reglab/housing_qa huggingface dataset:
NJ Rev Stat § 17B:26-2.1ee (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:26-2.1ee - Individual health insurance policy to provide coverage for sickle cell anemia.

17B:26-2.1ee Individual health insurance policy to provide coverage for sickle cell anemia.  5. Every individual health insurance policy that provides hospital and medical expense benefits and is delivered, issued, executed, or renewed in this State pursuant to chapter 26 of Title 17B of the New Jersey Statutes, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for medical expenses incurred by a covered person for the treatment of sickle cell anemia and, if the policy provides benefits for expenses incurred in the purchase of outpatient prescription drugs, then the policy shall provide coverage for prescription drug expenses incurred by a covered person for the treatment of sickle cell anemia. The benefits shall be provided to the same extent as for any other medical condition under the policy. This section shall apply to those policies in which the insurer has reserved the right to change the premium. L.2011, c.210, s.5.
NJ Rev Stat § 17B:26-2.1ff (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:26-2.1ff - Individual health insurer to provide coverage for prescription eye drops.

17B:26-2.1ff Individual health insurer to provide coverage for prescription eye drops.  4. a. An individual health insurer which provides hospital or medical expense benefits that include coverage for prescription eye drops under a policy delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for expenses incurred for refills of prescription eye drops in accordance with the Guidance for Early Refill Edits of Topical Ophthalmic Products provided to Medicare Part D plan sponsors by the Centers for Medicare & Medicaid Services of the U.S. Department of Health and Human Services, provided that: (1) the prescribing health care practitioner indicates on the original prescription that additional quantities of the prescription eye drops are needed; and (2) the refill requested by the insured or covered person does not exceed the number of additional quantities indicated on the original prescription by the prescribing health care practitioner. b. The provisions of this section shall apply to those policies in which the insurer has reserved the right to change the premium. L.2013, c.50, s.4.
NJ Rev Stat § 17B:26-2.1gg (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:26-2.1gg - Individual health insurance policy, contract, coverage for synchronization of prescribed medications.

17B:26-2.1gg Individual health insurance policy, contract, coverage for synchronization of prescribed medications.  4. a. Every individual health insurance policy or contract delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State on or after the effective date of this act, which provides benefits for pharmacy services, prescription drugs, or for participation in a prescription drug plan, shall, on at least one occasion per year for each covered person: (1) apply a prorated daily cost-sharing rate to prescriptions that are dispensed by a network pharmacy for less than a 30 days' supply if the prescriber or pharmacist indicates the fill or refill is in the best interest of the covered person or is for the purpose of synchronizing the covered person's chronic medications; (2) provide coverage for a drug prescribed for the treatment of a chronic illness dispensed in accordance with a plan among the covered person, the prescriber and the pharmacist to synchronize the refilling of multiple prescriptions for the covered person; and (3) determine dispensing fees based exclusively on the total number of prescriptions dispensed; dispensing fees shall not be prorated or based on the number of the days' supply of medication prescribed or dispensed.  b. This section shall apply to all policies in which the insurer has reserved the right to change the premium.  c. This section shall not apply to prescriptions for opioid analgesics. "Opioid analgesic" means a drug in the opioid analgesic drug class prescribed to treat moderate to severe pain or other conditions, whether in immediate release or extended release form, and whether or not combined with other drug substances to form a single drug product or dosage form. L.2015, c.206, s.4.
NJ Rev Stat § 17B:26-2.1jj (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:26-2.1jj - Individual health insurance policy to cover digital tomosynthesis of the breast.

17B:26-2.1jj Individual health insurance policy to cover digital tomosynthesis of the breast.  4. a. An individual health insurance policy that provides hospital and medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to N.J.S.17B:26-1 et seq., or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for expenses incurred in conducting digital tomosynthesis to detect or screen for breast cancer in women 40 years of age and over; and for diagnostic purposes in women of any age. b. In the case of digital tomosynthesis conducted to detect or screen for breast cancer in women 40 years of age and over, no deductible, coinsurance or other cost sharing shall be applied; and in the case of digital tomosynthesis conducted for diagnostic purposes in women of any age, the same deductibles, coinsurance, and other cost sharing as apply to similar services under the policy shall be applied.  c. This section shall apply to those individual health insurance policies in which the insurer has reserved the right to change the premium. L.2017, c.305, s.4.
NJ Rev Stat § 17B:26-2.1kk (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:26-2.1kk - Individual health insurance policy to provide coverage for donated human breast milk.

