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§ 17B:27A-1 |
Filing of paid hospital expense claims; definitions |
§ 17B:27A-2 |
Definitions |
§ 17B:27A-2.1 |
Regulations |
§ 17B:27A-2.2 |
Effective date |
§ 17B:27A-3 |
Individual health benefits plans, applicability of act |
§ 17B:27A-4 |
Offering of individual health benefits required by issuer of small employer health benefits plans |
§ 17B:27A-4.1 |
Individual policy, contract for hospital, medical expense benefits, coverage of subscriber’s child |
§ 17B:27A-4.2 |
Requirements applicable to State Medicaid |
§ 17B:27A-4.3 |
Eligibility for enrollment in individual health benefits plan |
§ 17B:27A-5 |
Laws not applicable to managed care health benefits plans |
§ 17B:27A-6 |
Individual health benefits plans, requirements |
§ 17B:27A-6.1 |
Individual Health Coverage Program, open enrollment period established |
§ 17B:27A-7 |
Approval of policy and contract forms, benefit levels |
§ 17B:27A-7.1 |
Coverage for birth and natal care; individual health policy |
§ 17B:27A-7.2 |
Coverage for minimum inpatient care following mastectomy by individual health benefits plan |
§ 17B:27A-7.3 |
Applicability of Health Care Quality Act |
§ 17B:27A-7.4 |
Coverage for treatment of inherited metabolic diseases by individual health benefits plan |
§ 17B:27A-7.5 |
Individual health benefits plan to provide coverage for mental health conditions, substance use disorders; collaborative care model |
§ 17B:27A-7.6 |
Coverage for hemophilia services by individual health policy |
§ 17B:27A-7.7 |
Individual health benefits plan to provide coverage for colorectal cancer screening |
§ 17B:27A-7.7 v2 |
Individual health benefits plan to provide coverage for colorectal cancer screening |
§ 17B:27A-7.8 |
Policy, contract issued under C.17B:27A-2 et seq. required to cover certain out-of-network services |
§ 17B:27A-7.9 |
Individual health benefits plan to offer coverage for domestic partner |
§ 17B:27A-7.10 |
Individual health benefits plan, mammogram examination benefits |
§ 17B:27A-7.11 |
Individual health benefits plan, high deductible, deductible inapplicable, certain circumstances |
§ 17B:27A-7.12 |
Individual health benefits plan, coverage for contraceptives |
§ 17B:27A-7.13 |
Individual health benefits plans to provide benefits for orthotic and prosthetic appliances |
§ 17B:27A-7.14 |
Individual health benefits plan to provide coverage for hearing aids for certain persons aged 15 or younger |
§ 17B:27A-7.15 |
Individual health benefits plan to provide installment payments to obstetrical provider for maternity services |
§ 17B:27A-7.16 |
Individual health benefits plan to provide benefits for treatment of autism or other developmental disability |
§ 17B:27A-7.17 |
Individual health benefits plan to provide coverage for oral anticancer medication |
§ 17B:27A-7.18 |
Individual health benefits plan to provide coverage for sickle cell anemia |
§ 17B:27A-7.19 |
Individual health benefits plan to provide coverage for prescription eye drops |
§ 17B:27A-7.20 |
Individual health benefits plan, coverage for synchronization of prescribed medications |
§ 17B:27A-7.21 |
Individual health benefits plan to provide benefits for treatment of substance use disorder |
§ 17B:27A-7.22 |
Individual health benefits plan to provide coverage regardless of gender identity, expression |
§ 17B:27A-7.23 |
Individual health benefits plan to cover digital tomosynthesis of the breast |
§ 17B:27A-7.24 |
Individual health benefits plan to provide coverage for donated human breast milk |
§ 17B:27A-7.25 |
Individual health benefits plan to provide coverage for breastfeeding support |
§ 17B:27A-7.26 |
Individual health benefits plan to meet essential health benefits requirements |
§ 17B:27A-7.27 |
Individual health benefits plan to cover preventive services |
§ 17B:27A-7.28 |
Individual health benefits plan to provide coverage for certain prescription drugs |
§ 17B:27A-7.29 |
Individual health benefits plan to cover adolescent depression screenings |
§ 17B:27A-7.30 |
Individual health benefits plan to cover newborn home nurse visitation |
§ 17B:27A-8 |
Offering of certain coverage not required |
§ 17B:27A-9 |
Determination of rates |
§ 17B:27A-10 |
New Jersey Individual Health Coverage Program; board of directors |
§ 17B:27A-10.1 |
Short title |
§ 17B:27A-10.2 |
Purpose of act |
§ 17B:27A-10.3 |
Definitions relative to health insurance premiums |
§ 17B:27A-10.4 |
Health Insurance Premium Security Plan |
§ 17B:27A-10.5 |
Payment parameters |
§ 17B:27A-10.6 |
Calculation of reinsurance payment |
