Title 17B, Title 17B: INSURANCE

17B:27A-10.11 Annual report. 11. a. The board shall present an annual report to the Governor, and to the Legislature pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1), which contains a summary of the operations of the Health Insurance Premium Security Plan and the impact of…

17B:27A-10.12 Violations, penalties. 12. If a carrier violates any provision of this act, the commissioner may, upon notice and hearing, assess a civil administrative penalty in an amount not less than $1,000 nor more than $10,000 for each day the carrier is in violation of this …

17B:27A-10.13 Rules, regulations. 13. The board, pursuant to section 8 of P.L.1993, c.164 (C.17B:27A-16.1), and the commissioner, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) and in consultation with each other, shall each adopt such rules …

17B:27A-10.14 Study, Department of Banking and Insurance, New Jersey Individual Health Coverage Program, New Jersey Small Employer Health Benefits Program; report, Governor, Legislature. 1. a. The Department of Banking and Insurance shall conduct a study of: (1) the potential imp…

17B:27A-10.2 Purpose of act. 2. It is the intent of the Legislature to stabilize or reduce premiums in the individual health insurance market by providing reinsurance payments to health insurance carriers with respect to claims for eligible individuals. The Commissioner of Bankin…

17B:27A-10.3 Definitions relative to health insurance premiums. 3. For the purposes of this act: "Affiliated carrier" means the same as defined in N.J.A.C.11:20-1.2. "Affordable Care Act" or "PPACA" means the federal Patient Protection and Affordable Care Act, Pub.L.111-148, as a…

17B:27A-10.4 Health Insurance Premium Security Plan. 4. a. There is hereby established, and the board in consultation with the commissioner shall administer, the Health Insurance Premium Security Plan. b. The board or commissioner may apply for any available federal funding for t…

17B:27A-10.5 Payment parameters. 5. The board shall propose to the commissioner the payment parameters for the next benefit year by April 30 of the year before the applicable benefit year. The commissioner shall have 15 days to review the payment parameters. If the commissioner t…

17B:27A-10.6 Calculation of reinsurance payment. 6. a. Each reinsurance payment shall be calculated with respect to an eligible carrier's paid claims for an individual enrollee's covered benefits in the applicable benefit year. If the paid claims do not exceed the attachment poin…

17B:27A-10.7 Requests for reinsurance payments. 7. a. An eligible carrier shall submit a request to the board for reinsurance payments when the eligible carrier's total amount paid for an enrollee meets the criteria for reinsurance payments. b. An eligible carrier shall make requ…

17B:27A-10.8 Accounting for each benefit year. 8. The board shall keep an accounting for each benefit year, including but not limited to, the following: a. funds appropriated for reinsurance payments and administrative and operational expenses; b. requests for reinsurance payment…

17B:27A-10.9 Application for waiver of ACA. 9. The commissioner shall apply to the United States Secretary of Health and Human Services under 42 U.S.C. s.18052 for a waiver of applicable provisions of the Affordable Care Act with respect to health insurance coverage in the State …

17B:27A-11 Powers, authority of program, board. 10. The program shall have the general powers and authority granted under the laws of New Jersey to insurance companies, health service corporations and health maintenance organizations licensed or approved to transact business in t…

17B:27A-12 Procedures for equitable sharing of program losses. 11. The board shall establish procedures for the equitable sharing of program losses among all members in accordance with their total market share as follows: a. (1) By March 1, 1999, and following the close of each t…

17B:27A-12.1 Exemption from liability, certain, for HMO formed by UMDNJ. 2. Notwithstanding the provisions of any statute to the contrary, a health maintenance organization established by the University of Medicine and Dentistry of New Jersey pursuant to the provisions of P.L.199…

17B:27A-13. Statement of net paid losses 12. a. No later than March 1, 1993, any carrier issuing individual health benefits plans in the State shall file with the board a statement of any net paid losses for the calendar year ending December 31, 1992, as calculated pursuant to su…

17B:27A-14. Determination of disproportionate share of substandard risks 13. The board shall determine whether any carrier has a disproportionate share of substandard risks insured or enrolled under its individual health benefits plans and shall make recommendations to the Govern…

17B:27A-15. Sale of health benefits plan 14. A health benefits plan issued pursuant to section 3 of this act may be sold through an insurance producer licensed pursuant to P.L.1987, c.293 (C.17:22A-1 et seq.). L.1992,c.161,s.14.

17B:27A-16. Submission of rate filings by health maintenance organization not required 15. Notwithstanding the provisions of P.L.1973, c.337 (C.26:2J-1 et seq.) to the contrary, a health maintenance organization shall not be required to submit any rate filings with the commission…

17B:27A-16.1. Board actions subject to provisions of section; "action" defined; procedure 8. 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 t…

17B:27A-16.2. Adoption of temporary plan of operation 9. a. The commissioner shall, under the procedures provided pursuant to section 7 of P.L.1993, c.164, adopt a temporary plan of operation prepared pursuant to section 9 of P.L.1992, c.161 (C.17B:27A-10), pending submission or …

17B:27A-16.3. Purchase of other insurance coverage not required 10. A carrier shall not require an eligible person to purchase any other insurance coverage, including, but not limited to, life insurance, accident insurance or disability insurance, as a condition of or in conjunct…

