New Jersey Statutes 17:48G-4. Inapplicability of act relative to certain decisions of insurers, third party administrators
Terms Used In New Jersey Statutes 17:48G-4
- Contract: A legal written agreement that becomes binding when signed.
- Fraud: Intentional deception resulting in injury to another.
- 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
a. To regulate insurers’ or third party administrators’ making any decision, including, but not limited to, a decision concerning benefit or insurance coverage, that does not involve the making of a dental decision;
b. To regulate insurers’ or third party administrators’ use of a protocol for denying or limiting benefit payments for dental services where the protocol:
(1) has been approved for use by a dentist who is duly licensed in this State or who has been issued a limited registration certificate pursuant to section 4 of this act; and
(2) does not involve evaluation of an individual patient’s dental care or condition; or
c. To regulate the application of contract limitations and exclusions, the credentialing of dentists or the conduct of retrospective fraud reviews.
L.2007, c.259, s.7.