Title 17B, Title 17B: INSURANCE

17B:30-13. Rebates and special inducements Except as otherwise expressly provided by law, no person shall knowingly make, permit to be made or offer to make any contract of life insurance, annuity or health insurance, or agreement as to such contract other than as plainly express…

17B:30-13.1. Unfair claim settlement practices No person shall engage in unfair claim settlement practices in this State. Unfair claim settlement practices which shall be unfair practices as defined in N.J.S. 17B:30-2, shall include the following practices: Committing or performi…

17B:30-13.2. Record of complaints Failure of any person to maintain a complete record of all the complaints which it has received since the date of its last examination shall be a practice prohibited by N.J.S. 17B:30-2. This record shall indicate the total number of complaints, t…

17B:30-14. Exceptions to discrimination and rebates Nothing in sections 17B:30-12 or 17B:30-13 shall be construed as including within the definition of discrimination or rebates any of the following practices: a. In the case of any contract of life or health insurance or annuity,…

17B:30-15. Enumeration of acts not exclusive The enumeration in this chapter of specific unfair methods of competition and unfair or deceptive acts and practices in the business of insurance or annuities is not exclusive or restrictive or intended to limit the powers of the commi…

17B:30-16. Commissioner's powers of investigation The commissioner shall have power to examine and investigate into the affairs of every person acting as an insurer or engaged in the business of insurance in this State in order to determine whether such person has been or is enga…

17B:30-17. Desist orders for prohibited practices; penalty a. If the commissioner has reason to believe that any person has been engaged or is engaging in this State in any unfair method of competition, or any unfair or deceptive act or practice expressly prohibited in this chapt…

17B:30-18. Procedures as to undefined practices Whenever the commissioner shall have reason to believe that any person engaged in the business of insurance or annuities is engaging in this State in any method of competition or in any act or practice in the conduct of such busines…

17B:30-19. Appeal by intervenor If the determination of the commissioner does not charge a violation of this chapter, then any intervenor in the proceedings before him may, within 30 days after the service of such determination, institute an action in the Superior Court to enjoin…

17B:30-2. Practices prohibited No person shall engage in this State in any trade practice which is defined in this chapter as or determined pursuant to this chapter to be an unfair method of competition or an unfair or deceptive act or practice in the business of life insurance, …

17B:30-20. Violation of cease and desist order; penalty Any person who violates a cease and desist order of the commissioner issued under this chapter shall be liable to a penalty not exceeding $5,000.00 for each violation, to be collected by the commissioner in the name of the S…

17B:30-21. Provisions of chapter additional to existing laws The powers vested in the commissioner by this chapter shall be additional to any other powers to enforce any penalties, fines or forfeitures authorized by law with respect to the methods, acts and practices hereby decla…

17B:30-22. Immunity from prosecution If any person shall ask to be excused from testifying or from producing any books, papers, records, correspondence or other documents at any hearing on the ground that the testimony or evidence required of him may tend to incriminate him or su…

17B:30-23 Timetable for implementation of electronic receipt, transmission of health care claim information; standard forms. 1. a. (1) The Commissioner of Banking and Insurance, in consultation with the Commissioner of Health, shall establish, by regulation, a timetable for imple…

17B:30-24 Regulations. 15. The Commissioner of Banking and Insurance, in consultation with the Commissioner of Health, shall adopt regulations to effectuate the purposes of sections 1 through 10 of this act, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14…

17B:30-25 Thomas A. Edison State College to study, monitor effectiveness of electronic data interchange technology, electronic health records. 16. Thomas A. Edison State College shall study and monitor the effectiveness of electronic data interchange technology and electronic hea…

17B:30-26 Definitions relative to payment of health and dental insurance plans. 1. As used in this act: "Capitation payment" means a periodic payment to a health care provider for his services under the terms of a contract between the provider and a payer, under which the provide…

17B:30-27 Applicability. 2. The provisions of this act shall apply only to insured health benefits or dental plans and insured claims submitted to payers. L.1999,c.155,s.2.

17B:30-28 Provision of information. 3. A payer shall, at the request of a covered person, that person's agent, or an eligible health care provider, provide information as to the material required to be submitted to the payer with a claim for reimbursement, including any documenta…

17B:30-29 Provision of toll-free telephone number. 4. A payer shall provide covered persons and eligible health care providers with a toll-free telephone number for making inquiries regarding paid claims or pending claims. If the commissioner determines that the toll-free telepho…

17B:30-3. Misrepresentations and false advertising of policies or annuity contracts No person shall make, issue, circulate or cause to be made, issued or circulated, any estimate, illustration, circular or statement misrepresenting the terms of any policy or annuity contract issu…

17B:30-30 Maintenance of claims records; audit required. 5. a. A payer shall maintain a record which shall be audited by a private auditing firm at the expense of the payer, to be submitted to the commissioner, Governor and the Legislature annually, in a form established by the c…

17B:30-31 Additional record of claims. 6. a. In addition to the annual audit required by section 5 of this act, the payer shall maintain and report to the commissioner on no less than a quarterly basis, a record of claims as provided in paragraphs (1) through (9) of subsection a.…

