Terms Used In New Jersey Statutes 17B:27A-19.24a

  • person: includes corporations, companies, associations, societies, firms, partnerships and joint stock companies as well as individuals, unless restricted by the context to an individual as distinguished from a corporate entity or specifically restricted to one or some of the above enumerated synonyms and, when used to designate the owner of property which may be the subject of an offense, includes this State, the United States, any other State of the United States as defined infra and any foreign country or government lawfully owning or possessing property within this State. See New Jersey Statutes 1:1-2
  • State: extends to and includes any State, territory or possession of the United States, the District of Columbia and the Canal Zone. See New Jersey Statutes 1:1-2
9. a. Except as provided in subsection b. of this section, a carrier that offers a small employer health benefits plan that provides benefits for expenses incurred in the purchase of prescription drugs and is delivered, issued, executed, or renewed in this State, pursuant to P.L.1992, c.162 (C. 17B:27A-17 et seq.), may use a prescription drug formulary to limit or exclude coverage for prescription drugs, provided that the carrier offers at least one plan with an open formulary and the carrier demonstrates to the satisfaction of the board that utilization and medical review panels are in place to allow formulary flexibility as necessary in the best interest of the insured person.

b. A carrier that offers a small employer health benefits plan that provides benefits for expenses incurred in the purchase of prescription drugs and is delivered, issued, executed, or renewed in this State, pursuant to P.L.1992, c.162 (C. 17B:27A-17 et seq.), shall not adopt a protocol, policy, or program that establishes the specific sequence in which prescription drugs for a specified medical condition, and medically appropriate for a particular patient, are required to be administered in order to be covered by a health benefits plan.

c. Notwithstanding the provisions of the “Administrative Procedure Act,” P.L.1968, c.410 (C. 52:14B-1 et seq.) to the contrary, the department shall, as appropriate and no later than in time for plan year 2025, update rules and regulations to ensure consistency with the provisions of this section and P.L.2023, c.194 (C. 17B:27A-33.1 et al.) immediately upon filing with the Office of Administrative Law. The rules and regulations adopted pursuant to this subsection shall be in effect only for plan year 2025. The rules and regulations shall thereafter be adopted, amended, or readopted for plan years 2026 and thereafter by the department in accordance with the requirements of the “Administrative Procedure Act,” P.L.1968, c.410 (C. 52:14B-1 et seq.).

L.2023, c.194, s.9.