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

17:48E-60 Abandonment, amendment of plan of conversion. 12. The health service corporation may, by action of not less than two-thirds of its board of directors, abandon or amend the plan of conversion at any time before the effective time. No amendment made after the public heari…

17:48E-61 Directors, officers continue to serve. 13. The directors and officers of the health service corporation, unless otherwise specified in the plan of conversion, shall serve as the directors and officers of the converted insurer until new directors and officers are duly el…

17:48E-62 Participation of Attorney General. 14. The Attorney General has the right to participate in any proceeding before the commissioner under this act and has the right to receive any documents or other information received by the commissioner in connection with the proceedi…

17:48E-63 Orders, rules, regulations. 15. The commissioner may issue orders as necessary to effect the conversion and promulgate rules and regulations to implement the provisions of this act pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.). L.2…

17:48E-64 Construction of act. 16. a. Nothing in this act shall be construed to limit the existing authority of the Attorney General, except that the procedures set forth in this act shall be exclusive. b. A health service corporation shall reimburse the Attorney General and the …

17:48E-65 Requirements prior to action constituting material change in form. 17. A health service corporation shall satisfy the requirements of sections 18 and 19 of this act prior to engaging in any actions that constitutes or may constitute a material change in form. Any materi…

17:48E-66 Notification of action constituting material change in form, procedure. 18. a. Except for a conversion pursuant to sections 2 through 14 and section 19 of this act, a health service corporation shall notify the Attorney General and the commissioner of the health service…

17:48E-67 Petition for review of foundation plan. 19. a. (1) A health service corporation shall submit to the Attorney General a petition for review of a foundation plan at the same time that it submits a plan of conversion to the commissioner. The petition shall include the foun…

17:48E-68 Foundations; board, membership. 20. a. (Deleted by amendment, P.L.2013, c.253) b. The foundation created pursuant to section 19 of P.L.2001, c.131 (C.17:48E-67) shall have a board of directors consisting of 15 members. Seven members shall be appointed by the Governor, i…

17:48E-7 Board of directors of health service corporation. 7. The board of directors of a health service corporation which is established in accordance with paragraph (1) of subsection a. of section 2 of P.L.1985, c.236 (C.17:48E-2) shall have four public members appointed by the…

17:48E-8. Vacancy procedure Within 10 days after a vacancy in the board of directors of a health service corporation has occurred, the corporation shall notify the commissioner in writing that a vacancy exists. If the vacancy is in one of the positions on the board which has been…

17:48E-9. Executive committee The board of directors of a health service corporation may, by resolution, elect an executive committee of the board, one-fourth of which shall be members appointed by the Governor. Vacancies in the executive committee shall be filled by the board of…

17:48F-1 Definitions relative to prepaid prescription service organizations. 1. As used in this act: "Affiliate" means a person that directly, or indirectly through one or more intermediaries, controls, or is controlled by, or is under common control with, the prepaid prescriptio…

17:48F-10 Prepaid prescription service organization deemed domestic insurer. 10. a. A prepaid prescription service organization which is organized under the laws of this State shall be deemed to be a domestic insurer for the purposes of P.L.1970, c.22 (C.17:27A-1 et seq.). b. An …

17:48F-11 Complaint system established. 11. A prepaid prescription service organization shall establish and maintain a complaint system providing reasonable procedures for resolving written complaints which are initiated by enrollees and providers, in accordance with minimum stan…

17:48F-12 Examination by commissioner. 12. The commissioner may conduct an examination of a prepaid prescription service organization as often as he deems necessary in order to protect the interests of providers, contract holders, enrollees, and the residents of this State. An or…

17:48F-13 Terms, conditions required in contracts. 13. All prepaid prescription service organization contracts with providers or with entities subcontracting for the provision of prescription services shall contain the following terms and conditions: a. In the event that the orga…

17:48F-13.1 Prepaid prescription service organization to receive, transmit transactions electronically; standards. 10. 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 prepaid prescription service organ…

17:48F-13.2 Prepaid prescription service organization; coverage for contraceptives. 9. a. A prepaid prescription service organization shall provide coverage under every contract delivered, issued, executed or renewed in this State or approved for issuance or renewal in this State…

17:48F-14 Maintenance of tangible net equity. 14. a. Except as provided in subsection b. of this section, each prepaid prescription service organization shall, at all times, have and maintain tangible net equity equal to the greater of: (1) $50,000; or (2) 2% of the organization'…

17:48F-15 Deposit of case, securities; net worth requirement. 15. a. A prepaid prescription service organization shall deposit with the commissioner or with an entity or trustee acceptable to the commissioner through which a custodial or controlled account is utilized, cash, secu…

17:48F-16 Maintenance of fidelity bond. 16. A prepaid prescription service organization shall maintain in force a fidelity bond in its own name on its officers and employees, in an amount established by the commissioner by regulation. In lieu of the bond, the organization may dep…

17:48F-17 Annual report. 17. A prepaid prescription service organization shall file an annual report with the commissioner, on or before March 1 of each year, attested to by at least two principal officers, which covers the preceding calendar year. The report shall be on a form p…

