Title 26, Title 26: HEALTH AND VITAL STATISTICS

26:2S-5 Additional disclosure requirements. 5. a. In addition to the disclosure requirements provided in section 4 of this act, a carrier which offers a managed care plan shall disclose to a subscriber, in writing, in a manner consistent with the "Life and Health Insurance Policy…

26:2S-5.1 Health insurance carriers to provide organ, tissue donation information to subscribers. 1. a. A carrier shall provide to subscribers written informational materials about organ and tissue donation and registration at each contract renewal. The materials shall be develop…

26:2S-6 Designation of licensed physician as medical director for managed care 6. a. A carrier which offers a managed care plan or uses a utilization management system in any of its health benefits plans shall designate a licensed physician to serve as medical director. The medic…

26:2S-6.1 Managed care plan to pay full contractual rate to out-of-network provider, direct payments, certain circumstances. 2. a. With respect to a carrier which offers a managed care plan that provides for both in-network and out-of-network benefits, in the event that: (1) a co…

26:2S-6.2 Waiver of health insurance copayments for certain active duty military and their families. 1. a. Notwithstanding any other law or contract provision to the contrary, if a covered person is a member of the military serving on active duty, or a family member of the covere…

26:2S-7 Review of application for participation 7. Each application for participation by a licensed health care professional that is submitted to a carrier which offers a managed care plan shall be reviewed by a committee of the carrier that includes appropriate representation of…

26:2S-7.1 Universal application for credentialing physicians for a carrier's provider network. 1. The Commissioner of Banking and Insurance, in consultation with the New Jersey Association of Health Plans, the Health Insurance Association of America, the Medical Society of New Je…

26:2S-7.2. Acceptance of application by carriers 2. Within 180 days of the adoption of the forms by regulation pursuant to this act, a carrier which offers a managed care plan shall accept the universal physician application for participation form and renewal form adopted pursuan…

26:2S-7.3 Rules, regulations. 3. The Commissioner of Banking and Insurance shall adopt regulations within 180 days of the date of enactment of this act, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), necessary to carry out the purposes of th…

26:2S-8 Establishment of policy governing removal of health care providers 8. A carrier which offers a managed care plan shall establish a policy governing removal of health care providers from the provider network which includes the following: a. The carrier shall inform a parti…

26:2S-9 Contract terms concerning appropriate medical care 9. The contract between a participating health care provider and a carrier which offers a managed care plan: a. Shall state that the health care provider shall not be penalized or the contract terminated by the carrier be…

26:2S-9.1 Managed care plan, continuing treatment of certain patients by physician no longer employed by plan; required. 1. a. Notwithstanding the provisions of any law to the contrary, a carrier which offers a managed care plan shall provide in that plan that if a covered person…

26:2S-9.2 Written fee schedule information furnished to health care providers, proprietary information. 1. a. A carrier which offers a managed care plan that negotiates with a health care provider to become a participating provider, who is reimbursed per procedure under the plan,…

26:2S-9.3 Violations, penalty. 2. A carrier which violates any provision of this act shall be liable to a penalty of not more than $1,000 for each violation. Each failure to timely respond to a health care provider's request for a fee schedule shall be considered a separate viola…