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

17:48A-7r Medical service corporation to cover certain audiology, speech-language pathology services. 3. Notwithstanding any other provision of P.L.1940, c.74 (C.17:48A-1 et seq.), benefits shall not be denied to any eligible individual for eligible services, as determined under …

17:48A-7rr Medical service corporation to provide certain coverage for prescription drugs. 2. a. Notwithstanding any other provision of law to the contrary, a medical service corporation that offers a contract that provides benefits for expenses incurred in the purchase of prescr…

17:48A-7s Coverage for treatment of domestic violence injuries by medical service corporation. 2. 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.), no group or individual medical service corporation contract providin…

17:48A-7ss Medical service corporation to cover adolescent depression screenings. 2. 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-1 et s…

17:48A-7t. Coverage for certain dental procedures for the severely disabled or child age five or under by medical service corporation 2. a. No group or individual medical service corporation contract providing hospital or medical expense benefits shall be delivered, issued, execu…

17:48A-7tt Medical service corporation to cover newborn home nurse visitation. 6. 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-7u Medical service corporation to provide coverage for mental health conditions, substance use disorders; collaborative care model. 2. a. (1) Every individual and group medical service corporation contract that provides hospital or medical expense benefits that is delivere…

17:48A-7uu Individual, group medical service corporation contract, coverage, epinephrine auto-injector device. 5. An individual or group medical service corporation contract providing hospital or medical expense benefits that is delivered, issued, executed, or renewed in this Sta…

17:48A-7v. Coverage for hemophilia services by medical services corporation 8. Notwithstanding the provisions of P.L.1940, c.74 (C.17:48A-1 et seq.) to the contrary, no individual or group contract shall be delivered, issued, executed or renewed on or after the effective date of …

17:48A-7vv Individual, group medical service corporation contract, coverage, prescription asthma inhaler. 6. An individual or group medical service corporation contract providing hospital or medical expense benefits that is delivered, issued, executed, or renewed in this State pu…

17:48A-7w Medical service corporation to provide coverage for treatment of infertility. 2. a. A medical service corporation contract which provides hospital or medical expense benefits for groups with more than 50 persons, which includes pregnancy-related benefits, shall not be d…

17:48A-7ww Biomarker precision medical testing coverage, medical service corporation contracts. 2. a. Each 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, c.…

17:48A-7x Medical service corporation to provide coverage for colorectal cancer screening. 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, c.74 (C…

17:48A-7xx Group, individual medical service corporation contracts, HIV preexposure prophylaxis, HIV postexposure prophylaxis. 4. a. (1) Except as provided in paragraph (2) of this subsection, no group or individual medical service corporation contract providing hospital or medic…

17:48A-7y Medical service corporation prescription drug plans to cover certain infant formulas. 2. A medical service corporation which provides hospital or medical expense benefits for expenses incurred in the purchase of prescription drugs under a contract that is delivered, iss…

17:48A-7yy Benefits provided under medical service corporation contracts. 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, c.74 (C.17:48A-1 et seq…

17:48A-7z Contract issued under C.17:48A-1 et seq. required to cover certain out-of-network services. 8. Notwithstanding the provisions of P.L.1940, c.74 (C.17:48A-1 et seq.) to the contrary, no individual or group contract shall be delivered, issued, executed or renewed on or af…

17:48A-8. Participating physicians; payments for medical services Any medical service corporation may enter into agreements with eligible persons whereby such persons become participating physicians of a plan operated by the corporation and may make to such persons such payments …

17:48A-9. Filing form of subscription certificate, etc.; disapproval by commissioner No subscription certificate shall be issued by any medical service corporation to any subscriber unless and until the form thereof shall have been filed with the Commissioner of Banking and Insur…

17:48A-9.1. Medical service corporation contract; compliance 7. No medical service corporation contract subject to the provisions of P.L.1940, c.74, (C.17:48A-1 et seq.) or application for that contract, if a written application is required and is to be made a part of that contra…

17:48A-9.2. Filing of contract or related forms 8. 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 contract subject to the provisions of P.L.1940, c.74 (C.17:48A-1 et seq.), including any application, rider,…

17:48A-9.3. Contract forms; certification memorandum 9. a. Pursuant to the provisions of this section, a medical service corporation authorized to do business in this State may file with the commissioner and use, in accordance with subsection d. of this section, any contract, end…

17:48B-1. Additional powers Any hospital service corporation and any medical service corporation, organized pursuant to the laws of this State, in addition to other powers conferred upon it, shall be authorized and empowered to issue contracts, policies or certificates of insuran…

