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

17:48F-13 Terms, conditions required in contracts. 13. All prepaid prescription service organization contracts with providers or with entities subcontracting for the provision of prescription services shall contain the following terms and conditions: a. In the event that the orga…

17:48F-13.1 Prepaid prescription service organization to receive, transmit transactions electronically; standards. 10. a. Within 180 days of the adoption of a timetable for implementation pursuant to section 1 of P.L.1999, c.154 (C.17B:30-23), a prepaid prescription service organ…

17:48F-13.2 Prepaid prescription service organization; coverage for contraceptives. 9. a. A prepaid prescription service organization shall provide coverage under every contract delivered, issued, executed or renewed in this State or approved for issuance or renewal in this State…

17:48F-14 Maintenance of tangible net equity. 14. a. Except as provided in subsection b. of this section, each prepaid prescription service organization shall, at all times, have and maintain tangible net equity equal to the greater of: (1) $50,000; or (2) 2% of the organization'…

17:48F-15 Deposit of case, securities; net worth requirement. 15. a. A prepaid prescription service organization shall deposit with the commissioner or with an entity or trustee acceptable to the commissioner through which a custodial or controlled account is utilized, cash, secu…

17:48F-16 Maintenance of fidelity bond. 16. A prepaid prescription service organization shall maintain in force a fidelity bond in its own name on its officers and employees, in an amount established by the commissioner by regulation. In lieu of the bond, the organization may dep…

17:48F-17 Annual report. 17. A prepaid prescription service organization shall file an annual report with the commissioner, on or before March 1 of each year, attested to by at least two principal officers, which covers the preceding calendar year. The report shall be on a form p…

17:48F-17.1 Definitions. 36. As used in sections 36 through 40 of P.L.2014, c.81 (C.17:48F-17.1 through C.17:48F-17.5): "Commissioner" means the Commissioner of Banking and Insurance. "Prepaid prescription service organization" means an entity authorized to transact business in t…

17:48F-17.2 Increase in amount of capital or surplus required of prepaid prescription service organization. 37. The commissioner may increase the amount of capital or surplus required of a prepaid prescription service organization, or subsequently revise or redetermine that incre…

17:48F-17.3 Determination of increase, revision or redetermination; factors. 38. In determining any increase, revision or redetermination in the capital or surplus of a prepaid prescription service organization pursuant to the provisions of section 37 of P.L.2014, c.81 (C.17:48F-…

17:48F-17.4 Suspension, revocation of authority to do business. 39. The commissioner may suspend or revoke the authority to do business in this State of any prepaid prescription services organization that does not comply with the provisions of sections 36 through 40 of P.L.2014, …

17:48F-17.5 Rules, regulations. 40. 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 36 through 40 of P.L.2014, c.81 (C.17:48F-17.1 through C.17:48F-17…

17:48F-18 Suspension, revocation of certificate of authority. 18. The commissioner may suspend or revoke the certificate of authority issued to a prepaid prescription service organization pursuant to this act upon his determination that: a. The organization is operating significa…

17:48F-19 Notification of suspension, revocation of certificate of authority. 19. If the commissioner has cause to believe that grounds exist for the suspension or revocation of a certificate of authority, he shall notify the prepaid prescription service organization in writing, …

17:48F-2 Prepaid prescription service organization, certificate of authority. 2. a. Beginning one year after the date of enactment of this act, no person, corporation, partnership, or other entity shall operate a prepaid prescription service organization in this State except in a…

17:48F-20 Maintenance of insurance to cover insolvency. 20. The commissioner may require, in connection with the plan for insolvency required pursuant to subsection p. of section 3 of this act, that a prepaid prescription service organization maintain insurance to cover the expen…

17:48F-21 Rehabilitation, liquidation, conservation of prepaid prescription service organization. 21. Any rehabilitation, liquidation or conservation of a prepaid prescription service organization shall be subject to the provisions of N.J.S.17B:32-1 et seq. and shall be conducted…

17:48F-22 Order of rehabilitation. 22. If an order of rehabilitation issued pursuant to this act directs or provides for the continued operation of the prepaid prescription service organization, including the receipt of payments from, and the provision of prescription services to…

17:48F-23 Providers enjoined from billing enrollees, beneficiaries under order of rehabilitation. 23. In the event that an order of rehabilitation or liquidation is granted, the order may enjoin providers from billing enrollees and their beneficiaries for health care services pro…

17:48F-24 Inapplicability of C.17B:32A-1 et seq. 24. A prepaid prescription service organization shall not be subject to the "New Jersey Life and Health Insurance Guaranty Association Act," P.L.1991, c.208 (C.17B:32A-1 et seq.), and the New Jersey Life and Health Insurance Guaran…

17:48F-25 Application, examination fees. 25. A prepaid prescription service organization subject to the provisions of this act shall pay to the commissioner such application fees and examination fees for applying for a certificate of authority as established by regulation by the …

17:48F-26 Violations; penalties. 26. a. The commissioner may, upon notice and hearing, levy an administrative penalty in an amount not less than $1,000 nor more than $30,000 for each violation, per contract or enrollee. Penalties imposed by the commissioner pursuant to this secti…

17:48F-27 Cease and desist order; injunctive relief. 27. a. The commissioner may issue an order directing a prepaid prescription service organization to cease and desist from engaging in any act or practice which is in violation of the provisions of this act. The order shall be s…

17:48F-28 Confidentiality of data, information. 28. Any data or information relating to the diagnosis, treatment or health of an enrollee or prospective enrollee obtained by a prepaid prescription service organization from the contract holder, enrollee, prospective enrollee or an…

17:48F-29 Rules, regulations. 29. The commissioner shall adopt rules and regulations pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), to effectuate the purposes of this act. L.1997,c.380,s.29.

17:48F-3 Application for certificate of authority, requirements. 3. Each application for a certificate of authority to operate a prepaid prescription service organization shall be made to the commissioner on a form prescribed by the commissioner, shall be certified by an officer …

17:48F-4 Review of application. 4. Following receipt of an application, the commissioner shall review it and notify the applicant of any deficiencies contained therein. a. The commissioner shall issue a certificate of authority to an applicant in a timely manner, if the following…

17:48F-5 Modification of matter, document, filing required; fixing of charges; filing of benefits offered. 5. a. An organization, unless otherwise provided for in this act, shall not materially modify any matter or document furnished to the commissioner pursuant to section 3 of t…

17:48F-6 Filing for approval by other insurers, etc. 6. Any insurer, hospital, medical or health service corporation or health maintenance organization which is not otherwise authorized to offer prescription services on a fixed prepayment basis may do so by filing for approval wi…

17:48F-7 Rights of prepaid prescription service organization. 7. A prepaid prescription service organization may: a. Purchase, lease, construct, renovate, operate and maintain such facilities, ancillary equipment and property which may be required for its principal office or for …

17:48F-8 Contract for provision of services. 8. A prepaid prescription service organization may contract with any person to provide some or all of the services it normally performs in providing prescription services and supplemental services to its enrollees and contract holders,…

17:48F-9 Issuance of evidence of coverage. 9. Every contract holder and enrollee shall be issued an evidence of coverage, which shall contain a clear and complete statement of: a. The coverage to which each enrollee is entitled; b. Any limitation to which covered services are sub…