Title 26, Title 26: HEALTH AND VITAL STATISTICS

26:2J-4.27 HMO to offer coverage for domestic partner. 52. Every health maintenance organization contract that is delivered, issued, executed or renewed in this State pursuant to P.L.1973, c.337 (C.26:2J-1 et seq.) or approved for issuance or renewal in this State by the Commissi…

26:2J-4.28 HMO, high deductible, coverage for preventive care. 11. A certificate of authority to establish and operate a health maintenance organization, which organization offers a contract that qualifies as a high deductible health plan for which qualified medical expenses are …

26:2J-4.29 Health service corporation, coverage for prescription female contraceptives. 12. Notwithstanding the provisions of section 4 of P.L.1995, c.316 (C.26:2J-4.10) regarding deductibles for a high deductible health plan, a contract offered by a health maintenance organizati…

26:2J-4.30 Health maintenance organization, coverage for contraceptives. 6. a. A certificate of authority to establish and operate a health maintenance organization in this State shall not be issued or continued on or after the effective date of this act for a health maintenance …

26:2J-4.31 HMOs to provide benefits for orthotic and prosthetic appliances. 8. a. A certificate of authority to establish and operate a health maintenance organization in this State pursuant to P.L.1973, c.337 (C.26:2J-1 et seq.) shall not be issued or continued by the Commission…

26:2J-4.32 Health maintenance organization to provide coverage for hearing aids, cochlear implant for enrollee. 9. a. A health maintenance organization contract for health care services that is delivered, issued, executed or renewed in this State pursuant to P.L.1973, c.337 (C.26…

26:2J-4.33 Health maintenance organization to provide installment payments to obstetrical provider for maternity services. 8. a. Every certificate of authority to establish and operate a health maintenance organization issued or continued in this State pursuant to P.L.1973, c.337…

26:2J-4.34 Health maintenance organization to provide benefits for treatment of autism or other developmental disability. 8. Notwithstanding any other provision of law to the contrary, a health maintenance organization enrollee agreement that provides health care services and is …

26:2J-4.35 HMO to provide coverage for oral anticancer medications. 8. a. A health maintenance organization contract for health care services that is delivered, issued, executed, or renewed in this State pursuant to P.L.1973, c.337 (C.26:2J-1 et seq.), or approved for issuance or…

26:2J-4.36 HMO to provide coverage for sickle cell anemia. 6. Every health maintenance organization contract that provides health care services and is delivered, issued, executed, or renewed in this State pursuant to P.L.1973, c.337 (C.26:2J-1 et seq.), or approved for issuance o…

26:2J-4.37 Health maintenance organization to provide coverage for prescription eye drops. 8. a. A health maintenance organization contract which provides hospital or medical expense benefits that include coverage for prescription eye drops, issued or continued in this State, or …

26:2J-4.38 Health maintenance organization, coverage for synchronization of prescribed medications. 6. a. Every certificate of authority to establish and operate a health maintenance organization in this State issued, continued or renewed in this State, or approved for issuance, …

26:2J-4.39 Health maintenance organization contract to provide benefits for substance use disorder. 8. a. A health maintenance organization contract that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State, or approved for iss…

26:2J-4.4 Health maintenance organization, mammogram examination benefits. 6. a. Notwithstanding any provision of law to the contrary, a certificate of authority to establish and operate a health maintenance organization in this State shall not be issued or continued by the Commi…

26:2J-4.40 Health maintenance organization to provide coverage regardless of gender identity, expression. 8. a. Notwithstanding any other law or regulation to the contrary, a health maintenance organization contract that provides hospital and medical expense benefits and is deliv…

26:2J-4.41 HMO to cover digital tomosynthesis of the breast. 8. a. A health maintenance organization contract for health care services that is delivered, issued, executed, or renewed in this State pursuant to P.L.1973, c.337 (C.26:2J-1 et seq.), or approved for issuance or renewa…

26:2J-4.42 HMO to provide coverage for donated human breast milk. 8. a. A health maintenance organization contract that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by …

26:2J-4.43 Health maintenance organization to provide coverage for standard fertility preservation services. 5. a. A health maintenance organization contract that provides hospital or medical expense benefits for groups with more than 50 persons and is delivered, issued, executed…

26:2J-4.44 Health maintenance organization to provide coverage for breastfeeding support. 8. a. A health maintenance organization contract that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State, or approved for issuance or r…

26:2J-4.45 Health maintenance organization to cover preventive services. 8. a. A health maintenance organization contract that provides hospital or medical expense benefits and is delivered, issued, executed, or renewed in this State, or approved for issuance or renewal in this S…

26:2J-4.46 Health maintenance organization to provide certain coverage for prescription drugs. 8. a. Notwithstanding any other provision of law to the contrary, a health maintenance organization that offers a contract that provides benefits for expenses incurred in the purchase o…

26:2J-4.47 Health maintenance organization to cover adolescent depression screenings. 8. A health maintenance organization contract for health care services that is delivered, issued, executed, or renewed in this State pursuant to P.L.1973, c.337 (C.26:2J-1 et seq.), or approved …

26:2J-4.48 HMO to cover newborn home nurse visitation. 12. a. Notwithstanding any provision of law to the contrary, a certificate of authority to establish and operate a health maintenance organization in this State shall not be issued or continued by the Commissioner of Banking …

