Title 17B, Title 17B: INSURANCE

17B:27E-4 Definitions relative to long-term care insurance. 4. As used in this act, unless the context requires otherwise: "Applicant" means: (1) In the case of an individual long-term care insurance policy, the person who seeks to contract for benefits; and (2) In the case of a …

17B:27E-5. Compliance required 5. a. Any policy, certificate or rider advertised, marketed or offered as long-term care insurance shall comply with the provisions of this act. b. No group long-term care insurance coverage shall be offered to a resident of this State under a group…

17B:27E-6 Prohibitions relative to long-term care insurance. 6. a. No long-term care insurance policy or certificate shall: (1) Be cancelled, nonrenewed or otherwise terminated on the grounds of the age or the deterioration of the mental or physical health of the insured individu…

17B:27E-7. Grounds for rescinding policy, denying a claim 7. a. For a policy or certificate that has been in force for less than six months, an insurer may rescind a long-term care insurance policy or certificate or deny an otherwise valid long-term care insurance claim upon a sh…

17B:27E-8. Conditions for delivery, issuance of policy 8. a. Except as provided in subsection b. of this section, a long-term care insurance policy shall not be delivered or issued for delivery in this State unless the policyholder or certificate holder has been offered the optio…

17B:27E-9. Regulations 9. The commissioner shall 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 this act including, but not limited to, regulations dealing with disclosure requi…

17B:27F-1 Definitions. 1. As used in P.L.2015, c.179 (C.17B:27F-1 et seq.): "Anticipated loss ratio" means the ratio of the present value of the future benefits payments, including claim offsets after the point of sale, to the present value of the future premiums of a policy form…

17B:27F-1.1 Pharmacy benefits manager, license, pharmacy services administrative, registration. 2. a. A corporation, business, or other entity shall not act as a pharmacy benefits manager without first obtaining a license from the department or as a pharmacy services administrati…

17B:27F-10 Violations, penalties. 7. a. A pharmacy benefits manager that violates any provision of P.L.2015, c.179 (C.17B:27F-1 et seq.) shall be subject to a penalty in an amount not exceeding the greater of: (1) a penalty of $5,000 for a first violation and a penalty of $10,000…

17B:27F-2 Duties, pharmacy benefits manager, contracts. 2. Upon execution or renewal of each contract, or at such a time when there is any material change in the term of the contract, a pharmacy benefits manager shall, with respect to contracts between a pharmacy benefits manager…

17B:27F-3 Carrier, pharmacy benefits manager under contract, single maximum allowable cost list; prescription drug, source generic list, requirements. 3. a. A carrier, or a pharmacy benefits manager under contract with a carrier, shall use a single maximum allowable cost list to …

17B:27F-3.1 Carrier duties, responsibilities. 3. a. A carrier shall: (1) monitor all activities carried out on behalf of the carrier by a pharmacy benefits manager if the carrier contracts with a pharmacy benefits manager and is related to a carrier's prescription drug benefits; …

17B:27F-3.2 Compensation remitted, pharmaceutical manufacturer, developer, labeler, carrier, pharmacy benefits manager under contract; report. 6. a. Compensation remitted by or on behalf of a pharmaceutical manufacturer, developer or labeler, directly or indirectly, to a carrier …

17B:27F-3.3 Carrier, pharmacy benefits manager under contract, pharmacy and therapeutics committee, established, formulary system management. 7. a. A carrier, or a pharmacy benefits manager under contract with a carrier, shall establish a pharmacy and therapeutics committee respo…

17B:27F-3.4 Carrier, use of pharmacy benefits manager, administer, manage, prescription drug benefits, claims, parameters. 9. a. If a carrier uses a pharmacy benefits manager to administer or manage the prescription drug benefits of covered persons, any pharmacy benefits manager …

17B:27F-4 Process for appeals, investigation and dispute. 4. All contracts between a pharmacy benefits manager and a pharmacy services administrative organization, or its contracted pharmacies, and all contracts directly between a pharmacy benefits manager and a pharmacy shall in…

17B:27F-5 Rules, regulations. 5. The Commissioner of Banking and Insurance shall adopt, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), rules and regulations, including any penalty provisions the commissioner deems to be necessary, to effectu…

17B:27F-6 Regulations, pharmacy benefits managers. 1. a. A pharmacy benefits manager, in connection with any contract or arrangement with a private health insurer, prescription benefit plan, or the State Health Benefits Program or School Employees' Health Benefits Program, shall …

17B:27F-6.1 Requirements for pharmacy benefits managers. 4. 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 covered under any…

17B:27F-7 "Clean Claim" made by a pharmacy, actions of pharmaceutical benefits managers. 1. a. After the date of receipt of a clean claim for payment made by a pharmacy, a pharmacy benefits manager shall not retroactively reduce payment on the claim, either directly or indirectly…

17B:27F-8 Commissioner review, approval. 5. The Commissioner of Banking and Insurance may review and approve the compensation program of a pharmacy benefits manager with a health benefits plan to ensure that the reimbursement for pharmacist services paid to a pharmacist or pharma…

17B:27F-9 Applicability of C.17B:27F-1 et seq. 6. The licensing requirements of P.L.2015, c.179 (C.17B:27F-1 et seq.) shall apply to all pharmacy benefits managers operating in the State of New Jersey. Requirements imposed on carriers by the provisions of P.L.2015, c.179 (C.17B:2…

