§ 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.”

Terms Used In New Jersey Statutes > Title 17B > Chapter 27A

  • Advice and consent: Under the Constitution, presidential nominations for executive and judicial posts take effect only when confirmed by the Senate, and international treaties become effective only when the Senate approves them by a two-thirds vote.
  • Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
  • Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
  • Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
  • Attachment: A procedure by which a person's property is seized to pay judgments levied by the court.
  • Baseline: Projection of the receipts, outlays, and other budget amounts that would ensue in the future without any change in existing policy. Baseline projections are used to gauge the extent to which proposed legislation, if enacted into law, would alter current spending and revenue levels.
  • Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. Source: OCC
  • certified mail: include private express carrier service, provided that the private express carrier service provides confirmation of mailing. See New Jersey Statutes 1:1-2
  • Contract: A legal written agreement that becomes binding when signed.
  • Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
  • Damages: Money paid by defendants to successful plaintiffs in civil cases to compensate the plaintiffs for their injuries.
  • Dependent: A person dependent for support upon another.
  • Donor: The person who makes a gift.
  • Equitable: Pertaining to civil suits in "equity" rather than in "law." In English legal history, the courts of "law" could order the payment of damages and could afford no other remedy. See damages. A separate court of "equity" could order someone to do something or to cease to do something. See, e.g., injunction. In American jurisprudence, the federal courts have both legal and equitable power, but the distinction is still an important one. For example, a trial by jury is normally available in "law" cases but not in "equity" cases. Source: U.S. Courts
  • Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
  • Ex officio: Literally, by virtue of one's office.
  • Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
  • Fraud: Intentional deception resulting in injury to another.
  • Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
  • month: means a calendar month, and the word "year" means a calendar year. See New Jersey Statutes 1:1-2
  • Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
  • Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
  • 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
  • population: when used in any statute, shall be taken to mean the population as shown by the latest Federal census effective within this State, and shall be construed as synonymous with "inhabitants. 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
  • Statute: A law passed by a legislature.
  • Tort: A civil wrong or breach of a duty to another person, as outlined by law. A very common tort is negligent operation of a motor vehicle that results in property damage and personal injury in an automobile accident.
  • Uphold: The decision of an appellate court not to reverse a lower court decision.