Title 17B, Title 17B: INSURANCE

17B:26-46. Violations; penalty; collection and enforcement If, after notice and hearing, the commissioner finds that an insurance company, agent or broker or any other person has violated the provisions of this act or any regulation promulgated pursuant to this act, he may, in ad…

17B:26-47. Injunction The commissioner may, through the Attorney General of this State, institute an action in the Superior Court to enjoin and restrain any insurer who has entered into a policy which does not conform to the regulations promulgated pursuant to this act or an insu…

17B:26-5. Time limit on certain defenses There shall be a provision as follows: Time limit on certain defenses: a. After 2 years from the date of issue of this policy no misstatements, except fraudulent misstatements, made by the applicant in the application for such policy shall…

17B:26-6. Grace period There shall be a provision as follows: Grace period: A grace period of (insert a number not less than "7" for weekly premium policies, "10" for monthly premium policies and "31" for all other policies) days will be granted for the payment of each premium fa…

17B:26-7. Reinstatement There shall be a provision as follows: Reinstatement: If any renewal premium be not paid within the time granted the insured for payment, a subsequent acceptance of premium by the insurer or by any agent duly authorized by the insurer to accept such premiu…

17B:26-8. Notice of claim There shall be a provision as follows: Notice of claim: Written notice of claim must be given to the insurer within 20 days after the occurrence or commencement of any loss covered by the policy, or as soon thereafter as is reasonably possible. Notice gi…

17B:26-9. Claim forms There shall be a provision as follows: Claim forms: The insurer, upon receipt of a notice of claim, will furnish to the claimant such forms as are usually furnished by it for filing proofs of loss. If such forms are not furnished within 15 days after the giv…

17B:26-9.1 Health insurer to receive, transmit transactions relative to individual policies electronically; standards. 5. 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 insurer or its agent or …

17B:26A-1. Definitions 1. For the purposes of this act: a. "Applicant" means: (1) In the case of an individual medicare supplement policy, the person who seeks to contract for insurance benefits, and (2) In the case of a group medicare supplement policy, the proposed certificate …

17B:26A-10. Filing of copies of advertising materials, regulations 8. a. Every insurer shall file with the Department of Insurance a copy of all advertising materials to be used in promoting medicare supplement policies to which residents of this State will have access, and throu…

17B:26A-11. Additional remedies 9. In addition to any other applicable penalties for violation of the provisions of Title 17B of the New Jersey Statutes, the commissioner may require any health insurer violating the provisions of P.L.1982, c.94 (C.17B:26A-1 et seq.) to cease mark…

17B:26A-12 Findings, declarations relative to Medicare supplement insurance. 1. The Legislature finds and declares that: a. As of April 1, 1995, individuals in the State of New Jersey under age 65 who became eligible for Medicare benefits due to a disability or because they suffe…

17B:26A-13 Medicare supplement plans offered. 2. a. Except as otherwise provided in subsection d. of this section, every carrier issuing or renewing Medicare supplement insurance policies or contracts shall, as a condition of issuing or renewing health benefits plans in this Stat…

17B:26A-14 Rules, regulations; rates; plan provisions. 3. a. The commissioner shall adopt rules and regulations establishing a plan to provide Medicare Supplement Plan C coverage of the standardized Medicare supplement plans to persons under 50 years of age in this State who are …

17B:26A-15. Procedures for equitable sharing of losses; conditions; filing statement 4. The plan shall establish procedures for the equitable sharing of any losses incurred by the contracting carrier providing coverage under the plan pursuant to subsection a. of section 3 of this…

17B:26A-16. Audit required, conditions 5. a. Whenever the contracting carrier reports a net loss to the commissioner pursuant to paragraph (2) of subsection a. of section 4 of this act, the related operations of the contracting carrier and any losses incurred by the contracting c…

17B:26A-17 Definitions. 6. As used in this act: "Carrier" means an insurance company or service corporation authorized to issue health benefits plans in this State. "Financially impaired" means a carrier or health maintenance organization which, after the effective date of P.L.19…

17B:26A-2. Regulations; medicare supplement policies The commissioner shall issue regulations to establish specific standards for policy provisions of medicare supplement policies, which shall be in addition to and in accordance with applicable laws of this State, and may cover, …

17B:26A-3. Prohibited provisions 3. a. No medicare supplement policy shall contain benefits which duplicate any benefits provided by medicare. b. The commissioner may issue regulations that specify prohibited policy provisions not otherwise specifically authorized by statute whic…

17B:26A-4. Preexisting condition; denial of claim for losses Notwithstanding any other provision of law of this State to the contrary, a medicare supplement policy may not deny a claim for losses incurred more than 6 months from the effective date of coverage for a preexisting co…

17B:26A-5. Regulations 5. The commissioner shall promulgate regulations to effectuate and enforce the provisions of P.L.1982, c.94 (C. 17B:26A-1 et seq.) and any regulations which are necessary to conform medicare supplement policies and certificates with federal law. These regul…

17B:26A-6. Medicare supplement policy or certificate, requirements 6. a. No insurer shall deliver or issue for delivery to a resident of this State a medicare supplement policy or certificate, or any application, rider or endorsement to be used in connection with the issuance or …