17B:27F-9.1 Carrier, health benefits plan, access data, administration, provision, prescription drug benefits; penalties. 8. a. A carrier or health benefits plan, including the State Health Benefits Program, the School Employees' Health Benefits Program, the State Medicaid progra…

17B:28-1. Definition When used in this chapter, the following terms shall have the following respective meanings: a. "Separate account contract" means any contract issued by an insurer under which amount (including without limitation proceeds applied under optional modes of settl…

17B:28-10. Valuation of assets Except as the commissioner may require or permit a different basis of valuation, the valuation of separate account assets for all purposes, including annual reports of the insurer to the commissioner, shall be determined in accordance with the marke…

17B:28-11. Reserve liability The reserve liability for contracts on a variable basis shall be established by the commissioner pursuant to the requirements of section 17B:19-8 (the Standard Valuation Law) in accordance with actuarial procedures that recognize the variable nature o…

17B:28-12. Annuities Any insurer which establishes one or more variable contract accounts and issues variable annuity contracts may in its discretion, but need not, require in any case the purchase of annuities which provide for benefits of predetermined dollar amount in specifie…

17B:28-14. Regulation of separate account contracts, insurers issuing the same and sales agents The commissioner shall have the sole and exclusive authority to regulate the issuance and sale of separate account contracts; and such contracts, the insurers which issue them and the …

17B:28-15. Application to separate accounts and separate account contracts of Title 17B; required provisions for variable life insurance contracts Except for N.J.S. 17B:25-3, 17B:25-8, 17B:25-9, 17B:25-13, 17B:25-19 and 17B:27-11, in the case of a variable life insurance policy a…

17B:28-2. Qualification of insurer No present or future domestic insurer shall undertake the issuance of any contract on a variable basis, and no foreign or alien insurer heretofore or hereafter admitted to transact in this State any class or classes of insurance authorized by th…

17B:28-3. Certificate to sell 17B:28-3. a. No agent or solicitor employed by an agent heretofore or hereafter licensed shall be authorized to sell or act or aid in any manner in the negotiation of a contract on a variable basis until he has received a certificate to sell contract…

17B:28-4. Required statements; procedure Any contract on a variable basis delivered or issued for delivery in this State, and any certificate evidencing variable benefits issued pursuant to any such contract on a group basis, shall contain a statement of the essential features of…

17B:28-5. Form of contract 17B:28-5. (a) No contract on a variable basis shall be delivered or issued for delivery in this State by any insurer until a copy of the form (and, in the case of a contract on a group basis, the form of any certificate evidencing variable benefits issu…

17B:28-6. Administration Any insurer maintaining one or more separate accounts shall submit annually to the commissioner a report of the business of its separate accounts. Such report shall be made either by a separate annual statement for such business or by suitable additions t…

17B:28-7. Separate accounts; approval by commissioner 17B:28-7. Separate accounts; approval by commissioner. Any present or future domestic insurer shall have authority to establish and operate one or more separate accounts and to issue separate account contracts, whether or not …

17B:28-8. Amounts placed in account; liabilities Except as may be otherwise specifically provided by the contract, all amounts with respect to any contract on a variable basis shall be placed in the variable contract account designated in such contract, and all liabilities on any…

17B:28-9. Investment of assets; eligibility; definition 17B:28-9. Investment of assets; eligibility; definition. a. The assets held in a separate account, or any part thereof, may be invested in: (i) Common stock or shares of any investment company specified in the contract or co…

17B:28A-1. Insurance against risk of loss in value of redeemable securities issued by investment company A domestic insurer authorized to do the business specified in N.J.S. 17B:17-3 may issue and deliver individual and group policies insuring against the risk of loss in the valu…

17B:28A-2. Limitation on benefit and protection Except with the approval of the commissioner and under such conditions as he may prescribe, the benefit provided by such insurance may not exceed the difference between the amount paid for such redeemable securities and the value of…

17B:28A-3. Undertaking or continuance; approval of commissioner; rules and regulations No domestic insurer shall undertake or continue the issuance of any such insurance unless the commissioner is satisfied that the condition or methods of operation of such domestic insurer in co…

17B:28A-4. Form of policy; submission to commissioner No policy providing investment return assurance shall be issued or delivered in this State until a copy of the form thereof is submitted to the commissioner. The provisions of N.J.S. 17B:25-18, relating to the filing of forms …

17B:28A-5. Foreign or alien insurers; conditions for qualification to issue No foreign or alien company shall deliver or issue for delivery within this State any policy of investment return assurance unless it is licensed to do life insurance business within this State, and the c…

17B:28A-6. Rules and regulations The commissioner shall make appropriate further rules and regulations for the protection of policyholders and the public, including requirements for nonforfeiture benefits where appropriate, and regulations for valuation methods and minimum requir…

17B:29-1. Scope; differences in long-term and short-term indebtedness; rules and regulations All life insurance and all health insurance in connection with loans or other credit transactions shall be subject to the provisions of this chapter, except where the issuance of such ins…

17B:29-10. Claims a. All claims shall be promptly reported to the insurer or its designated claim representative, and the insurer shall maintain adequate claim files. All claims shall be settled as soon as possible and in accordance with the terms of the insurance contract. b. Al…

17B:29-11. Existing insurance--choice of insurer When credit life insurance or credit health insurance is required as additional security for any indebtedness, the debtor shall, upon request to the creditor, have the option of furnishing the required amount of insurance through e…