New Jersey defines small companies for the sake of group health insurance as an employer with between 2-49 employees. They segment their small mid-market to 50-100 employees and anything over 100 would be considered in the large group market. That said a large group case to the Blue’s is normally one of many hundreds or even thousands of employees. In order to provide group insurance rates in New Jersey, it is a bit different than other close states such as New York. As such, a complete employee census must be provided for the entire company wishing to secure pricing. The census must include, age, gender, family status, home zip code. This is true for any market segment from 2 employees on up in NJ, and over 50 employees they begin asking for more information on the current health insurance plan and rates, and once over 100 employees even claims data.
The state of New Jersey is a modified community-rated system which allows insurance carriers to take in to account the gender, and age of employees along with location of the business, when calculating group insurance rates.
There are normally 5-7 leading carriers in the health market in New Jersey: Horizon Cross Blue Shield of New Jersey, Aetna, Cigna, Oxford Health Plans (owned by United Healthcare), Health Net, and Amerihealth. The has changed some in 2011 as Cigna left the small 2-49 employee market and HealthNet’s enrollment was gobbled up by United/Oxford in 2010. So the market has shrunk yet again.
Most carriers offer products along the full spectrum – PPO, HMO, POS, NG POS, NG HMO, EPO, H.S.A qualified plans, and also HRA products.
Insurance carriers file their rates with the NJ state department of Insurance at the beginning of the year and then each quarter the rates increase. As such during the course of the year insurance carriers can adjust their quarterly rates moving throughout the year.
