Title 26, Title 26: HEALTH AND VITAL STATISTICS

26:2S-10.3 Regulations by department. 11. The Department of Banking and Insurance, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), shall adopt regulations to carry out the provisions of sections 1 and 2 of this act. L.2000, c.121, s.11; amend…

26:2S-10.4 Optometrist not required to participate in certain plans. 1. a. A carrier shall not require an optometrist to participate in a vision care plan as a condition for entering into a contract with that carrier for the provision of medically necessary physician services wit…

26:2S-10.5 Contract between carrier and vision care provider, fees permissible. 2. a. No contract between a carrier or a vision care plan and a vision care provider may seek to or require that a vision care provider provide services or materials at a fee limited or set by the car…

26:2S-10.6 Vision care provider, choice of sources, providers. 3. No contract between a carrier or vision care plan and a vision care provider shall restrict or limit, either directly or indirectly, the vision care provider's choice of sources and suppliers of services or materia…

26:2S-10.7 Definitions relative to optometrists, vision care plans. 4. As used in this act: "Contractual discount" means a reduction from a vision care provider's usual and customary rate for covered services and materials required under a participating provider agreement. "Cover…

26:2S-10.8 Definitions relative to insurance coverage for mental health conditions and substance use disorders. 11. a. For the purposes of this section: "Benefit limits" includes both quantitative treatment limitations and non-quantitative treatment limitations. "Carrier" means a…

26:2S-10.9 Regulations for benefits carrier relative to prescription drug benefits. 3. a. A carrier that provides benefits for prescription drugs shall not require a covered person to make a payment at the point of sale for any amount for a deductible, coinsurance payment, or a c…

26:2S-11 Independent Health Care Appeals Program. 11. There is established the Independent Health Care Appeals Program in the department. The purpose of the appeals program is to provide an independent medical necessity or appropriateness of services review of final decisions by …

26:2S-12 Contract to conduct appeal reviews; procedures. 12. a. The commissioner shall contract with one or more independent utilization review organizations in the State that meet the requirements of this act to conduct the appeal reviews. The independent utilization review orga…

26:2S-13 Immunity from civil liability for participants in Independent Health Care Appeals Program 13. a. An employee of the department who participates in the Independent Health Care Appeals Program shall not be liable in any action for damages to any person for any action taken…

26:2S-14 Report to Legislature, Governor 14. The commissioner shall report every six months to the Senate and General Assembly standing reference committees on health and insurance and to the Governor on the status of the Independent Health Care Appeals Program. The report shall …

26:2S-14.1 General hospital to provide information concerning the Independent Health Care Appeals Program. 1. A general hospital licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.) shall be required, as prescribed by regulation of the Commissioner of Health, to: (1) post, in…

26:2S-14.2 Size, content, format of notice. 3. The Commissioner of Banking and Insurance, in consultation with the Commissioner of Health and the State Board of Medical Examiners, shall prescribe the size, content, and format of the notice about the Independent Health Care Appeal…

26:2S-14.3 Rules, regulations. 4. The Commissioner of Health and the State Board of Medical Examiners, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) and in consultation with each other and the Commissioner of Banking and Insurance, shall ado…

26:2S-15 Compliance with department reporting requirements 15. a. A carrier which offers a managed care plan shall comply with department reporting requirements with respect to quality outcomes measures of health care services and independent consumer satisfaction surveys. b. The…

26:2S-15.1 Annual report to carrier by managed behavioral health care organization. 4. a. A carrier that owns, wholly or in part, or contracts with a managed behavioral health care organization shall require the managed behavioral health care organization to provide the carrier a…

26:2S-16 Violations, penalties 16. a. A carrier that violates any provision of this act shall be liable to a civil penalty of not less than $250 and not greater than $10,000 for each day that the carrier is in violation of the act if reasonable notice in writing is given of the i…

26:2S-17 Recommendations for legislative action 17. The commissioner and the Commissioner of Banking and Insurance shall develop recommendations for legislative action to address the issue of regulating health care or managed care entities that seek to contract directly with empl…

26:2S-18 Enforcement; rules, regulations 19. The commissioner shall enforce the provisions of this act. Within six months of the effective date of this act, in consultation with the Commissioner of Banking and Insurance, the commissioner shall adopt rules and regulations, pursuan…

26:2S-18.1 Publication of annual financial statements. 5. The Department of Banking and Insurance shall, for each carrier in the State, publish on the department's website the annual financial statement, in the format adopted by the National Association of Insurance Commissioners…

26:2S-19. Findings, declarations relative to Managed Health Care Consumer Assistance Program 1. The Legislature finds and declares that: a. Managed health care, regardless of the form it takes, is now a major vehicle for the delivery of health care in this nation; and the rapid t…

26:2S-2 Definitions relative to health care quality. 2. As used in sections 2 through 19 of this act: "Behavioral health care services" means procedures or services rendered by a health care provider for the treatment of mental illness, emotional disorders, or drug or alcohol abu…

26:2S-20 Definitions relative to Managed Health Care Consumer Assistance Program. 2. As used in this act: "Carrier" means a carrier as defined in section 2 of P.L.1997, c.192 (C.26:2S-2). "Commissioner" means the Commissioner of Banking and Insurance. "Department" means the Depar…