17B:27A-16.4. Adoption of standard claim form 11. The board, in conjunction with the board of the New Jersey Small Employer Health Benefits Program established pursuant to section 12 of P.L.1992, c.162 (C.17B:27A-28), shall adopt one standard claim form. In order to provide a sta…

17B:27A-16.5 Hospital, medical insurance policy renewals; filing of rates. 5. A domestic mutual insurer which has converted from a health service corporation pursuant to the provisions of sections 2 through 4 of P.L.1995, c.196 (C.17:48E-46 through C.17:48E-48) shall not renew in…

17B:27A-17 Definitions relative to small employer health benefits plans. 1. As used in this act: "Actuarial certification" means a written statement by a member of the American Academy of Actuaries or other individual acceptable to the commissioner that a small employer carrier i…

17B:27A-18. Providers of health benefits, services subject to provisions of act 2. Every health insurer, health service corporation, medical service corporation, hospital service corporation, and health maintenance organization licensed or authorized to provide health benefits or…

17B:27A-18.1 Provision of benefits to subscriber's child under small employer policy, contract. 9. a. A policy or contract which provides hospital or medical expense benefits under which dependent coverage is available shall continue to make that coverage available for an adult c…

17B:27A-18.2. Requirements applicable to State Medicaid 10. 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 assist…

17B:27A-19 Health benefits plans offered to small employers; exceptions. 3. a. Except as provided in subsection f. of this section, every small employer carrier shall, as a condition of transacting business in this State, offer to every small employer at least three of the health…

17B:27A-19.1. Hospital confinement, other supplemental limited benefit insurance plans; requirements 10. a. A carrier shall not deliver or issue for delivery a hospital confinement or other supplemental limited benefit insurance plan unless the applicant for such coverage signs a…

17B:27A-19.10 Policy, contract issued under C.17B:27A-17 et seq. required to cover certain out-of-network services. 5. Notwithstanding the provisions of P.L.1992, c.162 (C.17B:27A-17 et seq.) to the contrary, no policy or contract shall be delivered, issued, executed or renewed o…

17B:27A-19.11 Carrier offering plans pursuant to C.17B:27A-17 et seq. may offer additional plan with certain limited benefits. 5. In addition to the standard health benefits plans offered by a carrier on the effective date of this act, a carrier that writes small employer health …

17B:27A-19.12 Small employer health benefits plan to offer coverage for domestic partner. 54. Every small employer health benefits plan that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1992, c.162 (C.17…

17B:27A-19.13 Small employer health benefits plan, mammogram examination benefits. 8. a. Every small employer health benefits plan that is delivered, issued, executed, or renewed in this State pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.) or approved for issuance or renewal …

17B:27A-19.14 High deductible health plan, small employer, deductible inapplicable, certain circumstances. 16. Notwithstanding the provisions of subsection k. of section 3 of P.L.1992, c.162 (C.17B:27A-19) regarding deductibles for a high deductible health plan, a health benefits…

17B:27A-19.15 Small employer health benefits plan, coverage for contraceptives. 8. a. A small employer health benefits plan required pursuant to section 3 of P.L.1992, c.162 (C.17B:27A-19) shall provide coverage for expenses incurred in the purchase of prescription female contrac…

17B:27A-19.16 Coverage for certain dependents until age 31 by small employer health benefits plan. 5. a. As used in this section, "dependent" means a covered person's child by blood or by law who: (1) is 30 years of age or younger; (2) is unmarried; (3) has no dependent of his ow…

17B:27A-19.17 Small employer health benefits plans to provide benefits for orthotic and prosthetic appliances. 7. a. Every small employer health benefits plan that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant t…

17B:27A-19.18 Small employer health benefits plan to provide coverage for hearing aids, cochlear implant for covered persons. 8. a. A small employer health benefits plan that provides hospital and medical expense benefits and is delivered, issued, executed or renewed in this Stat…

17B:27A-19.19 Small employer health benefits plan to provide installment payments to obstetrical provider for maternity services. 7. a. Every small employer health benefits plan that provides benefits for maternity services, and that is delivered, issued, executed or renewed in t…

17B:27A-19.2 Coverage for birth and natal care; small employer health policy. 6. a. Every policy that provides maternity benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.) or approved for issuance or renewal in …

17B:27A-19.20 Small employer health benefits plan to provide benefits for treatment of autism or other developmental disability. 7. Notwithstanding any other provision of law to the contrary, a small employer health benefits plan that provides hospital and medical expense benefit…

17B:27A-19.21 Small employer health benefits plan to provide coverage for oral anticancer medications. 7. a. A small employer health benefits plan that is delivered, issued, executed, or renewed in this State pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.), on or after the eff…

17B:27A-19.22 Small employer health benefits plan to provide coverage for sickle cell anemia. 8. Every small employer health benefits plan that provides hospital and medical expense benefits and is delivered, issued, executed, or renewed in this State pursuant to P.L.1992, c.162 …

17B:27A-19.23 Small employer health benefits plan to provide coverage for prescription eye drops. 7. a. A small employer health benefits plan which provides hospital or medical expense benefits that include coverage for prescription eye drops under a contract delivered, issued, e…

17B:27A-19.24 Small employer health benefits plan, coverage for synchronization of prescribed medications. 8. a. Every small employer health benefits plan delivered, issued, executed or renewed in this State pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.), or approved for issu…