reglab/housing_qa huggingface dataset:
NJ Rev Stat § 17B:27E-2 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27E-2 - Application of act

17B:27E-2. Application of act  2. The requirements of this act shall apply to policies delivered or issued for delivery in this State on or after the effective date of this act intended for use as long-term care insurance. This act is not intended to supersede the obligations of entities subject to this act to comply with the substance of other applicable insurance laws insofar as they do not conflict with this act, except that laws and regulations designed and intended to apply to Medicare supplement insurance policies shall not be applied to long-term care insurance. L.2003,c.207,s.2.
NJ Rev Stat § 17B:27E-3 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27E-3 - Short title

17B:27E-3. Short title  3. This act shall be known and may be cited as the "New Jersey Long-Term Care Insurance Act." L.2003,c.207,s.3.
NJ Rev Stat § 17B:27E-5 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27E-5 - Compliance required

17B:27E-5. Compliance required  5. a. Any policy, certificate or rider advertised, marketed or offered as long-term care insurance shall comply with the provisions of this act. b. No group long-term care insurance coverage shall be offered to a resident of this State under a group policy issued in another state to a group described in paragraph (2) of the definition of "group long-term care insurance" in section 4 of this act, unless this State, or another state having statutory and regulatory long-term care insurance requirements substantially similar to those adopted in this State, has made a determination that those requirements have been met. L.2003,c.207,s.5.
NJ Rev Stat § 17B:27E-7 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27E-7 - Grounds for rescinding policy, denying a claim

17B:27E-7. Grounds for rescinding policy, denying a claim  7. a. For a policy or certificate that has been in force for less than six months, an insurer may rescind a long-term care insurance policy or certificate or deny an otherwise valid long-term care insurance claim upon a showing of misrepresentation that is material to the acceptance for coverage. b. For a policy or certificate that has been in force for at least six months but less than two years, an insurer may rescind a long-term care insurance policy or certificate or deny an otherwise valid long-term care insurance claim upon a showing of misrepresentation that is both material to the acceptance for coverage and which pertains to the condition for which benefits are sought. c. After a policy or certificate has been in force for two years, it is not contestable upon the grounds of misrepresentation alone; such a policy or certificate may be contested only upon a showing that the insured knowingly and intentionally misrepresented relevant facts relating to the insured's health. d. If an insurer has paid benefits under the long-term care insurance policy or certificate, the benefit payments shall not be recovered by the insurer if the policy or certificate is rescinded. e. In the event of the death of the insured, this section shall not apply to the remaining death benefit of a life insurance policy that accelerates benefits for long-term care. In this situation, the remaining death benefits under these policies shall be governed by N.J.S.17B:25-4 or 17B:27-12, as appropriate. In all other situations, this section shall apply to life insurance policies that accelerate benefits for long-term care. L.2003,c.207,s.7.
NJ Rev Stat § 17B:27E-8 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27E-8 - Conditions for delivery, issuance of policy

17B:27E-8. Conditions for delivery, issuance of policy  8. a. Except as provided in subsection b. of this section, a long-term care insurance policy shall not be delivered or issued for delivery in this State unless the policyholder or certificate holder has been offered the option of purchasing a policy or certificate including a nonforfeiture benefit. The offer of a nonforfeiture benefit may be in the form of a rider that is attached to the policy. If the policyholder or certificate holder declines the nonforfeiture benefit, the insurer shall provide a contingent benefit upon lapse that shall be available for a specified period of time following a substantial increase in premium rates. b. When a group long-term care insurance policy is issued, the offer required in subsection a. of this section shall be made to the group policyholder. L.2003,c.207,s.8.
NJ Rev Stat § 17B:27E-9 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27E-9 - Regulations

17B:27E-9. Regulations  9. The commissioner shall promulgate regulations, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), necessary to effectuate the purposes of this act including, but not limited to, regulations dealing with disclosure requirements, eligibility, renewability, non-duplication of coverage, dependent coverage, preexisting conditions, termination of coverage, continuation or conversion, loss ratio, and other information that the commissioner feels necessary. L.2003,c.207,s.9.
NJ Rev Stat § 17B:27E-11 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27E-11 - Insurer to file rates, rating schedule, supporting documentation

