Title 17B, Title 17B: INSURANCE

17B:26-2.1v Individual health insurer prescription drug plans to cover certain infant formulas. 5. An individual health insurer which provides hospital or medical expense benefits for expenses incurred in the purchase of prescription drugs under a policy that is delivered, issued…

17B:26-2.1w Policy issued under Chapter 26 of Title 17B required to cover certain out-of-network services. 3. Notwithstanding the provisions of chapter 26 of Title 17B of the New Jersey Statutes to the contrary, no policy shall be delivered, issued, executed or renewed on or afte…

17B:26-2.1x Individual health insurer to offer coverage for domestic partner. 50. An individual health insurer that provides hospital or medical expense benefits under a policy that is delivered, issued, executed or renewed in this State or approved for issuance or renewal in thi…

17B:26-2.1y Individual health insurer, coverage for contraceptives. 5. a. An individual health insurer that provides hospital or medical expense benefits shall provide coverage under every policy delivered, issued, executed or renewed in this State or approved for issuance or ren…

17B:26-2.1z Individual health insurance policies to provide benefits for orthotic and prosthetic appliances. 4. a. Every individual health insurance policy that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to N…

17B:26-2.2. Second surgical opinions; definitions As used in this act: a. "Elective surgical procedure" means any nonemergency surgical procedure which may be scheduled at the convenience of the patient or the surgeon without jeopardizing the patient's life or causing serious imp…

17B:26-2.3. Policy benefits for second surgical opinion Any insurer issuing an individual insurance policy in accordance with chapter 26 of Title 17B of the New Jersey Statutes which provides coverage of surgical operations performed on a person while confined in a hospital as an…

17B:26-2.4. Benefit payments Benefits for a second surgical opinion shall include payment for the second surgical opinion services of an eligible physician and for essential laboratory and X-ray services incidental thereto, either as a benefit under the individual policy or, at t…

17B:26-2.5. Third surgical opinion If a second surgical opinion does not confirm that a proposed elective surgical procedure is medically advisable, benefits must be provided under the policy for a third surgical opinion in the same manner as for the second opinion. L.1979, c. 32…

17B:26-2.6. Excluded surgical procedures The second surgical opinion benefit provisions of a policy may exclude benefits while the patient is confined in a hospital as an inpatient, any surgical procedures not covered by the policy and surgical procedures in the following categor…

17B:26-2.7. Payment for opinion services of physician If a physician who furnishes a second or third surgical opinion also performs the surgical procedure, the policy need not provide payment for the second or third opinion services of that physician. L.1979, c. 328, s. 6.

17B:26-2.8. Application of act This act shall apply to all contracts in which the insurer has reserved the right to change the premium. L.1979, c. 328, s. 7.

17B:26-20. Insurance with other insurers There may be a provision as follows: Insurance with other insurers: If there be other valid coverage, not with this insurer, providing benefits for the same loss on a provision of service basis or on an expense incurred basis and of which …

17B:26-21. Insurance with other insurers There may be a provision as follows: Insurance with other insurers: If there be other valid coverage, not with this insurer, providing benefits for the same loss on other than an expense incurred basis and of which this insurer has not bee…

17B:26-22. Relation of earnings to insurance There may be a provision as follows: Relation of earnings to insurance: If the total monthly amount of loss of time benefits promised for the same loss under all valid loss of time coverage upon the insured, whether payable on a weekly…

17B:26-23. Unpaid premium There may be a provision as follows: Unpaid premium: Upon the payment of a claim under this policy, any premium then due and unpaid or covered by any note or written order may be deducted therefrom. L.1971, c. 144, s. 17B:26-23.

17B:26-24. Cancellation There may be a provision as follows: Cancellation: The insurer may cancel this policy at any time by written notice delivered to the insured, or mailed to his last address as shown by the records of the insurer, stating when, not less than five days therea…

17B:26-25. Conformity with State statutes There may be a provision as follows: Conformity with State statutes: Any provision of this policy which, on its effective date, is in conflict with the statutes of the State in which the insured resides on such date is hereby amended to c…

17B:26-26. Illegal occupation There may be a provision as follows: Illegal occupation: The insurer shall not be liable for any loss to which a contributing cause was the insured's commission of or attempt to commit a felony or to which a contributing cause was the insured's being…

17B:26-27. Intoxicants and narcotics There may be a provision as follows: Intoxicants and narcotics: The insurer shall not be liable for any loss sustained or contracted in consequence of the insured's being intoxicated or under the influence of any narcotic unless administered o…

17B:26-28. Inapplicable or inconsistent provisions If any provision of sections 17B:26-3 to 17B:26-31, inclusive, is in whole or in part inapplicable to or inconsistent with the coverage provided by a particular form of policy the insurer, with the approval of the commissioner, s…

17B:26-29. Order of certain policy provisions The provisions which are the subject of sections 17B:26-3 to 17B:26-27, inclusive, or any corresponding provisions which are used in lieu thereof in accordance with such sections, shall be printed in the consecutive order of the provi…

17B:26-3. Required provisions Except as provided in section 17B:26-28 each such policy delivered or issued for delivery to any person in this State shall contain the provisions specified in sections 17B:26-4 to 17B:26-15 inclusive, in words in which the same appear in the applica…