26:2J-4.49 Contract, health care services, coverage, epinephrine auto-injector device. 17. A contract for health care services that is delivered, issued, executed, or renewed in this State pursuant to P.L.1973, c.337 (C.26:2J-1 et seq.) or approved for issuance or renewal in this…

26:2J-4.5. Health maintenance organization, benefits for "off-label" drugs required 7. a. Notwithstanding any provision of law to the contrary, and except as otherwise provided in P.L.1992, c.161 (C.17B:27A-2 et al.) or P.L.1992, c.162 (C.17B:27A-17 et seq.), a certificate of aut…

26:2J-4.50 Contract, health care services, coverage, prescription asthma inhaler. 18. A contract for health care services that is delivered, issued, executed, or renewed in this State pursuant to P.L.1973, c.337 (C.26:2J-1 et seq.) or approved for issuance or renewal in this Stat…

26:2J-4.51 Biomarker precision medical testing coverage, health maintenance organization contracts. 8. a. Each health maintenance organization contract for health care services that is delivered, issued, executed, or renewed in this State pursuant to P.L.1973, c.337 (C.26:2J-1 et…

26:2J-4.52 Certificate of authority to establish and operate a health maintenance organization, HIV preexposure prophylaxis, HIV postexposure prophylaxis. 10. a. (1) Except as provided in paragraph (2) of this subsection, notwithstanding any provision of law to the contrary, a ce…

26:2J-4.53 Benefits provided under enrollee agreements. 6. a. Every enrollee agreement that provides hospital or medical expense benefits and is delivered, issued, executed, or renewed in this State pursuant to P.L.1973, c.337 (C.26:2J-1 et seq.), or approved for issuance or rene…

26:2J-4.6 Health maintenance organization, benefits for health promotion. 8. a. Notwithstanding any provision of this act or any other law to the contrary, a certificate of authority to establish and operate a health maintenance organization in this State shall not be issued or c…

26:2J-4.7 Requirements for health maintenance organization providing benefits for pharmacy services. 6. a. Notwithstanding any provision of law to the contrary, a certificate of authority to establish and operate a health maintenance organization in this State shall not be issued…

26:2J-4.8. Benefits for certain cancer treatments 6. In addition to benefits provided under regulations adopted pursuant to P.L.1992, c.161 (C.17B:27A-2 et seq.) and P.L.1992, c.162 (C.17B:27A-17 et seq.), no certificate of authority to establish and operate a health maintenance …

26:2J-4.9. Coverage for birth and natal care; HMO 8. a. Every enrollee agreement that provides maternity benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1973, c.337 (C.26:2J-1 et seq.) or approved for issuance or renewal in this State by the C…

26:2J-40. Filing of copy of advertising materials, regulations 10. a. Every health maintenance organization shall file with the department a copy of all advertising materials to be used in promoting medicare supplement health care services to which residents of this State will ha…

26:2J-41. Additional remedies 11. In addition to any other applicable penalties for violation of the relevant provisions of law, the commissioner may require a health maintenance organization violating the provisions of this act to cease marketing any medicare supplement contract…

26:2J-42. Health maintenance organization contract; compliance 24. No health maintenance organization contract, evidence of coverage, or other form subject to the filing requirements of P.L.1973, c.337 (C.26:2J-1 et seq.) or application for that coverage, if a written application…

26:2J-43. Filing of contract or related form 25. a. Except as otherwise provided in P.L.1992, c.161 (C.17B:27A-2 et seq.) and P.L.1992, c.162 (C.17B:27A-17 et seq.), any health maintenance organization contract or evidence of coverage or related form subject to the provisions of …

26:2J-44. Contract forms; certification memorandum 26. a. Pursuant to the provisions of this section, a health maintenance organization authorized to do business in this State may file with the Commissioner of Insurance and use, in accordance with subsection d. of this section, a…

26:2J-47 Annual assessment on HMOs. 3. a. (1) For the fiscal years 2005 and 2006, the Commissioner of Banking and Insurance shall issue, in accordance with the provisions of this section, a special interim assessment of one percent, and in fiscal year 2007 and each fiscal year th…

26:2J-48 Health maintenance organization, aggregate benefits. 5. a. Beginning with the calendar year starting on January 1, 2020, and in each calendar year thereafter, a health maintenance organization providing health benefits plans to a large employer shall return, in the form …

26:2J-5. Powers of health maintenance organizations a. The powers of a health maintenance organization include the following: (1) the purchase, lease, construction, renovation, operation, or maintenance of health care facilities, and their ancillary equipment, and such property a…

26:2J-6. Governing body a. The governing body of any health maintenance organization may include providers, other individuals, or both. b. Such governing body shall establish a mechanism to afford the enrollees an opportunity to participate in matters of policy and operation thro…

26:2J-7. Protection against wrongful acts Any director, officer employee or partner of a health maintenance organization who receives, collects, disburses, or invests funds in connection with the activities of such organization shall be bonded in an amount to be determined by the…

26:2J-8. Evidence of coverage 8. Evidence of coverage. a. (1) Enrollees are entitled to receive evidence of coverage and evidence of the total amount of payment which the enrollee is obligated to prepay for health care services and, where applicable, for indemnity benefits. If an…

26:2J-8.1 Health maintenance organization to receive, transmit transactions electronically; standards. 7. 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 health maintenance organization or its agent or…

26:2J-9. Annual report a. Every health maintenance organization shall annually, on or before March 1, file a report verified by at least two principal officers with the commissioner, with a copy to the Commissioner of Insurance covering the preceding calendar year. b. Such report…