17B:27E-11. Insurer to file rates, rating schedule, supporting documentation  11. An insurer providing long-term care insurance issued on an individual basis in this State shall file, for the commissioner's approval, its rates, rating schedule and supporting documentation demonstrating that it is in compliance with the applicable loss ratio standards of this State. All filings of rates and rating schedules shall demonstrate that the benefits are reasonable in relation to the premium charged and that the rates are not excessive, inadequate or unfairly discriminatory. L.2003,c.207,s.11.
NJ Rev Stat § 17B:27E-12 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27E-12 - Additional penalties

17B:27E-12. Additional penalties  12. In addition to any other penalties provided by the laws of this State, any insurer and any insurance producer found to have violated any requirement of this State relating to the regulation of long-term care insurance or the marketing of that insurance shall be subject to a fine of up to three times the amount of any commissions paid for each policy or certificate involved in the violation, or $10,000, whichever is greater. L.2003,c.207,s.12.
NJ Rev Stat § 17B:27F-2 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27F-2 - Duties of pharmacy benefits manager relative to contracts.

17B:27F-2 Duties of pharmacy benefits manager relative to contracts.  2. Upon execution or renewal of each contract, or at such a time when there is any material change in the term of the contract, a pharmacy benefits manager shall, with respect to contracts between a pharmacy benefits manager and a pharmacy services administrative organization, or between a pharmacy benefits manager and a contracted pharmacy: a. (1) include in the contract the sources utilized to determine multiple source generic drug pricing, brand drug pricing, and the wholesaler in the State of New Jersey where pharmacies may acquire the product including, if applicable, the brand effective rate, generic effective rate, dispensing fee effective rate, maximum allowable cost or any other pricing formula for pharmacy reimbursement; (2) update that pricing information every seven calendar days; and (3) establish a reasonable process by which contracted pharmacies have a method to access relevant maximum allowable cost pricing lists, brand effective rate, generic effective rate, and dispensing fee effective rate, or any other pricing formulas for pharmacy reimbursement; and b. Maintain a procedure to eliminate drugs from the list of drugs subject to multiple source generic drug pricing and brand drug pricing, or modify maximum allowable cost rates, brand effective rate, generic effective rate, dispensing fee effective rate or any other applicable pricing formula in a timely fashion and make that procedure easily accessible to the pharmacy services administrative organizations or the pharmacies that they are contractually obligated with to provide that information according to the requirements of this section. L.2015, c.179, s.2; amended 2019, c.274, s.3.
NJ Rev Stat § 17B:27F-3 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27F-3 - Requirements for placing prescription drug on multiple source generic list.

17B:27F-3 Requirements for placing prescription drug on multiple source generic list.  3. a. In order to place a particular prescription drug on a multiple source generic list, the pharmacy benefits manager shall, at a minimum, ensure that: (1) The drug is listed as therapeutically and pharmaceutically equivalent or "A," "B," "NR," or "NA" rated in the Food and Drug Administration's most recent version of the Approved Drug Products with Therapeutic Equivalence Evaluations, commonly known as the "Orange Book;" and (2) The drug is available for purchase without limitations by all pharmacies in the State from national or regional wholesalers and is not obsolete or temporarily unavailable. b. A pharmacy benefits manager shall not penalize a pharmacist or pharmacy on audit if the pharmacist or pharmacy performs a generic substitution pursuant to the "Prescription Drug Price and Quality Stabilization Act," P.L.1977, c.240 (C.24:6E-1 et seq.). L.2015, c.179, s.3.
NJ Rev Stat § 17B:27F-5 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27F-5 - Rules, regulations.

17B:27F-5 Rules, regulations.  5. The Commissioner of Banking and Insurance shall adopt, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), rules and regulations, including any penalty provisions the commissioner deems to be necessary, to effectuate the purposes of this act. L.2015, c.179, s.5.
NJ Rev Stat § 17B:27F-6 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27F-6 - Regulations relative to pharmacy benefits managers.