17B:30-32 Overdue capitation payment. 7. a. Payment of a capitation payment to a health care provider shall be deemed to be overdue if not remitted to the provider on the fifth business day following the due date of the payment in the contract, if: the health care provider is not…

17B:30-33 Regulations. 8. No later than 180 days following the date of enactment of this act, the commissioner shall adopt regulations pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) necessary to carry out the purposes of this act. L.1999,c.15…

17B:30-34 Inapplicability of act. 9. The provisions of this act shall not apply to any payer determined by the commissioner to be impaired, to be subject to the provisions of the "Life and Health Insurers Rehabilitation and Liquidation Act," P.L.1992, c.65 (C.17B:32-31 et seq.), …

17B:30-34.1 Health care provider, carrier, more than one method of payment, reimbursement; definitions. 1. a. Any network agreement entered into, amended, or renewed on or after the effective date of this act between a carrier, or the carrier's contracted vendor, and a health car…

17B:30-35. Definitions relative to standardized pharmacy identification cards 1. As used in this act: "Carrier" means an insurance company, health service corporation, hospital service corporation, medical service corporation or health maintenance organization authorized to issue…

17B:30-36. Issuance of standardized pharmacy identification information, card to primary insured 2. a. A carrier, multiple employer welfare arrangement or other health benefits plan provider, or its agents, contractors or administrators, including but not limited to a pharmacy be…

17B:30-37. Exceptions for issuance of card 3. a. A carrier, multiple employer welfare arrangement or other health benefits plan provider shall not be required to issue a pharmacy identification card separate from another identification card issued to an insured under a health ben…

17B:30-38. Provision of new pharmacy identification card 4. A carrier, multiple employer welfare arrangement or other health benefits plan provider shall provide each primary insured with a new pharmacy identification card within a reasonable time, not to exceed 180 days, after a…

17B:30-39. Rules, regulations 5. The Commissioner 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 carry out the purposes of this act. L.2001,c.200,s.5.

17B:30-4. False information and advertising No person shall make, publish, disseminate, circulate, or place before the public, or cause, directly or indirectly, to be made, published, disseminated, circulated, or placed before the public, in a newspaper, magazine or other publica…

17B:30-40 Definitions, construction, regulations on notice of premium increase to employers. 5. a. As used in this section: "Carrier"means any entity subject to the insurance laws and regulations of this State, or subject to the jurisdiction of the Commissioner of Banking and Ins…

17B:30-41 Findings, declarations relative to collection of unpaid hospital accounts. 1. The Legislature finds and declares that: a. The rising cost of hospital-based health care in this State impedes the ability of the State and insurers to provide reasonably priced, comprehensiv…

17B:30-42 Definitions relative to collection of unpaid hospital accounts. 2. As used in this act: "Coinsurance" means the percentage of a charge covered by a health plan that must be paid by a person covered under the health plan. "Collection agency" means the Department of the T…

17B:30-44 "New Jersey Hospital Care Payment Fund." 4. a. There is established the "New Jersey Hospital Care Payment Fund" in the Department of the Treasury. b. The fund shall be comprised of monies collected from debtors of hospitals pursuant to this act, and any other monies app…

17B:30-45 Authority of department. 5. The department is authorized to: a. Accept assignment of debts from hospitals which have followed the procedures outlined in section 7 of this act, or such other procedures as the department shall adopt. b. Pursue collection of debts pursuant…

17B:30-46 Decisions of department constitute final agency action. 6. Decisions of the department, regarding the fairness formula, the validity of debts, the adequacy of data provided to the department by hospitals for use in the program, and other such matters as shall arise conc…

17B:30-47 Procedures for participating hospitals. 7. a. The following procedures shall apply for those hospitals that wish to participate in the voluntary assignment program created by this act. b. The hospital shall file with the department a notice signifying its intent to part…

17B:30-5. False financial statements a. No person shall file with any supervisory or other public official, or make, publish, disseminate, circulate or deliver to any person, or place before the public, or cause directly or indirectly, to be made, published, disseminated, circula…

17B:30-55 Violations, penalties; rules, regulations. 17. a. The Commissioner of Banking and Insurance shall enforce the provisions of sections 2 through 7 of P.L.2005, c.352 (C17B:30-49 through C.17B:30-54) and sections 2, 3, 4, 5, 6, 7 and 10 of P.L.1999, c.154 (C.17:48-8.4, 17:…

17B:30-55.1 Short title. 2. This act shall be known and may be cited as the "Ensuring Transparency in Prior Authorization Act." L.2023, c.296, s.2.

17B:30-55.10 Payer to honor prior authorization granted to covered person by previous payer, initial coverage, upon receipt of documentation. 11. a. On receipt of information documenting a prior authorization from the covered person or the health care provider of the covered pers…

17B:30-55.11 Denial of prior authorization, communicated via written communication agreed to by payer, hospital, health care provider. 12. a. A denial of prior authorization shall be communicated to the hospital or health care provider by facsimile, e-mail, or any other means of …

17B:30-55.12 Adverse determinations, appeal, reviewed by physician. 13. A payer shall ensure that any adverse determinations of any appeal are reviewed by a physician. The physician shall: a. be board-certified in a same or similar specialty that has experience treating the condi…