26:2S-3.2 Definitions.
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/nj/title-26/chapter-2s/26-2s-3-2·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
2. As used in section 3 of P.L.2025, c.199 (C.26:2S-3.3):
“Carrier” means an insurance company, health service corporation, hospital service corporation, medical service corporation, or health maintenance organization authorized to issue health benefits plans in this State, or any other entity subject to the insurance laws and rules of insurance in this State or subject to the jurisdiction of the Department of Banking and Insurance, that contracts, or offers to contract, to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services under a health benefits plan in this State.
“Cost-sharing amount” means any copayment, coinsurance, deductible, or other similar charges required of an enrollee for a health care service covered by a health benefits plan, including a prescription drug, and paid by or on behalf of the enrollee.
“Enrollee” means any individual entitled to coverage of health care services from a carrier.
“Health benefits plan” means a policy, contract, certification, or agreement offered or issued by a carrier to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services. For the purposes of P.L.2025, c.199 (C.26:2S-3.1 et al.), “health benefits plans” shall not include the following plans, policies, or contracts: accident only; credit disability; long-term care; Medicare supplemental coverage; TRICARE supplement coverage; coverage for Medicare services pursuant to a contract with the United States government; the State Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.); coverage arising out of a worker’s compensation or similar law; the State Health Benefits Program; the School Employees’ Health Benefits Program; a self-insured health benefits plan governed by the provisions of the federal “Employee Retirement Income Security Act of 1974,” 29 U.S.C. s.1001 et seq.; coverage under a policy of private passenger automobile insurance issued pursuant to P.L.1972, c.70 (C.39:6A-1 et seq.); or hospital confinement indemnity coverage.
“Health care service” means an item or service furnished to any individual for the purpose of preventing, alleviating, curing, or healing human illness, injury, or disability.
“Third-party administrator” has the same meaning as defined in N.J.S.17B:27B-1.
L.2025, c.199, s.2.