17B:26-2.1kk Individual health insurance policy to provide coverage for donated human breast milk.  4. a. An individual health insurance policy that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for expenses incurred in the provision of pasteurized donated human breast milk, which may include human milk fortifiers if indicated by the prescribing licensed medical practitioner, provided that: (1) the covered person is an infant under the age of six months; (2) the milk is obtained from a human milk bank that meets quality guidelines established by the Department of Health ; and (3) a licensed medical practitioner has issued an order for an infant who is medically or physically unable to receive maternal breast milk or participate in breast feeding or whose mother is medically or physically unable to produce maternal breast milk in sufficient quantities or participate in breast feeding despite optimal lactation support; or (4) a licensed medical practitioner has issued an order for an infant who meets any of the following conditions:  (a) a body weight below healthy levels determined by the licensed medical practitioner; (b) a congenital or acquired condition that places the infant at a high risk for development of necrotizing enterocolitis; or  (c) a congenital or acquired condition that may benefit from the use of donor breast milk as determined by the Department of Health. b. The provisions of this section shall apply to those policies in which the insurer has reserved the right to change the premium.c. Nothing in this section shall preclude the insurer from performing utilization review, including periodic review of the medical necessity of a particular service. d. The benefits shall be provided to the same extent as for any other prescribed items under the policy. e. If there is no supply of human breast milk that meets the requirements of paragraph (2) of subsection a. of this section, the insurer shall not be required to provide coverage of expenses pursuant to this section. L.2017, c.309, s.4.
NJ Rev Stat § 17B:26-2.1mm (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:26-2.1mm - Individual health insurer policy to cover preventive services.

17B:26-2.1mm Individual health insurer policy to cover preventive services.  4. a. An individual health insurer policy that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage, without requiring any cost sharing, for the following preventive services: (1) evidence-based items or services that have in effect a rating of "A" or "B" in the current recommendations of the United States Preventive Services Task Force; (2) immunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention;  (3) with respect to infants, children, and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration; and (4) with respect to women, any additional preventive care and screenings not described in paragraph (1) as provided for in the comprehensive guidelines supported by the Health Resources and Services Administration. b. (1) Except as provided in paragraph (2) of this subsection, nothing in this section shall: (a) require a policy which has a network of providers to provide benefits for items or services described in subsection a. of this section that are delivered by an out-of-network provider; or (b) preclude a policy which has a network of providers from imposing cost-sharing requirements for items or services described in subsection a. of this section that are delivered by an out-of-network provider. (2) If a policy does not have in its network a provider who can provide an item or service described in subsection a. of this section, the policy shall cover the item or service when performed by an out-of-network provider, and shall not impose cost sharing with respect to that item or service. c. (1) A policy shall provide coverage for an item or service described in subsection a. of this section for plan years that begin on or after the date that is one year after the date the recommendation or guideline is issued. (2) (a) Except as provided in subparagraph (b) of this paragraph, a policy that is required to provide coverage for an item or service described in subsection a. of this section on the first day of a plan year shall provide coverage for that item or service through the last day of the plan year.  (b) The commissioner may remove a coverage requirement for an item or service during a plan year if the recommendation or guideline changes or is no longer described in subsection a. of this section. d. This section shall apply to those policies in which the insurer has reserved the right to change the premium. L.2019, c.360, s.4.
NJ Rev Stat § 17B:26-2.1nn (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:26-2.1nn - Individual health insurance policy to provide certain coverage for prescription drugs.

