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

17:48A-13. Administrative expenses No such corporation shall disburse during any one year, a sum greater than twenty per centum (20%) of payments received from subscribers during that year as administrative expenses. The term "administrative expense" as used in this section shall…

17:48A-13.1 Medical service corporation, aggregate benefits. 2. a. Beginning with the calendar year starting on January 1, 2020, and in each calendar year thereafter, a medical service corporation providing health benefits plans to a large employer shall return, in the form of ag…

17:48A-14. Investments; surplus The funds of any medical service corporation may be invested only in accordance with the requirements now or hereafter provided by law for the investment of funds of life insurance companies. Every medical service corporation after the first full c…

17:48A-15. Statement of financial condition; inquiries by commissioner Every medical service corporation transacting business in this State shall file annually, on or before the first day of March, in the Department of Banking and Insurance a statement, subscribed and sworn to by…

17:48A-16. Failure to file statement or answer inquiries; penalty Any medical service corporation neglecting to make and file its annual statement in the form and within the time provided by the last preceding section, or neglecting to reply in writing to inquiries of the Commiss…

17:48A-17. Examination of assets and affairs; assistants The Commissioner of Banking and Insurance shall have the power, whenever he deems the same expedient, to make or cause to be made an examination of the assets and liabilities, method of conducting business and all other aff…

17:48A-18. Expense of examination; gifts, etc., to departmental employees The reasonable expense of such examination shall be fixed and determined by the Commissioner of Banking and Insurance, and he shall collect the same from the corporation examined, which shall pay same on pr…

17:48A-19. Exhibition of records and accounts; examinations under oath It shall be the duty of the officers, agents and employees of any such corporation to exhibit all its books, records and accounts for the purpose of such examination and otherwise to facilitate the same so far…

17:48A-19.1 Definitions. 16. As used in sections 16 through 20 of P.L.2014, c.81 (C.17:48A-19.1 through C.17:48A-19.5): "Commissioner" means the Commissioner of Banking and Insurance. "Medical service corporation" means an entity authorized to transact business in this State purs…

17:48A-19.2 Increase in amount of capital or surplus required of medical service corporation. 17. The commissioner may increase the amount of capital or surplus required of a medical service corporation, or subsequently revise or redetermine that increase, using appropriate metho…

17:48A-19.3 Determination of increase, revision or redetermination; factors. 18. In determining any increase, revision or redetermination in the capital or surplus of a medical service corporation pursuant to the provisions of section 17 of P.L.2014, c.81 (C.17:48A-19.2) the comm…

17:48A-19.4 Suspension, revocation of authority to do business. 19. The commissioner may suspend or revoke the authority to do business in this State of any medical service corporation that does not comply with the provisions of sections 16 through 20 of P.L.2014, c.81 (C.17:48A-…

17:48A-19.5 Rules, regulations. 20. 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 16 through 20 of P.L.2014, c.81 (C.17:48A-19.1 through C.17:48A-19…

17:48A-2. Nonprofit corporation; trustees and physicians; who may operate medical service plan; certificate of authority No medical service corporation shall be converted into a corporation organized for pecuniary profit. Every such corporation shall be operated for the benefit o…

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

17:48A-21. 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…

17:48A-22. Violations of chapter; penalty and recovery thereof; misdemeanors Any medical 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 req…

17:48A-23. Grants for needy persons A medical service corporation may receive and accept from any governmental agencies any grant or allocation of funds for the purpose of providing payment for medical services, and hospital services when rendered incident thereto, to eligible pe…

17:48A-24. Corporation as charitable and benevolent institution; tax exemption Any corporation subject to the provisions of this act is hereby declared to be a charitable and benevolent institution, and its funds and property shall be exempt from taxation by the State or any poli…

17:48A-25. Partial invalidity Should any provision or section of this act be held invalid for any reason, such holding shall not be construed as affecting the validity of any remaining portion of such section or of this act, it being the legislative intent that this act shall sta…

17:48A-26 Podiatrist, services performed by. 1. Notwithstanding any other provision of the act to which this act is a supplement, benefits shall not be denied to an eligible individual for eligible services when such services are performed or rendered such persons by a licensed p…

17:48A-27. Bio-analytical laboratory, services performed by Notwithstanding any other provision of the act to which this act is a supplement, benefits shall not be denied to an eligible individual for eligible services when such services are performed or rendered such persons by …

17:48A-28. Dentists, services performed by Notwithstanding any other provision of the act to which this act is a supplement, benefits shall not be denied to an eligible individual for eligible services when such services are performed or rendered such persons by a licensed dentis…

17:48A-28.1. Policies providing for reimbursement of services of dentist; additional applicable provisions Notwithstanding any provision of a group or individual policy or contract of a medical service plan, whenever such a policy or contract provides for reimbursement for any se…

17:48A-28.2. Application of act to contracts with reservation of right to change premium This act shall apply to all contracts in which the company has reserved the right to change the premium. L.1978, c. 187, s. 2, eff. Jan. 9, 1979.

