New Jersey

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-7.8 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, cochlear implant for covered persons.

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-7.26 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-7.31 Individual health benefits plan, coverage, insulin for diabetes treatment.

17B:27A-7.32 Individual health benefits plan, coverage, epinephrine auto-injector device.

17B:27A-7.33 Individual health benefits plan, coverage, prescription asthma inhaler.

17B:27A-7.34 Biomarker precision medical testing coverage, individual health benefits plans.

17B:27A-7.35 Individual health benefits plan, HIV preexposure prophylaxis, HIV postexposure prophylaxis.

17B:27A-7.36 Benefits provided under individual health benefits plans.

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-10.12 Violations, penalties.

17B:27A-10.13 Rules, regulations.

17B:27A-10.14 Study, Department of Banking and Insurance, New Jersey Individual Health Coverage Program, New Jersey Small Employer Health Benefits Program; report, Governor, Legislature.

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-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-19.10 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 C.17B: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, cochlear implant for covered persons.

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-19.24a Carrier, small-employer health benefits plan, prescription drug formulary, flexibility, limitations.

17B:27A-19.24b Carrier, prescription drug formulary, exceptions and appeals process.

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-19.32 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-19.35 Small employer health benefits plan, coverage, insulin for diabetes treatment.

17B:27A-19.36 Small employer health benefits plan, coverage, epinephrine auto-injector device.

17B:27A-19.37 Small employer health benefits plan, coverage, prescription asthma inhaler.

17B:27A-19.38 Biomarker precision medical testing coverage, small employer health benefits plans.

17B:27A-19.39 Small employer health benefits plan, HIV preexposure prophylaxis, HIV postexposure prophylaxis.

17B:27A-19.40 Benefits provided under small employer health benefits plans.

17B:27A-19a Small employer carrier, offering of high deductible plan.

17B:27A-20. Coinsurance, deductibles applicable

17B:27A-20.1 Rules, regulations.

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-33.1 Short title.

17B:27A-33.2 Annual review, small-employer health benefits plans, publish findings, report, Department of Banking and Insurance website.

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-65 Definitions relative to certain assessments.

17B:27A-66 Filing of net written premiums.

17B:27A-67 "Health Insurance Affordability Fund."