Title 17B, Title 17B: INSURANCE

17B:30-47 Procedures for participating hospitals. 7. a. The following procedures shall apply for those hospitals that wish to participate in the voluntary assignment program created by this act. b. The hospital shall file with the department a notice signifying its intent to part…

17B:30-5. False financial statements a. No person shall file with any supervisory or other public official, or make, publish, disseminate, circulate or deliver to any person, or place before the public, or cause directly or indirectly, to be made, published, disseminated, circula…

17B:30-55 Violations, penalties; rules, regulations. 17. a. The Commissioner of Banking and Insurance shall enforce the provisions of sections 2 through 7 of P.L.2005, c.352 (C17B:30-49 through C.17B:30-54) and sections 2, 3, 4, 5, 6, 7 and 10 of P.L.1999, c.154 (C.17:48-8.4, 17:…

17B:30-55.1 Short title. 2. This act shall be known and may be cited as the "Ensuring Transparency in Prior Authorization Act." L.2023, c.296, s.2.

17B:30-55.10 Payer to honor prior authorization granted to covered person by previous payer, initial coverage, upon receipt of documentation. 11. a. On receipt of information documenting a prior authorization from the covered person or the health care provider of the covered pers…

17B:30-55.11 Denial of prior authorization, communicated via written communication agreed to by payer, hospital, health care provider. 12. a. A denial of prior authorization shall be communicated to the hospital or health care provider by facsimile, e-mail, or any other means of …

17B:30-55.12 Adverse determinations, appeal, reviewed by physician. 13. A payer shall ensure that any adverse determinations of any appeal are reviewed by a physician. The physician shall: a. be board-certified in a same or similar specialty that has experience treating the condi…

17B:30-55.13 Payer shall not deny reimbursement, hospital, health care provider in compliance, circumstances, 14. a. When a hospital or health care provider complies with the provisions set forth in P.L.2023, c.296 (C.17B:30-55.1 et al.), no payer shall deny reimbursement to a ho…

17B:30-55.14 Payer, reimbursement according to provider contract, medically necessary emergency, urgent care covered under plan. 15. a. A payer shall reimburse a hospital or health care provider according to the provider contract for all medically necessary emergency and urgent c…

17B:30-55.15 Failure by payer to comply with deadline, health care services subject to review, automatic authorization. 16. a. In addition to the protections afforded to a health care provider or patient by the requirements of P.L.2023, c.296 (C.17B:30-55.1 et al.), any failure b…

17B:30-55.16 Statistics available regarding prior authorization approvals, denials, website. 17. A payer shall make statistics available regarding prior authorization approvals and denials on its Internet website in a readily accessible format, as determined by the commissioner. …

17B:30-55.17 Liberal construction. 27. P.L.2023, c.296 (C.17B:30-55.1 et al.) shall be liberally construed to effectuate the legislative purposes thereof. L.2023, c.296, s.27.

17B:30-55.2 Findings, declarations. 3. The Legislature finds and declares that: a. Prior authorization is a type of utilization management technique used by health plans and carriers to ensure safety and appropriateness of medical and pharmacy services, reduce low-value care, and…

17B:30-55.3 Definitions. 4. As used in sections 4 through 17 of P.L.2023, c.296 (C.17B:30-55.3 through 17B:30-55.16): "Adverse determination" means a decision by a payer that the health care services furnished or proposed to be furnished to a covered person are not medically nece…

17B:30-55.4 Payer, information, utilization management, processing, payment of claims. 5. a. A payer shall provide the following information concerning utilization management and the processing and payment of claims in a clear and conspicuous manner, described in detail but also …

17B:30-55.5 Payer, respond, hospital, health care provider request, prior authorization. 6. A payer shall respond to a hospital or health care provider request for prior authorization of health care services by either approving or denying the request based on the covered person's…

17B:30-55.6 Carrier, respond, prior authorization requests, medication coverage submitted, NCPDP SCRIPT Standard for ePA transactions. 7. a. A carrier shall respond to prior authorization requests for medication coverage submitted using the NCPDP SCRIPT Standard for ePA (electron…

17B:30-55.7 Prior authorization, chronic, long-term care condition, validity, exception, timeline. 8. Except where shorter time frames are necessary to monitor patient safety or treatment effectiveness and with notice to the treating provider, if a payer requires prior authorizat…

17B:30-55.8 Prior authorization, denial, limitation imposed by payer, physician, scope of actions. 9. Any denial of a request for prior authorization or limitation imposed by a payer on a requested service on the basis of utilization management determination shall be made by a ph…

17B:30-55.9 Prior authorization, defined number, discrete services, set time frame, validity, exception. 10. Except where shorter time frames are necessary to monitor patient safety or treatment effectiveness and with notice to the treating provider, prior authorization for a ser…

17B:30-56 Rules, regulations. 20. The Commissioner of Banking and Insurance shall promulgate rules and regulations pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) necessary to carry out the purposes of P.L.2023, c.296 (C.17B:30-55.1 et al.). L…

17B:30-57 Liberal construction. 21. This act shall be liberally construed to effectuate the legislative purposes of the act. L.2005,c.352,s.21.

