency care.

Extending coverage to young adults. Beginning on or after September 23, 2010, plans and issuers that offer coverage to children on their parents’ policy must allow children to remain on their parents’ policy until they turn 26, unless the adult child has another offer of job-based coverage in some cases. This provision will bring relief to roughly 27,800 individuals in New Jersey who could now have quality affordable coverage through their parents.4  Some employers and the vast majority of insurers have agreed to cover adult children immediately.

Affordable insurance for uninsured with pre-existing conditions. $141 million federal dollars are available to New Jersey starting July 1 to provide coverage for uninsured residents with pre-existing medical conditions through a new transitional high-risk pool program, funded entirely by the Federal government. The program is a bridge to 2014 when Americans will have access to affordable coverage options in the new health insurance exchanges and insurance companies will be prohibited from denying coverage to Americans with pre-existing conditions. If states choose not to run the program, the Federal government will administer the program for those residents.

Strengthening community health centers. Beginning October 1, 2010, increased funding for Community Health Centers will help nearly double the number of patients seen by the centers over the next five years. The funding could not only help the 134 Community Health Centers in New Jersey but also support the construction of new centers.

More doctors where people need them. Beginning October 1, 2010, the Act will provide funding for the National Health Service Corps ($1.5 billion over five years) for scholarships and loan repayments for doctors, nurses and other health care providers who work in areas with a shortage of health professionals. This will help the 2% of New Jersey’s population who live in an underserved area.

New Medicaid options for states. For the first time, New Jersey has the option of Federal Medicaid funding for coverage for all low-income populations, irrespective of age, disability, or family status. 

"Vista Health Solutions" www.forhealthinsurance.com Tel (888)215-4045 Email [email protected]