17:48A-29. Optometrist, services performed by Notwithstanding any other provision of the act to which this act is a supplement, benefits shall not be denied to an eligible individual for eligible services when such services are performed or rendered such persons by a duly license…

17:48A-3. Issuance of certificate of authority; amendment; counties affected The Commissioner of Banking and Insurance shall issue such certificate of authority to any such medical service corporation of this State when it shall have filed in the Department of Banking and Insuran…

17:48A-30. Psychologist, services performed by Notwithstanding any other provision of the act to which this act is a supplement, benefits shall not be denied to any eligible individual for eligible services when such services are performed or rendered such persons by a licensed p…

17:48A-31. Physical therapist, services performed by Notwithstanding any other provision of the act to which this act is a supplement, benefits shall not be denied to an eligible individual for eligible services when such services are performed or rendered such persons by a duly …

17:48A-32. Chiropractors; authorization for payment for diagnostic X-rays; inclusion in act as physician licensed to practice medicine or surgery; liberal construction To the extent that under any contract issued by any medical service corporation, or rider or supplement thereto,…

17:48A-33. Chiropractors, services performed by Notwithstanding any other provision of P.L.1940, c. 74 (C. 17:48A-1 et seq.), benefits shall not be denied to any eligible individual for eligible services when such services are performed or rendered such persons by a licensed chir…

17:48A-34. Nurse-midwives, services performed by Notwithstanding any other provision of P.L.1940, c. 74 (C. 17:48A-1 et seq.), benefits shall not be denied to any eligible individual for eligible services when the services are performed or rendered those individuals by a certifie…

17:48A-35. Services provided by registered professional nurse; benefits Notwithstanding any other provision of P.L. 1940, c. 74 (C. 17:48A-1 et seq.), benefits shall not be denied to any eligible individual for eligible services when the services are performed or rendered to thos…

17:48A-4. Corporate funds required No certificate of authority shall be issued to any medical service corporation except on receipt of evidence by the Commissioner of Banking and Insurance that the corporation is in possession of unencumbered funds of not less than five thousand …

17:48A-5 Subscription contracts. 5. Every individual contract made by any corporation subject to the provisions of this chapter to provide payment for medical services shall provide for the payment of medical services for a period of 12 months from the date of issue of the subscr…

17:48A-6. Written contracts required; subscription certificates Every individual contract entered into by any such corporation with any subscriber shall be in writing and a certificate stating the terms and conditions thereof shall be furnished to the subscriber. No such subscrip…

17:48A-6.1. Elective surgery; definitions As used in this act: a. "Elective surgical procedure" means any nonemergency surgical procedure which may be scheduled at the convenience of the patient or the surgeon without jeopardizing the patient's life or causing serious impairment …

17:48A-6.10. Eligibility for enrollment in medical service corporation 2. Notwithstanding any other provision of law to the contrary, a medical 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.), or…

17:48A-6.11 Medical service corporation contract, exclusion, rates, terms based on genetic information prohibited. 12. Every individual or group medical service corporation contract providing hospital or medical expense benefits that is delivered, issued, executed or renewed in t…

17:48A-6.2. Second surgical opinion program Any corporation issuing a group or individual contract in accordance with chapter 48A of Title 17 of the Revised Statutes, which provides payment for surgical services rendered to a person while confined in a hospital as an inpatient, s…

17:48A-6.3. Payment for second surgical opinion A second surgical opinion program shall provide for payment for the second surgical opinion of an eligible physician and for essential laboratory and X-ray services incidental thereto. L.1979, c. 327, s. 3.

17:48A-6.4. Third surgical opinion If a second surgical opinion does not confirm that the proposed elective surgical procedure is medically advisable, the program shall cover a third surgical opinion in the same manner as the second opinion. L.1979, c. 327, s. 4.

17:48A-6.5. Second opinion exclusions A second surgical opinion program may exclude benefits while the patient is confined in a hospital as an inpatient, any surgical procedures not covered by the group or individual contract, and surgical procedures in the following categories: …

17:48A-6.6. Physicians furnishing opinion and performing surgical procedure; payment If a physician who furnishes a second or third surgical opinion also performs the surgical procedure, the second surgical opinion program need not provide payment for the second or third opinion …

17:48A-6.7. Application This act shall apply to all contracts in which the corporation has reserved the right to change the premium. L.1979, c. 327, s. 7.

17:48A-7. Formal requirements for subscription certificates In every such subscription certificate issued or delivered by any medical service corporation of this State: (a) All printed portions shall be plainly printed in type of which the face is not smaller than ten point; (b) …