17B:30-58 Definitions relative to reimbursement for certain ambulance services. 1. As used in this act: "Ambulance service" means the provision of emergency health care services, basic life support services, advanced life support services, critical care services, mobile intensive…

17B:30-59 Assignment of benefits to service provider of right to receive reimbursement for ambulance service. 2. a. Notwithstanding any provision of law to the contrary, a covered person may, through an assignment of benefits, assign to a service provider his right to receive rei…

17B:30-6. "Twisting" prohibited No person shall make any misleading representations or incomplete or fraudulent comparison of any insurance policies or annuity contracts or insurers for the purpose of inducing, or tending to induce, any person to lapse, forfeit, surrender, termin…

17B:30-60 Definitions relative to certain dental provider networks. 1. As used in this act: "Contracting entity" means any person or entity that enters into direct contracts with providers for the delivery of dental services in the ordinary course of business, including a third p…

17B:30-61 Third party access. 2. a. A contracting entity shall not grant to a third party access to a provider network contract, or a provider's dental services or contractual discounts, or both, pursuant to a provider network contract, unless the contracting entity meets the req…

17B:30-62 Inapplicability. 3. This act shall not apply to: a. a provider network contract for dental services provided to beneficiaries of the Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.), the Medicare program established pursuant to the federal So…

17B:30-63 Rules, regulations. 4. The Commissioner of Banking and Insurance shall, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), adopt rules and regulations necessary to effectuate the purpose of this act. The commissioner shall ensure the r…

17B:30-7. Defamation No person shall make, publish, disseminate, or circulate, directly or indirectly, or aid, abet or encourage the making, publishing, disseminating or circulating of any oral or written statement or any pamphlet, circular, article or literature which is false o…

17B:30-8. Boycott, coercion and intimidation No person or persons shall enter into any agreement to commit, or by any concerted action commit, any act of boycott, coercion or intimidation resulting in or tending to result in unreasonable restraint of, or monopoly in, the business…

17B:30-9. Stock operations and advisory board contracts No person shall issue or deliver or permit agents, officers, or employees to issue or deliver, agency company stock or other capital stock, or benefit certificates or shares in any common-law corporation, or securities or an…

17B:30B-1 Short title. 1. This act shall be known and may be cited as the "Viatical Settlements Act." L.2005,c.229,s.1.

17B:30B-10 Two-year period required between issuance of policy and viatical settlement; exceptions. 10. a. It is a violation of this act for any person to enter into a viatical settlement contract within a two-year period commencing with the date of issuance of the insurance poli…

17B:30B-11 Advertisement of viatical settlement contracts; guidelines, standards. 11. The purpose of this section is to provide prospective viators with clear and unambiguous statements in the advertisement of viatical settlement contracts and to assure the clear, truthful and ad…

17B:30B-12 Fraudulent viatical settlement acts, prohibited, reporting, investigation, prosecution. 12. a. A person shall not commit a fraudulent viatical settlement act as defined in section 2 of this act. b. A person shall not knowingly or intentionally interfere with the enforc…

17B:30B-13 Injunction in addition to penalties, enforcement provisions. 13. a. In addition to the penalties and other enforcement provisions of this act, if any person violates this act or any regulation implementing this act, the commissioner may seek an injunction in a court of…

17B:30B-14 Violation considered unfair trade practice; penalties. 14. A violation of this act shall be considered an unfair trade practice pursuant to N.J.S.17B:30-1 et seq. and shall be subject to the penalties contained in N.J.S.17B:30-17. L.2005,c.229,s.14.

17B:30B-15 Regulations, authority of commissioner. 15. The commissioner shall have the authority to promulgate regulations implementing the provisions of this act pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) including, but not limited to, t…

17B:30B-16 Construction of act with Uniform Securities Law. 16. Nothing in this act shall be construed to preempt or otherwise limit the provisions of the "Uniform Securities Law (1967)," P.L.1967, c.93 (C.49:3-47 et seq.) or any regulations, orders, policy statements, notices, b…

17B:30B-17 Continuation of negotiating viatical settlements, certain circumstances prior to act. 17. a. Notwithstanding the provisions of sections 1 through 16 of this act, a person who has lawfully negotiated viatical settlement contracts between a viator and one or more viatica…

17B:30B-18 Engaging in stranger-originated life insurance prohibited. 1. a. No person shall directly or indirectly engage in any act, practice or arrangement that constitutes stranger-originated life insurance. b. A contract, agreement, arrangement, or transaction, including, but…

17B:30B-19 Violations, remedies, penalties. 2. a. The Commissioner of Banking and Insurance may seek an injunction in a court of competent jurisdiction and may apply for temporary and permanent orders that the commissioner determines are necessary to restrain the person from comm…

17B:30B-2 Definitions relative to viatical settlements. 2. As used in this act: "Advertising" means any written, electronic or printed communication or any communication by means of recorded telephone messages or transmitted on radio, television, the Internet or similar communica…

17B:30B-20 Regulations. 3. The Commissioner of Banking and Insurance shall promulgate regulations implementing the provisions of this act pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.). L.2020, c.105, s.3.

17B:30B-3 License to operate as viatical settlement provider. 3. a. A person shall not operate as a viatical settlement provider without first obtaining a license from the commissioner of the state of residence of the viator. b. (1) No person shall act on behalf of a viator resid…