Title 17B, Title 17B: INSURANCE

17B:27A-31. Contents of plan of operation 15. The plan of operation shall constitute a public record and shall include, but not be limited to, the following: a. A method of handling and accounting for assets and moneys of the program and an annual fiscal reporting to the commissi…

17B:27A-32. Authority of board 16. The board shall have the authority to: a. Enter into contracts as are necessary or proper to carry out the provisions and purposes of this act; b. Sue or be sued, including taking any legal actions as may be necessary for recovery of any assessm…

17B:27A-33. Formulation of five health benefits plans 17. Subject to the approval of the commissioner, the board shall formulate the five health benefits plans to be made available by small employer carriers in accordance with the provisions of this act, and shall promulgate five…

17B:27A-33.1 Short title. 7. Sections 7 through 11 of P.L.2023, c.194 (C.17B:27A-33.1 et al.) shall be known and may be cited as the "Small Business Health Insurance Affordability Act." L.2023, c.194, s.7.

17B:27A-33.2 Annual review, small-employer health benefits plans, publish findings, report, Department of Banking and Insurance website. 8. a. The board shall annually review the small employer health benefits plans offered pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.) to en…

17B:27A-4 Offering of individual health benefits required by issuer of small employer health benefits plans. 3. a. Every carrier that offers individual health benefits plans shall make a good faith effort to market the individual health benefits plans. The department may impose f…

17B:27A-4.1 Individual policy, contract for hospital, medical expense benefits, coverage of subscriber's child. 7. a. A policy or contract which provides hospital or medical expense benefits under which dependent coverage is available shall continue to make that coverage availabl…

17B:27A-4.2. Requirements applicable to State Medicaid 8. A carrier shall not impose requirements on the Division of Medical Assistance and Health Services in the Department of Human Services which has been assigned the rights of an individual who is eligible for medical assistan…

17B:27A-4.3. Eligibility for enrollment in individual health benefits plan 4. Notwithstanding any other provision of law to the contrary, a carrier shall not consider a person's eligibility for medical assistance pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.), or the equivalent …

17B:27A-41. Violations, penalty 25. Any carrier which violates this act shall be subject to a penalty assessment, as determined by the commissioner. L.1992,c.162,s.25; amended 1995,c.298,s.9.

17B:27A-43. Violations, penalties 27. A carrier which violates any provision of this act shall be liable to a penalty of not less than $2,000 and not greater than $5,000 for each violation. The penalty shall be collected by the commissioner in the name of the State in a summary p…

17B:27A-44. Assessments not charged to policyholders, public 28. No assessment provided for under this act shall be charged, directly or indirectly, to policyholders or the public, provided that a carrier may charge such an assessment to policyholders to the extent that the charg…

17B:27A-45. Standard claim form 29. The board, in conjunction with the board of the New Jersey Individual Health Coverage Program established pursuant to section 9 of P.L.1992, c.161 (C.17B:27A-10) shall promulgate one standard claim form. In order to provide a standard system of…

17B:27A-47. Coverage obtained through out-of-State trust, compliance required 12. Group hospital or medical coverage obtained through an out-of-State trust covering a group of 49 or fewer employees or participating persons who are residents of this State shall comply with the pro…

17B:27A-48. Multiple employer arrangement; requirements 13. A multiple employer arrangement covering a group of 49 or fewer employees or participating persons of an individual employer who are residents of this State shall register with the board of directors established pursuant…

17B:27A-49. Notification to commissioner by carrier of multiple employer arrangement 14. A carrier shall notify the commissioner by December 31 of each year of any health care coverage or benefits, stop-loss coverage or administrative services only contracts it provides or enters…

17B:27A-5 Laws not applicable to managed care health benefits plans. 4. The following provisions shall not apply to managed care health benefits plans issued pursuant to section 3 of this act: Sections 12, 32 through 35, inclusive, of P.L.1985, c.236 (C.17:48E-12 and C.17:48E-32 …

17B:27A-50. Change of coverage by small employer; restrictions 15. a. A small employer who purchases a health benefits plan or rider pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.) shall not be permitted to purchase a health benefits plan or rider with a greater actuarial valu…

17B:27A-51. Board actions subject to provisions of section; "action" defined; procedure 17. Effective January 1, 1994, all actions adopted by the board shall be subject to the provisions of this section, notwithstanding the provisions of P.L.1968, c.410 (C.52:14B-1 et seq.) to th…

17B:27A-53. Other insurance purchases not required 21. A carrier shall not require a small employer to purchase any other insurance coverage, including, but not limited to, life insurance, accident insurance or disability insurance, as a condition of or in conjunction with the pu…

17B:27A-54. Commissioner authorized to approve establishment of arrangement; rules, regulations 22. Notwithstanding any other law to the contrary, the commissioner is authorized to approve the establishment of an arrangement by an insurance company operating pursuant to Title 17B…

17B:27A-55 Written notice required for issuance, renewal of high deductible health plan; declaration of understanding. 18. a. An insurance company, health service corporation, hospital service corporation, medical service corporation or health maintenance organization authorized …

17B:27A-56 Provision of biannual surveys to DOBI by health insurers. 19. a. Any health insurer, as a condition of transacting business in this State, offering a contract, policy, or plan that qualifies as a high deductible health plan for which qualified medical expenses are paid…

17B:27A-57 "Health Insurance Exchange Trust Fund." 1. a. There is established in the Department of the Treasury a nonlapsing revolving fund to be known as the "Health Insurance Exchange Trust Fund." This fund shall be the repository for monies collected pursuant to subsection c. …

17B:27A-58 Authority to operate a State-based exchange, coordinate operations with other entities; advisory committee. 2. a. Notwithstanding any other law to the contrary, the Department of Banking and Insurance shall have the authority to operate a State-based exchange and coord…

17B:27A-59 Rules, regulations. 4. The Department of Banking and Insurance shall adopt rules and regulations pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), to effectuate the purposes of this act. L.2019, c.141, s.4.

