Title 17, Title 17: CORPORATIONS AND INSTITUTIONS FOR FINANCE AND INSURANCE

17:48-1.4. Application The provisions of this act shall be applicable to contracts heretofore made under the authority of the act to which this act is a supplement, as well as to such contracts as may be hereafter made and, in the case of existing contracts, supplementary contrac…

17:48-1.5. Health care services by voluntary visiting nurse organizations Any contract made by a corporation subject to the provisions of the act to which this act is a supplement, may provide for the furnishing of health care services elsewhere than in a hospital by voluntary no…

17:48-1.6. Application The provisions of this act shall be applicable to contracts heretofore made under the authority of the act to which this act is a supplement, as well as to such contracts as may be hereafter made and, in the case of existing contracts, supplementary contrac…

17:48-1.7. Additional powers; contract benefits; disapproval by commissioner; review Any hospital service corporation organized pursuant to the laws of this State, in addition to other powers conferred upon it, shall be authorized and empowered to include in its contracts benefit…

17:48-10. Solicitation and administrative expenses; investment of funds; surplus No corporation subject to the provisions of this chapter shall during any one year disburse more than 10% of the aggregate amount of the payments received from subscribers during that year as expendi…

17:48-10.1 Hospital service corporation, aggregate benefits. 1. a. Beginning with the calendar year starting on January 1, 2020, and in each calendar year thereafter, a hospital service corporation providing health benefits plan to a large employer shall return, in the form of ag…

17:48-11. Statement of financial condition; inquiries by Commissioner; penalties Every hospital service corporation transacting business in this State shall annually on or before the first day of March file in the Department of Banking and Insurance a statement, subscribed and sw…

17:48-12. Examination of assets and liabilities and affairs; expenses; duty to exhibit books, records and accounts The Commissioner of Banking and Insurance shall have the power, whenever he deems it expedient, to make or cause to be made an examination of the assets and liabilit…

17:48-12.1 Definitions. 11. As used in sections 11 through 15 of P.L.2014, c.81 (C.17:48-12.1 through C.17:48-12.5): "Commissioner" means the Commissioner of Banking and Insurance. "Hospital service corporation" means an entity authorized to transact business in this State pursua…

17:48-12.2 Increase in amount of capital or surplus required of hospital service corporation. 12. The commissioner may increase the amount of capital or surplus required of a hospital service corporation, or subsequently revise or redetermine that increase, using appropriate meth…

17:48-12.3 Determination of increase, revision or redetermination; factors. 13. In determining any increase, revision or redetermination in the capital or surplus of a hospital service corporation pursuant to the provisions of section 12 of P.L.2014, c.81 (C.17:48-12.2) the commi…

17:48-12.4 Suspension, revocation to do business. 14. The commissioner may suspend or revoke the authority to do business in this State of any hospital service corporation that does not comply with the provisions of sections 11 through 15 of P.L.2014, c.81 (C.17:48-12.1 through C…

17:48-12.5 Rules, regulations. 15. The commissioner may promulgate regulations pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C. 52:14B-1 et seq.) necessary to effectuate the purposes of sections 11 through 15 of P.L.2014, c.81 (C.17:48-12.1 through C.17:48-12.5…

17:48-14. Fees Every corporation to which this chapter shall be applicable shall pay the following fees to the Commissioner of Insurance for enforcement of the provisions of this chapter, viz.: for filing its application and charter, $10.00; for filing each annual statement, $20.…

17:48-15. Violations of Act; penalties; enforcement Any hospital service corporation of this or any other State, country or province which shall have violated any of the provisions of or shall have neglected, failed or refused to comply with any of the requirements of this act, e…

17:48-16. Disputes between corporation and hospitals; review Any dispute arising between a corporation subject to the provisions of this act and any hospital with which such corporation has a contract for hospital service may be submitted to the Commissioner of Banking and Insura…

17:48-17. Application of chapter The provisions of this chapter shall not apply to any corporation carrying on the business of life, health or accident insurance, for profit or gain, nor to fraternal beneficiary associations as defined in section 17:39-1 of the Revised Statutes. …

17:48-18. Corporation as charitable and benevolent institution; exemption from taxation Every corporation subject to the provisions of this chapter is hereby declared to be a charitable and benevolent institution and all of its funds shall be exempt from every State, county, dist…

17:48-2. Operation as non-profit corporation; who may operate hospital service plan; certificate of authority No hospital service corporation shall be converted into a corporation organized for pecuniary profit. Every such corporation shall be operated for the benefit of the subs…

17:48-2.1. Hospital service corporation merger procedure A hospital service corporation established pursuant to the provisions of P.L. 1938, c. 366 (C. 17:48-1 et seq.) may merge with a medical service corporation established pursuant to the provisions of P.L. 1940, c. 74 (C. 17:…

17:48-3. Issuance of certificate of authority; conditions and requirements; alteration or amendment of certificate The Commissioner of Banking and Insurance may issue such certificate of authority to any such hospital service corporation of this State when it shall have filed in …

17:48-4. Applications for hospital service contracts as condition precedent to issuance of certificate of authority No certificate of authority shall be issued to any hospital service corporation except on receipt of evidence by the Commissioner of Banking and Insurance that the …