§ 17B:27A-10.7 |
Requests for reinsurance payments |
§ 17B:27A-10.8 |
Accounting for each benefit year |
§ 17B:27A-10.9 |
Application for waiver of ACA |
§ 17B:27A-10.10 |
New Jersey Health Insurance Premium Security Fund |
§ 17B:27A-10.11 |
Annual report |
§ 17B:27A-10.12 |
Violations, penalties |
§ 17B:27A-10.13 |
Rules, regulations |
§ 17B:27A-11 |
Powers, authority of program, board |
§ 17B:27A-12 |
Procedures for equitable sharing of program losses |
§ 17B:27A-12.1 |
Exemption from liability, certain, for HMO formed by UMDNJ |
§ 17B:27A-13 |
Statement of net paid losses |
§ 17B:27A-14 |
Determination of disproportionate share of substandard risks |
§ 17B:27A-15 |
Sale of health benefits plan |
§ 17B:27A-16 |
Submission of rate filings by health maintenance organization not required |
§ 17B:27A-16.1 |
Board actions subject to provisions of section; “action” defined; procedure |
§ 17B:27A-16.2 |
Adoption of temporary plan of operation |
§ 17B:27A-16.3 |
Purchase of other insurance coverage not required |
§ 17B:27A-16.4 |
Adoption of standard claim form |
§ 17B:27A-16.5 |
Hospital, medical insurance policy renewals; filing of rates |
§ 17B:27A-17 |
Definitions relative to small employer health benefits plans |
§ 17B:27A-18 |
Providers of health benefits, services subject to provisions of act |
§ 17B:27A-18.1 |
Provision of benefits to subscriber’s child under small employer policy, contract |
§ 17B:27A-18.2 |
Requirements applicable to State Medicaid |
§ 17B:27A-19 |
Health benefits plans offered to small employers; exceptions |
§ 17B:27A-19a |
Small employer carrier, offering of high deductible plan |
§ 17B:27A-19.1 |
Hospital confinement, other supplemental limited benefit insurance plans; requirements |
§ 17B:27A-19.2 |
Coverage for birth and natal care; small employer health policy |
§ 17B:27A-19.3 |
Regulations governing rating methodology, calculation of loss ratios |
§ 17B:27A-19.4 |
Coverage for minimum inpatient care following mastectomy by small employer health benefits plan |
§ 17B:27A-19.5 |
Applicability of Health Care Quality Act |
§ 17B:27A-19.6 |
Coverage for treatment of inherited metabolic diseases by small employer health benefits plan |
§ 17B:27A-19.7 |
Small employer health benefits plan to provide coverage for mental health conditions, substance use disorders; collaborative care model |
§ 17B:27A-19.8 |
Coverage for hemophilia services by small employer plan |
§ 17B:27A-19.9 |
Small employer health benefits plan to provide coverage for colorectal cancer screening |
§ 17B:27A-19.9 v2 |
Small employer health benefits plan to provide coverage for colorectal cancer screening |
§ 17B:27A-19.10 |
Policy, contract issued under C.17B:27A-17 et seq. required to cover certain out-of-network services |
§ 17B:27A-19.11 |
Carrier offering plans pursuant to C17B:27A-17 et seq may offer additional plan with certain limited benefits |
§ 17B:27A-19.12 |
Small employer health benefits plan to offer coverage for domestic partner |
§ 17B:27A-19.13 |
Small employer health benefits plan, mammogram examination benefits |
§ 17B:27A-19.14 |
High deductible health plan, small employer, deductible inapplicable, certain circumstances |
§ 17B:27A-19.15 |
Small employer health benefits plan, coverage for contraceptives |
§ 17B:27A-19.16 |
Coverage for certain dependents until age 31 by small employer health benefits plan |
§ 17B:27A-19.17 |
Small employer health benefits plans to provide benefits for orthotic and prosthetic appliances |
§ 17B:27A-19.18 |
Small employer health benefits plan to provide coverage for hearing aids for certain persons aged 15 or younger |
§ 17B:27A-19.19 |
Small employer health benefits plan to provide installment payments to obstetrical provider for maternity services |
§ 17B:27A-19.20 |
Small employer health benefits plan to provide benefits for treatment of autism or other developmental disability |
§ 17B:27A-19.21 |
Small employer health benefits plan to provide coverage for oral anticancer medications |
§ 17B:27A-19.22 |
Small employer health benefits plan to provide coverage for sickle cell anemia |
§ 17B:27A-19.23 |
Small employer health benefits plan to provide coverage for prescription eye drops |
§ 17B:27A-19.24 |
Small employer health benefits plan, coverage for synchronization of prescribed medications |
§ 17B:27A-19.25 |
Small employer health benefits plan to provide benefits for treatment of substance use disorder |
§ 17B:27A-19.26 |
Small employer health benefits plan to provide coverage regardless of gender identity, expression |
