The answers below are for NJ based groups only. These answers may or may not apply to your group if it is not sitused in NJ. For complete answers to these questions and how they pertain to your group coverage, please contact us.
1. Is pregnancy a pre-existing condition?
Answer: No, The Federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) prohibits a pre-existing condition limitation exclusion relating to pregnancy for any group plan.
2. Is it legal to set up an association plan?
Answer: No, no new association plans can be created in NJ. There is a Purchasing Alliance legislation in NJ which permits employers in similar geographical areas or with similar industry to create an alliance in the NJ Small Group market. Each group entity is rated on its own demographics, meaning ages of the employees and if they enroll dependents. The rating is not as a large group entity. The carrier must also agree to negotiating a lesser rate based on the volume of enrollment.
3. Is infertility a covered benefit?
Answer: Yes. For NJ Small Employers (2-50 employees), in vivo, which for example includes artificial insemination, is covered with limitations and with pre-approval from the insurance carrier.
Following is what is excluded:
Services or supplies furnished in connection with any procedures to enhance fertility which involve harvesting, storage and / or manipulation of eggs and sperm. This includes, but is not limited to the following: a) procedures: in vitro fertilization; embryo transfer; embryo freezing; and Gamete intra-fallopian Transfer (GIFT) and Zygote Intrafallopian Transfer (ZIFT); donor sperm, surrogate motherhood and b) Prescription Drugs not eligible under the Prescription Drugs section of the Policy.
For NJ Large Employers (51+ employees), in 2001, NJ passed legislation that
requires coverage for diagnosis and treatment of infertility under contracts providing pregnancy related benefits to groups of over 50 persons.
It requires hospital and medical expense contracts to provide coverage for medically necessary expenses incurred in the diagnosis and treatment of infertility. Coverage must include: diagnosis and diagnostic tests; medications; surgery; in vitro fertilization; embryo transfer; artificial insemination; gamete intra fallopian transfer; zygote intra fallopian transfer; intracytoplasmic sperm injection, and four completed egg retrievals per lifetime of the coverage person who is 45 years of age or younger.
A religious employer may be granted an exclusion.
4. Is that guy on the other side really the president of Customized Benefits Solutions?
Answer: Yes, it really is! To find out more about Vlad and the team, check out About Us.
- Advocacy. In every interaction and transaction, we fight for our clients' best interests. We also provide education, giving clients the insight and understanding they need to make the most effective business decisions.
- Creativity. CBSI has access to multiple insurance companies, helping secure optimal benefits at an optimal price. With extensive knowledge and experience in employee benefits and HR administration, we provide outside-the-box solutions and unsurpassed service.
- Integrity. Integrity is evident in everything we do — from how we treat our clients and each other to the way we conduct business with our network of partners.