Title 26, HEALTH AND VITAL STATISTICS

26:2S-15 Compliance with department reporting requirements 15. a. A carrier which offers a managed care plan shall comply with department reporting requirements with respect to quality outcomes measures of health care services and independent consumer satisfaction surveys. b. The…

26:2S-15.1 Annual report to carrier by managed behavioral health care organization. 4. a. A carrier that owns, wholly or in part, or contracts with a managed behavioral health care organization shall require the managed behavioral health care organization to provide the carrier a…

26:2S-16 Violations, penalties 16. a. A carrier that violates any provision of this act shall be liable to a civil penalty of not less than $250 and not greater than $10,000 for each day that the carrier is in violation of the act if reasonable notice in writing is given of the i…

26:2S-17 Recommendations for legislative action 17. The commissioner and the Commissioner of Banking and Insurance shall develop recommendations for legislative action to address the issue of regulating health care or managed care entities that seek to contract directly with empl…

26:2S-18 Enforcement; rules, regulations 19. The commissioner shall enforce the provisions of this act. Within six months of the effective date of this act, in consultation with the Commissioner of Banking and Insurance, the commissioner shall adopt rules and regulations, pursuan…

26:2S-18.1 Publication of annual financial statements. 5. The Department of Banking and Insurance shall, for each carrier in the State, publish on the department's website the annual financial statement, in the format adopted by the National Association of Insurance Commissioners…

26:2S-19. Findings, declarations relative to Managed Health Care Consumer Assistance Program 1. The Legislature finds and declares that: a. Managed health care, regardless of the form it takes, is now a major vehicle for the delivery of health care in this nation; and the rapid t…

26:2S-2 Definitions relative to health care quality. 2. As used in sections 2 through 19 of this act: "Behavioral health care services" means procedures or services rendered by a health care provider for the treatment of mental illness, emotional disorders, or drug or alcohol abu…

26:2S-20 Definitions relative to Managed Health Care Consumer Assistance Program. 2. As used in this act: "Carrier" means a carrier as defined in section 2 of P.L.1997, c.192 (C.26:2S-2). "Commissioner" means the Commissioner of Banking and Insurance. "Department" means the Depar…

26:2S-21 Managed Health Care Consumer Assistance Program. 3. a. There is established the Managed Health Care Consumer Assistance Program in the Department of Banking and Insurance. The commissioner shall make agreements to operate the program as necessary, in consultation with th…

26:2S-22. Report to Governor, Legislature 4. The commissioner shall report to the Governor and the Legislature, no later than 18 months after the effective date of this act and annually thereafter, on the data collected by the program, the activities of the program and its effect…

26:2S-23. Immunity from liability 5. An employee, volunteer, board member or other representative of an organization selected by the commissioner pursuant to section 3 of this act shall be immune from liability for any action taken in the good faith performance of their official …

26:2S-24. Appropriations; fees, use 6. a. There is appropriated $500,000 to the department from the General Fund to provide funding for the program, except that funds may be appropriated, in lieu of part or all of the amount appropriated from the General Fund, from the monies mad…

26:2S-25 Rules, regulations. 8. The Commissioner of Banking and Insurance, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), shall adopt rules and regulations to effectuate the purposes of this act. L.2001, c.14, s.8; amended 2012, c.17, s.304.…

26:2S-26 Definitions relative to certain dental benefit plans. 1. As used in this act: "Carrier" means an insurance company, health service corporation, hospital service corporation, medical service corporation, dental service corporation, dental plan organization, or health main…

26:2S-27 Covered services. 2. Notwithstanding section 22 of P.L.1993, c.162 (C.17B:27A-54) or any other law or regulation to the contrary, a contract between a carrier and a dentist to provide covered services shall not require, directly or indirectly, that a dentist provide serv…

26:2S-28 Rules, regulations. 3. The Commissioner of Banking and Insurance shall promulgate rules and regulations pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) necessary to effectuate the purposes of this act. L.2014, c.70, s.3.

26:2S-29 Carrier offering a health benefits plan to provide coverage, payment. 8. a. A carrier that offers a health benefits plan in this State shall provide coverage and payment for health care services delivered to a covered person through telemedicine or telehealth, on the sam…

26:2S-3 Form to be filed by carrier; minimum information required 3. a. A carrier which offers a health benefits plan to residents of this State on the effective date of this act, shall file a form, as prescribed by the commissioner, with the department within 90 days of the effe…

26:2S-3.1 Short title. 1. This act shall be known and may be cited as the “Ensuring Fairness in Cost-Sharing Amounts Act of 2025.” L.2025, c.199, s.1.

