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

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) …

17:48A-7.1 Group contracts; issuance; description; benefits; employees defined. 1. A medical service corporation may issue to a policyholder a group contract, covering at least 10 employees or members at the date of issue, if it conforms to the following description: (a) A contra…

17:48A-7.10 Coverage provided by medical service corporation for subscriber's child. 3. a. A medical service corporation contract which provides hospital or medical expense benefits under which dependent coverage is available shall continue to make that coverage available for an …

17:48A-7.11. Requirements applicable to State Medicaid 4. A medical service corporation 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 …

17:48A-7.12 Medical service corporation to receive, transmit transactions electronically; standards. 3. 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 medical service corporation or its agent or a sub…

17:48A-7.13 Coverage for certain dependents until age 31 by medical service corporation. 2. a. As used in this section, "dependent" means a subscriber'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…

17:48A-7.2. Provisions applicable to group contracts The provisions of the act to which this act is a supplement shall apply to group contracts except that sections 5, 6, 7 and 10 of such act shall not apply. The word "subscriber" as used in said act means the policyholder under …

17:48A-7.3. Group contract form Every group contract entered into by a medical service corporation with any policyholder shall be in writing and a contract form stating the terms and conditions thereof shall be furnished to the policyholder to be kept by him. No group contract fo…

17:48A-7.4. Participation agreements A medical service corporation of this State may enter into agreements to participate with other corporations in the issuance of group contracts to policyholders whose employees or members are located in more than one State. Such agreements may…

17:48A-7.5. Schedule of rates No medical service corporation shall issue group contracts which are not experience-rated pursuant to section 4 of this act, until it shall have filed with the commissioner a full schedule of the rates which are to apply to such contracts. The commis…

17:48A-7.6. Combined hospital-medical contract A medical service corporation and a hospital service corporation authorized to do business in this State may issue a combined contract providing for medical care and hospital care but no one of such corporations shall issue any such …

17:48A-7.7. Review of determinations of commissioner of banking and insurance All determinations of the Commissioner of Banking and Insurance made under the provisions of this act, or the act to which this act is a supplement, shall be subject to review by the Superior Court in a…

17:48A-7.8. Review of practices, rules and procedures of medical service corporations All practices, rules, and procedures of a medical service corporation, involving termination or refusal to renew coverage, modification of coverage or rates in the case of persons classified as …

17:48A-7.9. Adjustment of rates; experience rating formula; approval Group contracts, covering at least 50 employees or members, may provide for the adjustment of the rate of premium at the end of the first year or any subsequent year of insurance thereunder based on the experien…

17:48A-7aa Medical service corporation to offer coverage for domestic partner. 48. A medical service corporation that provides hospital or medical expense benefits under a contract that is delivered, issued, executed or renewed in this State or approved for issuance or renewal in…

17:48A-7b. Reconstructive breast surgery; benefits 1. Every subscription certificate and group and individual contract providing medical service benefits delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of…

17:48A-7bb Medical service corporation, coverage for contraceptives. 2. a. A medical service corporation that provides hospital or medical expense benefits shall provide coverage under every contract delivered, issued, executed or renewed in this State or approved for issuance or…

17:48A-7c. Medical service contracts Every group and individual contract providing medical service benefits delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Insurance on or after the effective date of t…

17:48A-7cc Medical service corporation to provide benefits for orthotic and prosthetic appliances. 2. a. Every medical service corporation contract that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1940,…

17:48A-7d Medical service corporation insurance benefits for preexisting condition. 1. a. Notwithstanding any other provision of law to the contrary, no group health insurance contract issued by a medical service corporation pursuant to the provisions of P.L.1940, c.74 (C.17:48A-…

17:48A-7dd Medical service corporation to provide coverage for hearing aids, cochlear implant for covered persons. 3. a. A medical service corporation contract that provides hospital and medical expense benefits and is delivered, issued, executed or renewed in this State pursuant…

17:48A-7e. Medical service corporation to pay benefits for treatment of Wilm's tumor Every group or individual medical service corporation contract providing hospital or medical expense benefits shall provide benefits to any subscriber or other person covered thereunder for expen…

17:48A-7ee Individual, group medical service corporation to provide installment payments to obstetrical provider for maternity services. 2. a. Every individual or group medical service corporation contract that provides benefits for maternity services, and that is delivered, issu…