17B:26-2.1nn Individual health insurance policy to provide certain coverage for prescription drugs.  4. a. Notwithstanding any other provision of law to the contrary, an insurer that offers an individual health insurance policy that provides benefits for expenses incurred in the purchase of prescription drugs and is delivered, issued, executed, or renewed in this State, shall ensure that at least 25 percent of all plans, or at least one plan if the carrier offers less than four plans, offered by the carrier in each rating area and in each of the bronze, silver, gold, and platinum levels of coverage, in the individual market pursuant to P.L.1992, c.161 (C.17B:27A-2 et seq.), shall conform with the following:  (1) (a) a policy that provides a silver, gold, or platinum level of coverage, as defined in 45 C.F.R. s.156.140, shall limit a covered person's cost-sharing, including any copayment or coinsurance, for prescription drugs, including specialty drugs, to no more than $150 per month for each prescription drug for up to a 30-day supply of any single drug; (b) a policy that provides a bronze level of coverage, as defined in 45 C.F.R. s.156.140, shall ensure that any required covered person's cost-sharing, including any copayment or coinsurance, does not exceed $250 per month for each prescription drug for up to a 30-day supply of any single drug;  (c) a policy that meets the requirements of a catastrophic plan, as defined in 45 C.F.R. s.156.155, shall be exempt from the requirements of subparagraphs (a) and (b) of this paragraph; (2) except as provided in paragraph (3) of this subsection, the limits described in paragraph (1) of this subsection shall apply at any point in the benefit design, including before and after any applicable deductible is reached; and (3) for prescription drug benefits offered in conjunction with a high-deductible health plan, the policy shall not provide prescription drug benefits until the expenditures applicable to the deductible under the plan have met the amount of the minimum annual deductibles in effect for self-only and family coverage under section 223(c)(2)(A)(i) of the federal Internal Revenue Code (26 U.S.C. s.223(c)(2)(A)(i)) for self-only and family coverage, respectively. Once the foregoing expenditure amount has been met under the plan, coverage for prescription drug benefits shall begin, and the limit on out-of-pocket expenditures for prescription drug benefits shall be as specified in paragraph (1) of this subsection. b. The provisions of this section shall apply to all policies in which the insurer has reserved the right to change the premium. L.2019, c.471, s.4.
NJ Rev Stat § 17B:26-2.1oo (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:26-2.1oo - Individual health insurance policy to cover adolescent depression screenings.

17B:26-2.1oo Individual health insurance policy to cover adolescent depression screenings.  4. An individual health insurance policy that provides hospital and medical expense benefits and is delivered, issued, executed, or renewed in this State pursuant to chapter 26 of Title 17B of the New Jersey Statutes, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for expenses incurred in screening adolescents between the ages of 12 and 18 for major depressive disorder, so long as screening for major depressive disorder in adolescents continues to receive a rating of "A" or "B" from the United States Preventative Services Task Force. Coverage shall not be denied solely on the basis that the screening is provided in conjunction with any other health care evaluation, treatment, or service. The benefits shall be provided to the same extent as for any other condition under the policy, except that the insurer shall not impose on covered persons receiving these services any form of cost sharing, including, but not limited to, copayments, deductibles, or coinsurance. This section shall apply to those policies in which the insurer has reserved the right to change the premium. L.2021, c.73, s.4.
NJ Rev Stat § 17B:26-2.2 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:26-2.2 - Second surgical opinions; definitions

17B:26-2.2. Second surgical opinions; definitions  As used in this act: a. "Elective surgical procedure" means any nonemergency surgical procedure which may be scheduled at the convenience of the patient or the surgeon without jeopardizing the patient's life or causing serious impairment to the patient's bodily functions. b. "Second surgical opinion" means an opinion of an eligible physician based on that physician's examination of a person for the purpose of evaluating the medical advisability of that person undergoing an elective surgical procedure. The examinations must be performed after another physician licensed to practice medicine and surgery has proposed to perform such surgical procedure on the person but prior to the performance of such surgical procedure. c. "Eligible physician" means a physician licensed to practice medicine and surgery who holds the rank of Diplomate of an American Board (M.D.) or Certified Specialist (D.O.) in the surgical or medical specialty for which surgery is proposed. L.1979, c. 328, s. 1.
NJ Rev Stat § 17B:26-2.3 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:26-2.3 - Policy benefits for second surgical opinion

17B:26-2.3. Policy benefits for second surgical opinion  Any insurer issuing an individual insurance policy in accordance with chapter 26 of Title 17B of the New Jersey Statutes which provides coverage of surgical operations performed on a person while confined in a hospital as an inpatient shall make available under the policy benefits for a second surgical opinion for elective surgical procedures which would require inpatient admission to a hospital. L.1979, c. 328, s. 2.
NJ Rev Stat § 17B:26-2.4 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:26-2.4 - Benefit payments

17B:26-2.4. Benefit payments  Benefits for a second surgical opinion shall include payment for the second surgical opinion services of an eligible physician and for essential laboratory and X-ray services incidental thereto, either as a benefit under the individual policy or, at the insurer's option, as an additional benefit offered to the prospective policyholder at issue of a policy. Benefit payments may be limited to second surgical opinion services of eligible physicians who have agreed to participate in an insurer's second surgical opinion program. The benefits shall be reasonably related to amounts payable under the policy for covered surgical procedures. L.1979, c. 328, s. 3.
NJ Rev Stat § 17B:26-2.5 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:26-2.5 - Third surgical opinion