17B:27F-6 Regulations relative to pharmacy benefits managers.  1. a. A pharmacy benefits manager, in connection with any contract or arrangement with a private health insurer, prescription benefit plan, or the State Health Benefits Program or School Employees' Health Benefits Program, shall not require a covered person to make a payment at the point of sale for any amount for a deductible, coinsurance payment, or a copayment for a prescription drug benefit in an amount that exceeds the amount the covered person would pay for the prescription drug if the covered person purchased the prescription drug without using a health benefits plan. b. A pharmacy benefits manager shall not prohibit a network pharmacy from disclosing, and shall not apply a penalty or any other type of disincentive to a network pharmacy that discloses, to a covered person lower cost prescription drug options, including those that are available to the covered person if the covered person purchases the prescription drug without using health insurance coverage. c. Any provision of a contract that conflicts with the provisions of subsection b. of this section shall be void and unenforceable. d. A violation of this section shall be an unlawful practice and a violation of P.L.1960, c.39 (C.56:8-1 et seq.), and shall also be subject to any enforcement action that the Commissioner of Banking and Insurance is authorized to take pursuant to section 5 of P.L.2015, c.179 (C.17B:27F-5). L.2019, c.257, s.1.
NJ Rev Stat § 17B:27F-7 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27F-7 - "Clean Claim" made by a pharmacy, actions of pharmaceutical benefits managers.

17B:27F-7 "Clean Claim" made by a pharmacy, actions of pharmaceutical benefits managers.  1. a. After the date of receipt of a clean claim for payment made by a pharmacy, a pharmacy benefits manager shall not retroactively reduce payment on the claim, either directly or indirectly, through aggregated effective rate, direct or indirect remuneration, quality assurance program, or otherwise,except if the claim is found not to be a clean claim during the course of a routine audit performed pursuant to an agreement between the pharmacy benefits manager and the pharmacy. When a pharmacy adjudicates a claim at the point of sale, the reimbursement amount provided to the pharmacy by the pharmacy benefits manager shall constitute a final reimbursement amount. Nothing in this section shall be construed to prohibit any retroactive increase in payment to a pharmacy pursuant to a contract between the pharmacy benefits manager, and the pharmacy services administration organization, or a pharmacy. b. For the purpose of this section, "clean claim" means a claim that has no defect or impropriety, including a lack of any required substantiating documentation, or other circumstance requiring special treatment, including, but not limited to, those listed in subsection d. of this section, that prevents timely payment from being made on the claim. c. A pharmacy benefit manager shall not recoup funds from a pharmacy in connection with claims for which the pharmacy has already been paid unless the recoupment is: (1) otherwise permitted or required by law;  (2) the result of an audit, performed pursuant to a contract between the pharmacy benefits manager and the pharmacy; or (3) the result of an audit, performed pursuant to a contract between the pharmacy benefits manager and the designated pharmacy services administrative organization. d. The provisions of this section shall not apply to an investigative audit of pharmacy records when:  (1) fraud, waste, abuse or other intentional misconduct is indicated by physical review or review of claims data or statements; or (2) other investigative methods indicate a pharmacy is or has been engaged in criminal wrongdoing, fraud or other intentional or willful misrepresentation. L.2019, c.274, s.1.
NJ Rev Stat § 17B:27F-8 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27F-8 - Commissioner review, approval.

17B:27F-8 Commissioner review, approval.  5. The Commissioner of Banking and Insurance may review and approve the compensation program of a pharmacy benefits manager with a health benefits plan to ensure that the reimbursement for pharmacist services paid to a pharmacist or pharmacy is fair and reasonable to provide an adequate pharmacy benefits manager network for a health benefits plan. L.2019, c.274, s.5.
NJ Rev Stat § 17B:27F-9 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27F-9 - Applicability of C.17B:27F-1 et seq.

17B:27F-9 Applicability of C.17B:27F-1 et seq.  6. P.L.2015, c.179 (C.17B:27F-1 et seq.) shall apply to all pharmacy benefits managers operating in the State of New Jersey, except for any agreement by a pharmacy benefits manager to administer prescription drug benefits on behalf of the State Health Benefits Plan, the School Employees Health Benefits Plan, the State Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.), or 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. L.2019, c.274, s.6.
NJ Rev Stat § 17B:27F-10 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27F-10 - Violations, penalties.