26:2S-3.2 Definitions. 2. As used in section 3 of P.L.2025, c.199 (C.26:2S-3.3): “Carrier” means an insurance company, health service corporation, hospital service corporation, medical service corporation, or health maintenance organization authorized to issue health benefits pla…

26:2S-3.3 Requirements for carriers and third-party administrators. 3. a. The annual limitation on cost-sharing amounts provided for in section 1302 of the Patient Protection and Affordable Care Act, Pub.L.111-148 (42 U.S.C. s.18022), shall apply to all health care services cover…

26:2S-30. Definitions regarding dental plan application forms 1. As used in this act: "Carrier" means an insurance company, health service corporation, hospital service corporation, medical service corporation, dental service corporation, dental plan organization, or health maint…

26:2S-31. Adoption of dental plan application forms 2. a. The Commissioner of Banking and Insurance shall adopt by regulation a universal dentist application for participation form for use by carriers which offer or administer dental plans for the purpose of credentialing dentist…

26:2S-32. Acceptance of universal dentist application 3. a. Within 180 days of the adoption of the forms by regulation pursuant to this act, a carrier which offers or administers a dental plan shall accept the universal dentist application for participation form and renewal form …

26:2S-33. Adoption of regulations 4. The Commissioner of Banking and Insurance shall adopt regulations within 180 days of the date of enactment of this act, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), necessary to carry out the purposes o…

26:2S-33.1 Carrier, participating dentist, agreement, collecting, covered procedures, services; refund, difference. 1. a. A carrier shall not include in an agreement between the carrier and a participating dentist a provision that prohibits a participating dentist from collecting…

26:2S-34 Preexisting condition provision prohibited in health benefits plan. 6. A carrier that offers a health benefits plan in this State shall ensure that the plan does not contain any provision that: a. denies or limits benefits for a preexisting condition to any covered perso…

26:2S-35 Imposition of limits prohibited. 4. Notwithstanding any law to the contrary, a health benefits plan shall not impose: (1) any lifetime limits on the dollar value of benefits for any individual insured pursuant to the plan; or (2) any annual limits on the dollar value of …

26:2S-36 Provision of emergency, urgent services. 5. A carrier that offers a health benefits plan in this State shall provide that coverage for medically necessary services on an emergency or urgent basis shall be provided without imposing any requirement under the plan for prior…

26:2S-37 Insurance plans to cover prescription refills during state of emergency. 2. a. Subject to subsection b. of this section and to the extent consistent with clinical guidelines, the Commissioner of Banking and Insurance shall require carriers to provide coverage of prescrip…

26:2S-38 Prescription drug benefit carrier contracts, opioid antidote coverage. 1. a. A carrier shall ensure that every contract to provide prescription drug benefits, or to authorize the purchase of a contract to provide prescription drug benefits, shall provide coverage for an …

26:2S-39 Health benefit plans, coverage for abortion, certain religious employers exempt. 3. a. Upon concluding a study and issuing a report to the Governor and the Legislature demonstrating that such a regulation is necessary, the Department of Banking and Insurance may, through…

26:2S-4 Disclosure of terms and conditions in writing to subscriber. 4. A carrier shall disclose in writing to a subscriber, in a manner consistent with the "Life and Health Insurance Policy Language Simplification Act," P.L.1979, c.167 (C.17B:17-17 et seq.), the terms and condit…

26:2S-40 Carrier to ensure provision of comprehensive behavioral health crisis intervention services coverage. 8. A carrier that offers a health benefits plan in this State shall ensure that the plan provides comprehensive coverage for behavioral health crisis intervention servic…

26:2S-41 Coverage for screening, prevention, treatment services of behavioral health issues in children. 1. a. A carrier that offers a health benefits plan in this State shall provide benefits to any subscriber for medical expenses incurred in screening, prevention, and treatment…

26:2S-5 Additional disclosure requirements. 5. a. In addition to the disclosure requirements provided in section 4 of this act, a carrier which offers a managed care plan shall disclose to a subscriber, in writing, in a manner consistent with the "Life and Health Insurance Policy…

26:2S-5.1 Health insurance carriers to provide organ, tissue donation information to subscribers. 1. a. A carrier shall provide to subscribers written informational materials about organ and tissue donation and registration at each contract renewal. The materials shall be develop…

26:2S-6 Designation of licensed physician as medical director for managed care 6. a. A carrier which offers a managed care plan or uses a utilization management system in any of its health benefits plans shall designate a licensed physician to serve as medical director. The medic…

26:2S-6.1 Managed care plan to pay full contractual rate to out-of-network provider, direct payments, certain circumstances. 2. a. With respect to a carrier which offers a managed care plan that provides for both in-network and out-of-network benefits, in the event that: (1) a co…

26:2S-6.2 Waiver of health insurance copayments for certain active duty military and their families. 1. a. Notwithstanding any other law or contract provision to the contrary, if a covered person is a member of the military serving on active duty, or a family member of the covere…

26:2S-7 Review of application for participation 7. Each application for participation by a licensed health care professional that is submitted to a carrier which offers a managed care plan shall be reviewed by a committee of the carrier that includes appropriate representation of…

26:2S-7.1 Universal application for credentialing physicians for a carrier's provider network. 1. The Commissioner of Banking and Insurance, in consultation with the New Jersey Association of Health Plans, the Health Insurance Association of America, the Medical Society of New Je…

26:2S-7.2. Acceptance of application by carriers 2. Within 180 days of the adoption of the forms by regulation pursuant to this act, a carrier which offers a managed care plan shall accept the universal physician application for participation form and renewal form adopted pursuan…

26:2S-7.3 Rules, regulations. 3. The Commissioner of Banking and Insurance shall adopt regulations within 180 days of the date of enactment of this act, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), necessary to carry out the purposes of th…

26:2S-8 Establishment of policy governing removal of health care providers 8. A carrier which offers a managed care plan shall establish a policy governing removal of health care providers from the provider network which includes the following: a. The carrier shall inform a parti…