This version of the form is not currently in use and is provided for reference only. Download this version of the document for the current year.
Nongroup Enrollment/Change Request is a legal document that was released by the New Jersey Department of Banking and Insurance - a government authority operating within New Jersey.
Q: What is a Nongroup Enrollment/Change Request?
A: A Nongroup Enrollment/Change Request is a form used in New Jersey to enroll or make changes to an insurance plan outside of the group coverage offered by an employer.
Q: Who can use a Nongroup Enrollment/Change Request form?
A: Any individual in New Jersey who is not eligible for group coverage through an employer can use a Nongroup Enrollment/Change Request form.
Q: What changes can be made using a Nongroup Enrollment/Change Request form?
A: Using this form, individuals can enroll in a new insurance plan, make changes to their existing plan, or terminate their coverage.
Q: Is there a deadline for submitting a Nongroup Enrollment/Change Request form?
A: Yes, there are specific open enrollment periods during which you can submit a Nongroup Enrollment/Change Request form. Outside of those periods, you may be eligible for a special enrollment period if you experience a qualifying life event.
Q: What are examples of qualifying life events for a special enrollment period?
A: Examples of qualifying life events include getting married, having a baby, losing other health coverage, or permanently moving to a new area.
Form Details:
Download a printable version of the form by clicking the link below or browse more documents and templates provided by the New Jersey Department of Banking and Insurance.