17B:27A-59.1 Definitions. 1. As used in this act: "Commissioner" means the Commissioner of Banking and Insurance. "Department" means the Department of Banking and Insurance. "Insurance affordability assistance" means: (1) the State Medicaid program established pursuant to P.L.196…

17B:27A-59.2 "New Jersey Easy Enrollment Health Insurance Program" established. 2. a. The Department of Banking and Insurance shall establish and have the authority to operate the New Jersey Easy Enrollment Health Insurance Program. The department shall integrate the program with…

17B:27A-59.3 Assistance eligibility, Department of Banking and Insurance. 3. a. The Department of Banking and Insurance may assess or determine, as appropriate, eligibility for insurance affordability assistance as soon as possible after an individual files a State income tax ret…

17B:27A-59.4 Special enrollment period, New Jersey individual health insurance market, established. 4. a. The Department of Banking and Insurance shall establish a special enrollment period for the New Jersey individual health insurance market to facilitate the objectives of the …

17B:27A-59.5 Data privacy, security safeguards. 5. a. The Department of Banking and Insurance shall develop data privacy and data security safeguards to govern the conveyance, storage, and utilization of data under the program. b. The safeguards developed under subsection a. of t…

17B:27A-59.6 Tax return, individual not covered, minimum essential coverage. 6. a. If a State income tax return indicates that an individual is not covered under minimum essential coverage at the time the tax return is filed, consistent with the provisions of P.L.2018, c.31 (C.54…

17B:27A-59.7 Consenting to information sharing, system established. 7. a. An individual that consents to share information through the system established pursuant to section 8 of this act shall be eligible for a special enrollment period pursuant to subsection b. of this section.…

17B:27A-59.8 Unemployment claim, indication of interest in obtaining minimum coverage, information sharing, consent. 8. a. The Department of Labor and Workforce Development shall implement a system through which an individual who has filed a claim for unemployment insurance benef…

17B:27A-6 Individual health benefits plans, requirements. 5. An individual health benefits plan issued pursuant to section 3 of P.L.1992, c.161 (C.17B:27A-4) is subject to the following provisions: a. The health benefits plan shall guarantee coverage for an eligible person and hi…

17B:27A-6.1 Individual Health Coverage Program, open enrollment period established. 1. Notwithstanding the provisions of any other law, rule or regulation to the contrary, the board of the New Jersey Individual Health Coverage Program established pursuant to section 9 of P.L.1992…

17B:27A-60 Essential health benefits defined. 3. In defining the essential health benefits pursuant to P.L.2019, c.354 (C.17B:27A-7.26 et al.), the commissioner shall: a. ensure that the essential health benefits shall be at least as comprehensive as the essential health benefits…

17B:27A-61 Carrier seeking rate increase. 1. In addition to any other applicable laws or regulations, a carrier that seeks a rate increase as part of an informational filing for an individual or small employer health benefits plan shall comply with all of the provisions of this a…

17B:27A-62 Information to support, justify rate requests. 2. a. An informational rate filing by a carrier for an individual or small employer health benefits plan offered in this State shall contain information to support and justify rate requests. A rate increase shall be subjec…

17B:27A-63 Additional information requested by department. 3. a. If the department determines that a carrier's requested rate increase exceeds the 10 percent threshold for expanded rate review set forth in section 2 of this act, the department shall require the carrier to submit …

17B:27A-64 Disclosure of information. 4. a. Any information filed with the department pursuant to this act may be disclosed in accordance with P.L.1963, c.73 (C.47:1A-1 et seq.), except that confidential information shall not be disclosed by the department to any person other tha…

17B:27A-65 Definitions relative to certain assessments. 1. As used in this act: "Commissioner" means the Commissioner of Banking and Insurance. "Entity subject to this act" or "entity" means an insurance company, health service corporation, hospital service corporation, medical s…

17B:27A-66 Filing of net written premiums. 2. a. An entity subject to this act shall annually file with the commissioner its net written premiums for the preceding year, no later than April 1 of each year. b. The commissioner shall calculate and issue to the entity a certified as…

17B:27A-67 "Health Insurance Affordability Fund." 3. a. There is established in the Department of the Treasury a nonlapsing revolving fund to be known as the "Health Insurance Affordability Fund." This fund shall be the repository for all monies collected pursuant to this act. As…

17B:27A-7 Approval of policy and contract forms, benefit levels. 6. The commissioner shall approve the policy and contract forms and benefit levels to be made available by all carriers for the health benefits plans required to be issued pursuant to section 3 of P.L.1992, c.161 (C…

17B:27A-7.1. Coverage for birth and natal care; individual health policy 5. a. Every policy that provides maternity benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1992, c.161 (C.17B:27A-2 et seq.) or approved for issuance or renewal in this S…