17B:26A-7. Outline of coverage, regulations 7. a. In order to provide for full and fair disclosure in the sale of medicare supplement policies, no medicare supplement policy or certificate shall be delivered or issued for delivery in this State unless an outline of coverage is de…

17B:26A-8. 30-day examination period, refunds 8. Medicare supplement policies or certificates shall have a notice prominently printed on the first page of the policy or certificate or attached thereto stating in substance that the applicant shall have the right to return the poli…

17B:26A-9. Applicability 1. Except as otherwise specifically provided: a. The provisions of P.L.1982, c.94 (C.17B:26A-1 et seq.) shall apply to all medicare supplement policies delivered or issued for delivery in this State and all certificates issued under group medicare supplem…

17B:27-26. Definitions and requirements Any policy or contract of health insurance which covers more than one person, other than a blanket insurance policy, or a policy issued pursuant to section 17B:26-2a(3), shall be deemed a group health insurance policy. No group health insur…

17B:27-27. Employer, trustee, labor union, association groups A policy issued to an employer or to the trustees of a fund established by one or more employers, or issued to a labor union, or issued to an association formed for purposes other than obtaining such insurance, or issu…

17B:27-28. Other groups as permitted under group life insurance Group health insurance may also be provided under a policy issued to cover such other groups as may be covered for group life insurance. L.1971, c. 144, s. 17B:27-28.

17B:27-29. Discretionary groups A policy issued to insure any other group which, in the opinion of the commissioner, may be insured for group health insurance in accordance with sound underwriting principles. L.1971, c. 144, s. 17B:27-29.

17B:27-30 Dependents. 17B:27-30. Benefits of group health insurance, except benefits for loss of time on account of disability, may be provided for one or more members of the families or one or more dependents of persons who may be insured under a group policy referred to in sect…

17B:27-30.1 Benefits provided by group policy to subscriber's child. 11. a. A policy which provides hospital or medical expense benefits under which dependent coverage is available shall continue to make that coverage available for an adult child until the child turns 26 years of…

17B:27-30.2. Requirements applicable to State Medicaid 12. An insurer 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 for medical assist…

17B:27-30.3 Coverage provided by group health plan to subscriber's child. 15. a. A group health plan as defined in section 607(1) of the "Employee Retirement Income Security Act of 1974," 29 U.S.C.1167(1) which provides hospital or medical expense benefits under which dependent c…

17B:27-30.4. Requirements applicable to State Medicaid 16. A group health plan as defined in section 607(1) of the "Employee Retirement Income Security Act of 1974," 29 U.S.C.1167(1) shall not impose requirements on the Division of Medical Assistance and Health Services in the De…

17B:27-30.5 Coverage for certain dependents until age 31 by group health insurance policy. 4. a. As used in this section, "dependent" means an insured'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…

17B:27-31. "Employees" defined The policy may provide that the term "employees" shall include as employees of a single employer the employees of one or more subsidiary corporations and the employees, individual proprietors and partners of affiliated corporations, proprietorships …

17B:27-32. Blanket insurance a. Any policy or contract of insurance against death or injury resulting from accident or from accidental means which conforms with the description and complies with the requirements contained in one of the following paragraphs shall be deemed a blank…

17B:27-33. Standard provisions No policy of group health or blanket insurance and no certificate thereunder shall be delivered or issued for delivery in this State unless the policy contains in substance all the provisions specified in sections 17B:27-34 to 17B:27-46 following. L…

17B:27-34. Application; statements There shall be a provision that a copy of the application, if any, of the policyholder shall be attached to the policy when issued, that all statements made by the policyholder or by the persons insured shall be deemed representations and not wa…

17B:27-35. Policy changes There shall be a provision that no agent has authority to change the policy or to waive any of its provisions and that no change in the policy shall be valid unless approved by an officer of the insurer and evidenced by endorsement on the policy, or by a…

17B:27-36. New entrants There shall be a provision that all new employees or new members, as the case may be, in the groups or classes eligible for such insurance must be added to such eligible groups or classes. L.1971, c. 144, s. 17B:27-36.

17B:27-36.1. Eligibility for enrollment under policy providing hospital, medical expense benefits. 6. Notwithstanding any other provision of law to the contrary, an insurer shall not consider a person's eligibility for medical assistance pursuant to P.L.1968, c.413 (C.30:4D-1 et …

17B:27-36.2. Group health insurance, policy, exclusion, rates, terms based on genetic information prohibited 15. Every group health insurance policy providing hospital or medical expense benefits that is delivered, issued, executed or renewed in this State pursuant to Chapter 27 …

17B:27-37. Payment of premiums There shall be a provision that all premiums due under the policy shall be remitted by the employer or employers of the persons insured, by the policyholder, or by some other designated person acting on behalf of the association or group insured, to…

17B:27-38. Certificate There shall be a provision that the insurer shall issue to the employer, the policyholder, or other person or association in whose name such policy is issued, for delivery to each employee or member, a certificate setting forth in summary form a statement o…

17B:27-39. Age limits There shall be a provision specifying the ages, if any there be, to which the insurance provided therein shall be limited; and the ages, if any there be, for which additional restrictions are placed on benefits, and the additional restrictions placed on the …