§ 17B:27A-19.27 |
Small employer health benefits plan to cover digital tomosynthesis of the breast |
§ 17B:27A-19.28 |
Small employer health benefits plan to provide coverage for donated human breast milk |
§ 17B:27A-19.29 |
Small employer health benefits plan to provide coverage for breastfeeding support |
§ 17B:27A-19.30 |
Small employer health benefits plan to meet essential health benefits requirements |
§ 17B:27A-19.31 |
Small employer health benefits plan to cover preventive services |
§ 17B:27A-19.32 |
Small employer health benefits plan to provide certain coverage for prescription drugs |
§ 17B:27A-19.33 |
Small employer health benefits plan to cover adolescent depression screenings |
§ 17B:27A-19.34 |
Small employer health benefits plan to cover newborn home nurse visitation |
§ 17B:27A-20 |
Coinsurance, deductibles applicable |
§ 17B:27A-21 |
Standard coordination of benefits provisions applicable |
§ 17B:27A-21.1 |
Eligibility for enrollment in small employer health benefits plan |
§ 17B:27A-22 |
Preexisting condition provisions |
§ 17B:27A-23 |
Policies, contracts renewable; exceptions |
§ 17B:27A-24 |
Reasonable specified minimum participation |
§ 17B:27A-25 |
Premium rates; other plan requirements |
§ 17B:27A-25.1 |
Findings, declarations relative to small employer health benefits purchasing alliances |
§ 17B:27A-25.2 |
Definitions relative to small employer benefits purchasing alliances |
§ 17B:27A-25.3 |
“Small Employer Purchasing Alliance formation.” |
§ 17B:27A-25.4 |
Board of directors |
§ 17B:27A-25.5 |
Bylaws, contents |
§ 17B:27A-25.6 |
Further authority of alliance |
§ 17B:27A-25.7 |
Restrictions on alliances |
§ 17B:27A-25.8 |
Certificate from alliance to commissioner |
§ 17B:27A-25.9 |
Rules, regulations |
§ 17B:27A-26 |
Health maintenance organization coverage; exceptions |
§ 17B:27A-27 |
Continued coverage for certain terminated employees, dependents |
§ 17B:27A-28 |
New Jersey Small Employer Health Benefits Program created |
§ 17B:27A-29 |
Meetings, organization of board; terms |
§ 17B:27A-29.1 |
Immunity from liability for board |
§ 17B:27A-29.2 |
Rules, regulations for voluntary risk pooling arrangement |
§ 17B:27A-30 |
Submission of plan of operation |
§ 17B:27A-31 |
Contents of plan of operation |
§ 17B:27A-32 |
Authority of board |
§ 17B:27A-33 |
Formulation of five health benefits plans |
§ 17B:27A-41 |
Violations, penalty |
§ 17B:27A-43 |
Violations, penalties |
§ 17B:27A-44 |
Assessments not charged to policyholders, public |
§ 17B:27A-45 |
Standard claim form |
§ 17B:27A-47 |
Coverage obtained through out-of-State trust, compliance required |
§ 17B:27A-48 |
Multiple employer arrangement; requirements |
§ 17B:27A-49 |
Notification to commissioner by carrier of multiple employer arrangement |
§ 17B:27A-50 |
Change of coverage by small employer; restrictions |
§ 17B:27A-51 |
Board actions subject to provisions of section; “action” defined; procedure |
§ 17B:27A-53 |
Other insurance purchases not required |
§ 17B:27A-54 |
Commissioner authorized to approve establishment of arrangement; rules, regulations |
§ 17B:27A-55 |
Written notice required for issuance, renewal of high deductible health plan; declaration of understanding |
§ 17B:27A-56 |
Provision of biannual surveys to DOBI by health insurers |
§ 17B:27A-57 |
“Health Insurance Exchange Trust Fund.” |
§ 17B:27A-58 |
Authority to operate a State-based exchange, coordinate operations with other entities; advisory committee |
§ 17B:27A-59 |
Rules, regulations |
§ 17B:27A-59.1 |
Definitions |
§ 17B:27A-59.2 |
“New Jersey Easy Enrollment Health Insurance Program” established |
§ 17B:27A-59.3 |
Assistance eligibility, Department of Banking and Insurance |
§ 17B:27A-59.4 |
Special enrollment period, New Jersey individual health insurance market, established |
§ 17B:27A-59.5 |
Data privacy, security safeguards |
§ 17B:27A-59.6 |
Tax return, individual not covered, minimum essential coverage |
§ 17B:27A-59.7 |
Consenting to information sharing, system established |
§ 17B:27A-59.8 |
Unemployment claim, indication of interest in obtaining minimum coverage, information sharing, consent |
§ 17B:27A-60 |
Essential health benefits defined |
§ 17B:27A-61 |
Carrier seeking rate increase |
§ 17B:27A-62 |
Information to support, justify rate requests |
§ 17B:27A-63 |
Additional information requested by department |
§ 17B:27A-64 |
Disclosure of information |
§ 17B:27A-65 |
Definitions relative to certain assessments |
§ 17B:27A-66 |
Filing of net written premiums |
§ 17B:27A-67 |
“Health Insurance Affordability Fund.” |