17:48A-7f Medical service corporation contract, mammogram examination benefits. 2. a. No group or individual medical service corporation contract providing hospital or medical expense benefits shall be delivered, issued, executed, or renewed in this State or approved for issuance…

17:48A-7ff Medical service corporation to provide benefits for treatment of autism or other developmental disability. 2. Notwithstanding any other provision of law to the contrary, every medical service corporation contract that provides hospital and medical expense benefits and …

17:48A-7g. Medical service corporation, benefits for "off-label" drugs required 3. a. Except as provided in P.L.1992, c.161 (C.17B:27A-2 et al.) and P.L.1992, c.162 (C.17B:27A-17 et seq.), no group or individual medical service corporation contract which provides benefits for exp…

17:48A-7gg Medical service corporation to provide coverage for oral anticancer medications. 2. a. A medical service corporation contract that provides hospital and medical expense benefits and is delivered, issued, executed, or renewed in this State pursuant to P.L.1940, c.74 (C.…

17:48A-7h. Medical service corporation, benefits for health promotion 4. a. Every medical service corporation contract that provides hospital and medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1940, c.74 (C.17:48A-1 et seq.), …

17:48A-7hh Medical service corporation to provide coverage for sickle cell anemia. 2. Every medical service corporation contract that provides hospital and medical expense benefits and is delivered, issued, executed, or renewed in this State pursuant to P.L.1940, c.74 (C.17:48A-1…

17:48A-7i Requirements for medical service corporation providing benefits for pharmacy services. 2. a. Notwithstanding any other provision of law to the contrary, no group or individual medical service corporation contract which provides benefits for pharmacy services, prescripti…

17:48A-7ii Medical service corporation to provide coverage for prescription eye drops. 2. a. A medical service corporation which provides hospital or medical expense benefits that include coverage for prescription eye drops under a contract delivered, issued, executed or renewed …

17:48A-7j. Benefits for certain cancer treatments 2. 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.), a medical service corporation shall offer under every group or individual …

17:48A-7jj Medical service corporation contract, coverage for synchronization of prescribed medications. 2. a. Every group or individual medical service corporation contract delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State on…

17:48A-7k. Coverage for birth and natal care; medical service corporation 2. a. Every individual or group contract that provides maternity benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1940, c.74 (C.17:48A-1 et seq.) or approved for issuance…

17:48A-7kk Medical service corporation to provide benefits for treatment of substance use disorder. 2. a. A medical service corporation contract that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State, or approved for issuanc…

17:48A-7l. Coverage, diabetes treatment, individual, group medical service corporation. 2. a. Every individual or group medical service corporation contract providing hospital or medical expense benefits that is delivered, issued, executed or renewed in this State pursuant to P.L…

17:48A-7ll Medical service corporation to provide coverage regardless of gender identity, expression. 2. a. Notwithstanding any other law or regulation to the contrary, a medical service corporation contract that provides hospital and medical expense benefits and is delivered, is…

17:48A-7m. Medical service corporation contract, Pap smear benefits 3. No medical service corporation contract providing hospital or medical expense benefits for groups with greater than 50 persons shall be delivered, issued, executed or renewed in this State, or approved for iss…

17:48A-7mm Medical service corporation contract to cover digital tomosynthesis of the breast. 2. a. A medical service corporation contract that provides hospital and medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1940, c.74 (C…

17:48A-7n. Medical service corporation contract, prostate cancer testing 3. No medical service corporation contract providing hospital or medical expense benefits for groups with greater than 49 persons shall be delivered, issued, executed or renewed in this State, or approved fo…

17:48A-7nn Medical service corporation to provide coverage for donated human breast milk. 2. a. A medical service corporation contract that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State, or approved for issuance or renew…

17:48A-7o. Coverage for minimum inpatient care following mastectomy by individual, group medical service corporation 2. a. Every individual or group medical service corporation contract that provides hospital or medical expense benefits and is delivered, issued, executed or renew…

17:48A-7oo Medical service corporation to provide coverage for standard fertility preservation services. 2. a. A medical service corporation contract which provides hospital or medical expense benefits for groups with more than 50 persons and is delivered, issued, executed or ren…