17B:26-2.5. Third surgical opinion  If a second surgical opinion does not confirm that a proposed elective surgical procedure is medically advisable, benefits must be provided under the policy for a third surgical opinion in the same manner as for the second opinion. L.1979, c. 328, s. 4.
NJ Rev Stat § 17B:26-2.6 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:26-2.6 - Excluded surgical procedures

17B:26-2.6. Excluded surgical procedures  The second surgical opinion benefit provisions of a policy may exclude benefits while the patient is confined in a hospital as an inpatient, any surgical procedures not covered by the policy and surgical procedures in the following categories: cosmetic surgery, dental surgery, and podiatric surgery. L. 1979, c. 328, s. 5. Amended by L. 1985, c. 275, s. 1.
NJ Rev Stat § 17B:26-2.7 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:26-2.7 - Payment for opinion services of physician

17B:26-2.7. Payment for opinion services of physician  If a physician who furnishes a second or third surgical opinion also performs the surgical procedure, the policy need not provide payment for the second or third opinion services of that physician. L.1979, c. 328, s. 6.
NJ Rev Stat § 17B:26-2.8 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:26-2.8 - Application of act

17B:26-2.8. Application of act  This act shall apply to all contracts in which the insurer has reserved the right to change the premium. L.1979, c. 328, s. 7.
NJ Rev Stat § 17B:26-3 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:26-3 - Required provisions

17B:26-3. Required provisions  Except as provided in section 17B:26-28 each such policy delivered or issued for delivery to any person in this State shall contain the provisions specified in sections 17B:26-4 to 17B:26-15 inclusive, in words in which the same appear in the applicable sections; provided, however, that the insurer may, at its option, substitute for one or more of such provisions corresponding provisions of different wording approved by the commissioner which are in each instance not less favorable in any respect to the insured or the owner, if other than the insured. Such provisions shall be preceded individually by the appropriate caption appearing in each of such sections or, at the option of the insurer, by such appropriate individual or group captions or subcaptions as the commissioner may approve. L.1971, c. 144, s. 17B:26-3.
NJ Rev Stat § 17B:26-3.1 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:26-3.1 - Cancellation of policy within 10 days after receipt

17B:26-3.1. Cancellation of policy within 10 days after receipt  Except as provided in N.J.S. 17B:26-28, each health insurance policy, other than group and blanket insurance, delivered or issued for delivery to any person in this State shall contain a provision or have attached to it a notice as follows: Cancellation during first 10 days: During a period of 10 days after the date the policyholder receives the policy, the policyholder may cancel the policy and receive from the insurer a prompt refund of any premium paid therefor, including any policy fees or other charges, by mailing or otherwise surrendering the policy to the insurer together with a written request for cancellation. L.1980, c. 38, s. 2.
NJ Rev Stat § 17B:26-3.2 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:26-3.2 - Individual health insurance policy, exclusion, rates, terms based on genetic information prohibited

17B:26-3.2. Individual health insurance policy, exclusion, rates, terms based on genetic information prohibited  14. Every individual health insurance policy providing hospital and medical expense benefits that is delivered, issued, executed or renewed in this State pursuant to Chapter 26 of Title 17B of the New Jersey Statutes or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act shall not exclude any person or eligible dependent and shall not establish any rates or terms therefor on the basis of an actual or expected health condition or on the basis of any genetic characteristic. For the purposes of this section, "genetic characteristic" means any inherited gene or chromosome, or alteration thereof, that is scientifically or medically believed to predispose an individual to a disease, disorder or syndrome, or to be associated with statistically increased risk of development of a disease, disorder or syndrome.  L.1996,c.126,s.14.
NJ Rev Stat § 17B:26-4 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:26-4 - Entire contract; changes

17B:26-4. Entire contract; changes  There shall be a provision as follows: Entire contract; changes: This policy, including the endorsements and the attached papers, if any, constitutes the entire contract of insurance. No change in this policy shall be valid until approved by an executive officer of the insurer and unless such approval be endorsed hereon or attached hereto. No agent has authority to change this policy or to waive any of its provisions. L.1971, c. 144, s. 17B:26-4.