17:48B-2. Rules and regulations The Commissioner of Banking and Insurance is authorized to promulgate rules and regulations, not inconsistent with this act, with respect to the keeping of records, reporting of information, segregation of accounts, entry of credits and charges, us…

17:48C-1. Objects and purposes The objects and purposes of a dental service corporation authorized pursuant to this act shall be to establish, maintain and operate a nonprofit dental service plan or plans in the public interest whereby dental care may be provided to individuals e…

17:48C-10. Liability of corporation for injuries Any subscription certificate may contain a provision that all dental services paid for by a dental service corporation shall be in accordance with the accepted dental practices in the community at the time, but the corporation shal…

17:48C-11. Formal requirements for subscription certificates In every subscription certificate issued or delivered by any dental service corporation of this State: (a) All printed portions shall be plainly printed in type of which the face is not smaller than 10 point; (b) there …

17:48C-12. Participating dentists; payments for dental services Any dental service corporation may enter into agreements with eligible dentists whereby such dentists become participating dentists in a plan operated by the corporation and may make to such dentists such payments as…

17:48C-13. Filing form of subscription certificate; disapproval No subscription certificate shall be issued by any dental service corporation to any subscriber unless and until the form thereof shall have been filed with the commissioner, together with all applications, riders an…

17:48C-14. Schedule of rates; filing; disapproval No dental service corporation shall enter into any contract with a subscriber unless and until it shall have filed with the commissioner a full schedule of the rates to be paid by the subscribers to such contracts. The commissione…

17:48C-15 Agreements with dentists; approval of payments; corporate records. 15. No dental service corporation shall enter into any contract with a subscriber unless and until it shall have filed with the commissioner a copy of the agreement proposed to be entered into by the cor…

17:48C-16 Group contract; benefits; "employees" defined. 16. A dental service corporation may also issue to a policyholder a group contract, covering at least one employee other than a proprietor, a partner in a partnership or a shareholder that owns more than two percent of the …

17:48C-17. Application of act to group contracts; "subscriber" defined The provisions of this act shall apply to group contracts except that sections 7, 8, 11 and 14 of this act shall not apply. The word "subscriber" as used in this act means the policyholder under a group contra…

17:48C-18 Written group contracts; statements. 18. Every group contract entered into by a dental 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…

17:48C-18.1. Alternative dental coverage; original coverage restricted to limited number of providers Each employer or other organization which employs or has 25 or more employees or members during the full preceding calendar year and which contributes to a dental service corpora…

17:48C-18.2. Employer contribution An employer or other organization shall be required to pay for or contribute towards the provision of alternative coverage an amount equal to the premium or cost which it pays or contributes to the dental service corporation contract which limit…

17:48C-18.3. Rules and regulations Within 120 days of the effective date of this act, the Commissioner of the Department of Insurance shall promulgate rules and regulations necessary to effectuate the purpose of this act, including procedures for notice to covered persons, employ…

17:48C-19.1 Adjustment of rate of premium for dental service corporations, certain circumstances. 1. a. A group contract covering at least 10 employees or members may provide for the adjustment of the rate of premium based on past or projected experience, and may include those cl…

17:48C-2 Definitions. 2. As used in this act the following words and phrases shall have the stated meanings unless a different meaning clearly appears from the context: (a) The term "dental service corporation" or "the corporation" shall mean a corporation which is (1) organized,…

17:48C-20 Agreements for participation with other corporations for issuance of group contracts. 20. A dental 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 m…

17:48C-21 Experience rates, commissioner's determination. 21. No dental service corporation shall issue group contracts which are not experience rated pursuant to section 20 of this act, if the commissioner has determined that those rates are excessive, inadequate or unfairly dis…

17:48C-22. Practices, rules and procedures subject to review; orders; disapproval; judicial review All practices, rules and procedures of a dental service corporation, involving termination or refusal to renew coverage, modification of coverage or rates in the case of persons cla…

17:48C-23. Fees Every corporation to which this act shall be applicable shall pay the following fees to the commissioner for enforcement of the provisions of this act, viz.: for filing its application and charter, $10.00; for filing each annual statement, $20.00; for each copy of…

17:48C-24. Disbursements by corporation If the commissioner shall determine that the amount disbursed during any 12-month period by a dental service corporation as expenses of operation is excessive in proportion to the amount it received from subscribers during that period, the …

17:48C-25. Investments; surplus The funds of any dental service corporation may be invested only in accordance with the requirements now or hereafter provided by law for the investment of funds of life insurance companies. Every dental service corporation after the first full cal…

17:48C-26. Statement of financial condition; inquiries by commissioner Every dental service corporation transacting business in this State shall file annually, on or before March 1, in the Department of Banking and Insurance, a statement in such form and detail as the commissione…