17B:26-3.1. Cancellation of policy within 10 days after receipt Except as provided in N.J.S. 17B:26-28, each health insurance policy, other than group and blanket insurance, delivered or issued for delivery to any person in this State shall contain a provision or have attached to…

17B:26-3.2. Individual health insurance policy, exclusion, rates, terms based on genetic information prohibited 14. Every individual health insurance policy providing hospital and medical expense benefits that is delivered, issued, executed or renewed in this State pursuant to Ch…

17B:26-30. Third party ownership The word "insured," as used in this chapter, shall not be construed as preventing a person other than the insured with a proper insurable interest from making application for and owning a policy covering the insured or from being entitled under su…

17B:26-31. Requirements of other jurisdictions a. Any policy of a foreign or alien insurer, when delivered or issued for delivery to any person in this State, may contain any provision which is not less favorable to the insured or the owner, if other than the insured, than the pr…

17B:26-32. Other policy provisions No policy provision which is not subject to sections 17B:26-3 to 17B:26-31, inclusive, of this chapter shall make a policy, or any portion thereof, less favorable in any respect to the insured or the owner, if other than the insured, than the pr…

17B:26-33. Policy conflicting with this chapter A policy delivered or issued for delivery to any person in this State in violation of this chapter shall be held valid but shall be construed as provided in this chapter. When any provision in a policy subject to this chapter is in …

17B:26-34. Time limit on certain defenses with respect to reinstatement A policy provision complying with the requirements of section 17B:26-5, relating to a time limit on certain defenses, shall also apply to any reinstatement of the policy except that the period of time establi…

17B:26-35. Waiver of rights of insurer The acknowledgment by any insurer of the receipt of notice given under any policy covered by this chapter, or the furnishing of forms for filing proofs of loss, or the acceptance of such proofs, or the investigation of any claim thereunder s…

17B:26-36. Age limit If any policy contains a provision establishing, as an age limit or otherwise, a date after which the coverage provided by the policy will not be effective, and if such date falls within a period for which premium is accepted by the insurer or if the insurer …

17B:26-37. Scope of chapter Nothing in this chapter shall apply to or affect a. any policy of workmen's compensation insurance or any policy of liability insurance with or without supplementary coverage therein as authorized by section 17:28-1; or b. any policy or contract of rei…

17B:26-38. Penalty Any person who delivers or issues for delivery to any person in this State any policy in willful violation of the provisions of this chapter shall be liable to a penalty not exceeding $500.00 for each offense to be collected by the commissioner in the name of t…

17B:26-39. Legislative findings and declarations The Legislature hereby finds and declares that the high cost of hospital care necessitates the establishment of alternative means of caring for patients who need some professional health care, but who do not need to remain hospital…

17B:26-4. Entire contract; changes There shall be a provision as follows: Entire contract; changes: This policy, including the endorsements and the attached papers, if any, constitutes the entire contract of insurance. No change in this policy shall be valid until approved by an …

17B:26-40. Definitions As used in this act: a. "Home health care" means those nursing and other home health care services rendered to a person in his place of residence, under the following conditions: (1) On a part-time and intermittent basis, except when full-time or 24-hour se…

17B:26-41. Home health care; requirement for provisions for coverage Notwithstanding any provision of a policy of health insurance, hereafter delivered or issued for delivery in this State, whenever such policy provides coverage for inpatient hospital care or skilled nursing faci…

17B:26-42. Benefits Every policy shall provide benefits required by section 3 without a separate deductible or coinsurance provision for the home health care benefit. For the purpose of determining the benefits for home health care, each visit by a member of a home health care te…

17B:26-43. Direct reimbursement to home health care providers The State Commissioner of Insurance, after consultation with the State Commissioner of Health, shall provide for a system of direct reimbursement to home health care providers for services rendered pursuant to this act…

17B:26-44. Regulations The State Commissioner of Insurance, after consultation with the State Commissioner of Health, is hereby empowered and directed to promulgate regulations necessary to effectuate the provisions of this act. L.1977, c. 98, s. 6.

17B:26-44.1. Policy provision for reimbursement of dental services; payment regardless of discipline of provider Notwithstanding any provision of a policy or individual health insurance contract hereafter delivered, issued for delivery, amended, renewed or ratified in this State,…

17B:26-44.2. Application to policy or contract not limited to reimbursement of specific types of duly licensed health care professionals other than dentists The provisions of section 1 of this act shall also apply to any policy or contract of individual health insurance already d…

17B:26-44.3. Renewal date; policy with reservation of right to change premium For the purposes of this act, a policy or contract in which the company has reserved the right to change the premium shall be considered renewed as of the date on which the premium is changed or is subj…

17B:26-44.4. Alternative dental coverage; original coverage restricted to limited number of providers Each employer or other organization which employs or has 25 or more employees or members during the full preceding calendar year and which contributes to a health insurance contr…

17B:26-44.5. Employer contribution An employer or other organization shall be required to pay for or contribute towards the provision of alternative coverage an amount equal to the premium or cost which it pays or contributes to the health insurance contract for dental services w…