26:2S-21 Managed Health Care Consumer Assistance Program. 3. a. There is established the Managed Health Care Consumer Assistance Program in the Department of Banking and Insurance. The commissioner shall make agreements to operate the program as necessary, in consultation with th…

26:2S-22. Report to Governor, Legislature 4. The commissioner shall report to the Governor and the Legislature, no later than 18 months after the effective date of this act and annually thereafter, on the data collected by the program, the activities of the program and its effect…

26:2S-23. Immunity from liability 5. An employee, volunteer, board member or other representative of an organization selected by the commissioner pursuant to section 3 of this act shall be immune from liability for any action taken in the good faith performance of their official …

26:2S-24. Appropriations; fees, use 6. a. There is appropriated $500,000 to the department from the General Fund to provide funding for the program, except that funds may be appropriated, in lieu of part or all of the amount appropriated from the General Fund, from the monies mad…

26:2S-25 Rules, regulations. 8. The Commissioner of Banking and Insurance, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), shall adopt rules and regulations to effectuate the purposes of this act. L.2001, c.14, s.8; amended 2012, c.17, s.304.…

26:2S-26 Definitions relative to certain dental benefit plans. 1. As used in this act: "Carrier" means an insurance company, health service corporation, hospital service corporation, medical service corporation, dental service corporation, dental plan organization, or health main…

26:2S-27 Covered services. 2. Notwithstanding section 22 of P.L.1993, c.162 (C.17B:27A-54) or any other law or regulation to the contrary, a contract between a carrier and a dentist to provide covered services shall not require, directly or indirectly, that a dentist provide serv…

26:2S-28 Rules, regulations. 3. The Commissioner of Banking and Insurance shall promulgate rules and regulations pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) necessary to effectuate the purposes of this act. L.2014, c.70, s.3.

26:2S-29 Carrier offering a health benefits plan to provide coverage, payment. 8. a. A carrier that offers a health benefits plan in this State shall provide coverage and payment for health care services delivered to a covered person through telemedicine or telehealth, on the sam…

26:2S-3 Form to be filed by carrier; minimum information required 3. a. A carrier which offers a health benefits plan to residents of this State on the effective date of this act, shall file a form, as prescribed by the commissioner, with the department within 90 days of the effe…

26:2S-3.1 Short title. 1. This act shall be known and may be cited as the “Ensuring Fairness in Cost-Sharing Amounts Act of 2025.” L.2025, c.199, s.1.

26:2S-3.2 Definitions. 2. As used in section 3 of P.L.2025, c.199 (C.26:2S-3.3): “Carrier” means an insurance company, health service corporation, hospital service corporation, medical service corporation, or health maintenance organization authorized to issue health benefits pla…

26:2S-3.3 Requirements for carriers and third-party administrators. 3. a. The annual limitation on cost-sharing amounts provided for in section 1302 of the Patient Protection and Affordable Care Act, Pub.L.111-148 (42 U.S.C. s.18022), shall apply to all health care services cover…

26:2S-30. Definitions regarding dental plan application forms 1. As used in this act: "Carrier" means an insurance company, health service corporation, hospital service corporation, medical service corporation, dental service corporation, dental plan organization, or health maint…

26:2S-31. Adoption of dental plan application forms 2. a. The Commissioner of Banking and Insurance shall adopt by regulation a universal dentist application for participation form for use by carriers which offer or administer dental plans for the purpose of credentialing dentist…

26:2S-32. Acceptance of universal dentist application 3. a. Within 180 days of the adoption of the forms by regulation pursuant to this act, a carrier which offers or administers a dental plan shall accept the universal dentist application for participation form and renewal form …

26:2S-33. Adoption of regulations 4. 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 o…

26:2S-33.1 Carrier, participating dentist, agreement, collecting, covered procedures, services; refund, difference. 1. a. A carrier shall not include in an agreement between the carrier and a participating dentist a provision that prohibits a participating dentist from collecting…

26:2S-34 Preexisting condition provision prohibited in health benefits plan. 6. A carrier that offers a health benefits plan in this State shall ensure that the plan does not contain any provision that: a. denies or limits benefits for a preexisting condition to any covered perso…

26:2S-35 Imposition of limits prohibited. 4. Notwithstanding any law to the contrary, a health benefits plan shall not impose: (1) any lifetime limits on the dollar value of benefits for any individual insured pursuant to the plan; or (2) any annual limits on the dollar value of …

26:2S-36 Provision of emergency, urgent services. 5. A carrier that offers a health benefits plan in this State shall provide that coverage for medically necessary services on an emergency or urgent basis shall be provided without imposing any requirement under the plan for prior…

26:2S-37 Insurance plans to cover prescription refills during state of emergency. 2. a. Subject to subsection b. of this section and to the extent consistent with clinical guidelines, the Commissioner of Banking and Insurance shall require carriers to provide coverage of prescrip…

26:2S-38 Prescription drug benefit carrier contracts, opioid antidote coverage. 1. a. A carrier shall ensure that every contract to provide prescription drug benefits, or to authorize the purchase of a contract to provide prescription drug benefits, shall provide coverage for an …