17:48-5. Filing copy of certificate of incorporation; qualification of directors A copy of a certificate of incorporation of a hospital service corporation may be filed in the Department of Insurance as aforesaid only when there shall be indorsed on or appended to the original th…

17:48-6 Contracts; certificates; contents. 6. Every individual contract made by a corporation subject to the provisions of this chapter to furnish services to a subscriber shall provide for the furnishing of services for a period of 12 months, and no contract shall be made provid…

17:48-6.1 Group contracts issued by hospital service corporation. 2. A hospital service corporation may issue to a policyholder a group contract, covering at least two employees or members at the date of issue, if it conforms to the following description: (a) A contract issued to…

17:48-6.10. Definitions As used in this act: a. "Group policy" means a group contract or individual group certificate delivered or issued for delivery by a hospital service corporation, medical service corporation or similar corporation or organization. b. "Insurer" means the ent…

17:48-6.11. Group contract or individual group certificate; total disability of employee or member; continuation of coverage; conditions A group contract or individual group certificate delivered or issued for delivery in this State which covers employees or members and their dep…

17:48-6.12. Inapplicability of act if insurer not have right to terminate contract or certificate without consent of insured The provisions of this act shall not apply to any contract or individual group certificate in which the insurer does not have the right to terminate the co…

17:48-6.15 Coverage provided by hospital service corporation for subscriber's child. 1. a. A hospital service corporation contract which provides hospital or medical expense benefits under which dependent coverage is available shall continue to make that coverage available for an…

17:48-6.16. Requirements applicable to State Medicaid 2. A hospital service corporation 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 …

17:48-6.17. Eligibility for enrollment in hospital service corporation 1. Notwithstanding any other provision of law to the contrary, a hospital service corporation shall not consider a person's eligibility for medical assistance pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.), o…

17:48-6.18. Hospital service corporation contract, exclusion, rates, terms based on genetic information prohibited 11. Every individual or group hospital service corporation contract providing hospital or medical expense benefits that is delivered, issued, executed or renewed in …

17:48-6.19 Coverage for certain dependents until age 31 by hospital service corporation. 1. a. As used in this section, "dependent" means a subscriber'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 own; (4) is a re…

17:48-6.2. Provisions applicable to group contracts; subscriber defined The provisions of the act to which this act is a supplement shall apply to group contracts except that sections 6 and 9 of such act shall not apply. The word "subscriber" as used in said act means the policyh…

17:48-6.3. Group contract form Every group contract entered into by a hospital service corporation with any policyholder shall be in writing and a contract form stating the terms and conditions thereof shall be furnished to the policyholder to be kept by him. No group contract fo…

17:48-6.4. Participation agreements A hospital service corporation of this State may enter into agreements to participate with other corporations in the issuance of group contracts to policyholders whose employees or members are located in more than one state. Such agreements may…

17:48-6.5. Schedule of rates No hospital service corporation shall issue group contracts which are not experience rated pursuant to section 5 of this act, until it shall have filed with the commissioner a full schedule of the rates which are to apply to such contracts. The commis…

17:48-6.6. Combined hospital-medical contracts A hospital service corporation and a medical service corporation authorized to do business in this State may issue a combined contract providing for hospital care and medical care but no one of such corporations shall issue any such …

17:48-6.7. Review of determinations of commissioner of banking and insurance All determinations of the Commissioner of Banking and Insurance made under the provisions of this act, or of the act to which this act is a supplement, shall be subject to review by the Superior Court in…

17:48-6.8. Review of practices, rules and procedures of hospital service corporation All practices, rules and procedures of a hospital service corporation, involving termination or refusal to renew coverage, modification of coverage or rates in the case of persons classified as l…

17:48-6.9. Adjustment of rates; experience rating formulas; approval Any group contract, covering at least 50 employees or members, may provide for the adjustment of the rate of premium at the end of the first year or any subsequent year of insurance thereunder based on the exper…

17:48-6aa Contracts issued under C.17:48-1 et seq. required to cover certain out-of-network services. 7. Notwithstanding the provisions of P.L.1938, c.366 (C.17:48-1 et seq.) to the contrary, no individual or group contract shall be delivered, issued, executed or renewed on or af…

17:48-6aaa Group, individual hospital service corporation contracts, HIV preexposure prophylaxis, HIV postexposure prophylaxis. 3. a. (1) Except as provided in paragraph (2) of this subsection, no group or individual hospital service corporation contract providing hospital or med…

17:48-6b. Benefits for reconstructive breast surgery 1. Every subscription certificate and group and individual contract providing hospital service benefits delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner…

17:48-6bb Hospital service corporation to offer coverage for domestic partner. 47. A hospital service corporation that provides hospital or medical expense benefits under a contract that is delivered, issued, executed or renewed in this State or approved for issuance or renewal i…

17:48-6bbb Benefits provided under hospital service corporation contracts. 1. a. A hospital service corporation contract that provides hospital or medical expense benefits and is delivered, issued, executed, or renewed in this State pursuant to P.L.1938, c.366 (C.17:48-1 et seq.)…