03 Nov Pre-existing condition coverage in NJ

Q. Pre-existing conditions were covered in New Jersey prior to ACA after a six-month waiting period. So if ACA was repealed or modified, wouldn’t New Jersey citizens still have coverage for pre-existing conditions?
— Paying attention

A. Here goes the New Jersey health insurance history lesson.

Let’s go back to Gov. Jim Florio, who enacted some state health care reforms in the early 1990s.

“That reform guaranteed coverage so those with pre-existing conditions could get coverage,” said Ed Gaelick, a Chartered Life Underwriter and Chartered Financial Consultant with PSI Consultants in Glen Rock. “Previously, in some situations, those same people could have been denied.”

But to protect insurance companies from individuals coming into the system only when they needed care, then getting treatment and jumping back out, the law allowed a pre-existing condition exclusion, Gaelick said.

The actual exclusion time period varied between none, six months and 12 months, depending on the market an individual was in — individual, small group or large group, he said.

The Affordable Care Act remains uncertain and its future could include repeal, replace, modifications, improvements to it or sticking to the status quo.

“My opinion is regardless of what happens, all individuals nationally, not just New Jersey, will continue to have no exclusions for pre-existing conditions,” Gaelick said.

He said he believes open enrollment will continue to be the protection device to prevent abuse.

“So someone with a pre-existing condition will need to have an open enrollment opportunity — they can’t just come into the system anytime they want — yet have immediate coverage,” he said. “In the unlikely event the federal law adds back pre-existing condition exclusions, New Jersey certainly can continue with its laws.”

If only we had a crystal ball…

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The post was originally published in November 2017.