17:48F-17.1 Definitions. 36. As used in sections 36 through 40 of P.L.2014, c.81 (C.17:48F-17.1 through C.17:48F-17.5): "Commissioner" means the Commissioner of Banking and Insurance. "Prepaid prescription service organization" means an entity authorized to transact business in t…

17:48F-17.2 Increase in amount of capital or surplus required of prepaid prescription service organization. 37. The commissioner may increase the amount of capital or surplus required of a prepaid prescription service organization, or subsequently revise or redetermine that incre…

17:48F-17.3 Determination of increase, revision or redetermination; factors. 38. In determining any increase, revision or redetermination in the capital or surplus of a prepaid prescription service organization pursuant to the provisions of section 37 of P.L.2014, c.81 (C.17:48F-…

17:48F-17.4 Suspension, revocation of authority to do business. 39. The commissioner may suspend or revoke the authority to do business in this State of any prepaid prescription services organization that does not comply with the provisions of sections 36 through 40 of P.L.2014, …

17:48F-17.5 Rules, regulations. 40. The commissioner may promulgate regulations pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) necessary to effectuate the purposes of sections 36 through 40 of P.L.2014, c.81 (C.17:48F-17.1 through C.17:48F-17…

17:48F-18 Suspension, revocation of certificate of authority. 18. The commissioner may suspend or revoke the certificate of authority issued to a prepaid prescription service organization pursuant to this act upon his determination that: a. The organization is operating significa…

17:48F-19 Notification of suspension, revocation of certificate of authority. 19. If the commissioner has cause to believe that grounds exist for the suspension or revocation of a certificate of authority, he shall notify the prepaid prescription service organization in writing, …

17:48F-2 Prepaid prescription service organization, certificate of authority. 2. a. Beginning one year after the date of enactment of this act, no person, corporation, partnership, or other entity shall operate a prepaid prescription service organization in this State except in a…

17:48F-20 Maintenance of insurance to cover insolvency. 20. The commissioner may require, in connection with the plan for insolvency required pursuant to subsection p. of section 3 of this act, that a prepaid prescription service organization maintain insurance to cover the expen…

17:48F-21 Rehabilitation, liquidation, conservation of prepaid prescription service organization. 21. Any rehabilitation, liquidation or conservation of a prepaid prescription service organization shall be subject to the provisions of N.J.S.17B:32-1 et seq. and shall be conducted…

17:48F-22 Order of rehabilitation. 22. If an order of rehabilitation issued pursuant to this act directs or provides for the continued operation of the prepaid prescription service organization, including the receipt of payments from, and the provision of prescription services to…

17:48F-23 Providers enjoined from billing enrollees, beneficiaries under order of rehabilitation. 23. In the event that an order of rehabilitation or liquidation is granted, the order may enjoin providers from billing enrollees and their beneficiaries for health care services pro…

17:48F-24 Inapplicability of C.17B:32A-1 et seq. 24. A prepaid prescription service organization shall not be subject to the "New Jersey Life and Health Insurance Guaranty Association Act," P.L.1991, c.208 (C.17B:32A-1 et seq.), and the New Jersey Life and Health Insurance Guaran…

17:48F-25 Application, examination fees. 25. A prepaid prescription service organization subject to the provisions of this act shall pay to the commissioner such application fees and examination fees for applying for a certificate of authority as established by regulation by the …

17:48F-26 Violations; penalties. 26. a. The commissioner may, upon notice and hearing, levy an administrative penalty in an amount not less than $1,000 nor more than $30,000 for each violation, per contract or enrollee. Penalties imposed by the commissioner pursuant to this secti…

17:48F-27 Cease and desist order; injunctive relief. 27. a. The commissioner may issue an order directing a prepaid prescription service organization to cease and desist from engaging in any act or practice which is in violation of the provisions of this act. The order shall be s…

17:48F-28 Confidentiality of data, information. 28. Any data or information relating to the diagnosis, treatment or health of an enrollee or prospective enrollee obtained by a prepaid prescription service organization from the contract holder, enrollee, prospective enrollee or an…

17:48F-29 Rules, regulations. 29. The commissioner shall adopt rules and regulations pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), to effectuate the purposes of this act. L.1997,c.380,s.29.

17:48F-3 Application for certificate of authority, requirements. 3. Each application for a certificate of authority to operate a prepaid prescription service organization shall be made to the commissioner on a form prescribed by the commissioner, shall be certified by an officer …

17:48F-4 Review of application. 4. Following receipt of an application, the commissioner shall review it and notify the applicant of any deficiencies contained therein. a. The commissioner shall issue a certificate of authority to an applicant in a timely manner, if the following…

17:48F-5 Modification of matter, document, filing required; fixing of charges; filing of benefits offered. 5. a. An organization, unless otherwise provided for in this act, shall not materially modify any matter or document furnished to the commissioner pursuant to section 3 of t…

17:48F-6 Filing for approval by other insurers, etc. 6. Any insurer, hospital, medical or health service corporation or health maintenance organization which is not otherwise authorized to offer prescription services on a fixed prepayment basis may do so by filing for approval wi…

17:48F-7 Rights of prepaid prescription service organization. 7. A prepaid prescription service organization may: a. Purchase, lease, construct, renovate, operate and maintain such facilities, ancillary equipment and property which may be required for its principal office or for …