17B:27F-10 Violations, penalties.  7. A pharmacy benefits manager that violates any provision of P.L.2015, c.179 (C.17B:27F-1 et seq.) shall be subject to:  a. a warning notice; b. an opportunity to cure the violation within 14 days following the issuance of the notice; c. a hearing before the commissioner within 70 days following the issuance of the notice; and d. if the violation has not been cured pursuant to subsection b. of this section, a penalty of not less than $5,000 or more than $10,000 for each violation. L.2019, c.274, s.7.
NJ Rev Stat § 17B:28-1 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:28-1 - Definition

17B:28-1. Definition  When used in this chapter, the following terms shall have the following respective meanings: a. "Separate account contract" means any contract issued by an insurer under which amount (including without limitation proceeds applied under optional modes of settlement or under dividend options) are allocated by the insurer to one or more separate accounts; b. "Separate account" means any segregated portfolio of investments or designated account of an insurer established pursuant to this chapter; c. "Contract on a variable basis" means any separate account contract providing for the dollar amount of life insurance or annuity benefits or other contractual payments or values thereunder to vary so as to reflect investment results of one or more separate accounts in which amounts with respect to any such contracts shall have been placed; and d. "Variable contract account" means any such separate account. L.1971, c. 144, s. 17B:28-1. Amended by L.1977, c. 37, s. 1, eff. March 10, 1977.
NJ Rev Stat § 17B:28-2 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:28-2 - Qualification of insurer

17B:28-2. Qualification of insurer  No present or future domestic insurer shall undertake the issuance of any contract on a variable basis, and no foreign or alien insurer heretofore or hereafter admitted to transact in this State any class or classes of insurance authorized by this code shall undertake the issuance or delivery of any contract on a variable basis within this State, unless said insurer shall have the authority to write life insurance or annuities or both and until said insurer has satisfied the commissioner that it has been engaged in transacting the business of life insurance for a period of at least 2 years and that its condition or methods of operation in connection with the issuance of such contracts on a variable basis will not be such as would render its operation hazardous to the public or its policyholders in this State. In determining the qualification of an insurer requesting authority to issue or deliver contracts on a variable basis within this State, the commissioner will consider, among other things, the history of the insurer; the character, responsibility and general fitness of the officers and directors of the insurer; and the regulation of such insurer by its jurisdiction of domicile. If the insurer is a subsidiary of an authorized insurer, or affiliated with such authorized insurer by common management or ownership, it may be deemed by the commissioner to have satisfied the aforementioned provisions if either it or such authorized insurer satisfies said provisions. L.1971, c. 144, s. 17B:28-2.
NJ Rev Stat § 17B:28-4 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:28-4 - Required statements; procedure

17B:28-4. Required statements; procedure  Any contract on a variable basis delivered or issued for delivery in this State, and any certificate evidencing variable benefits issued pursuant to any such contract on a group basis, shall contain a statement of the essential features of the procedure to be followed by the insurer in determining the dollar amount of variable benefits or other contractual payments or values thereunder and shall state in clear terms that such amount may decrease or increase according to such procedure. Any such contract delivered or issued for delivery in this State, and any such certificate, shall contain on its first page, in a prominent position, a clear statement that the benefits or other contractual payments or values thereunder are on a variable basis. L.1971, c. 144, s. 17B:28-4.
NJ Rev Stat § 17B:28-6 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:28-6 - Administration

17B:28-6. Administration  Any insurer maintaining one or more separate accounts shall submit annually to the commissioner a report of the business of its separate accounts. Such report shall be made either by a separate annual statement for such business or by suitable additions to such insurer's regular annual statement, in either case on a form prescribed by the commissioner, and shall include details as to all of the income, disbursements, assets and liability items associated with the separate accounts. The commissioner shall make a separate valuation of the assets of the separate accounts and a copy of such valuation shall be filed in the commissioner's office as a public document. Such valuation shall be in accordance with section 17B:28-10. The commissioner shall further prescribe by regulation the steps to be taken by the insurer in disposing of those holdings which at any time subsequent to purchase fail to meet the standards and regulations for new investments. L.1971, c. 144, s. 17B:28-6. Amended by L.1977, c. 37, s. 4, eff. March 10, 1977.
NJ Rev Stat § 17B:28-7 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:28-7 - Separate accounts; approval by commissioner

17B:28-7. Separate accounts; approval by commissioner  17B:28-7. Separate accounts; approval by commissioner. Any present or future domestic insurer shall have authority to establish and operate one or more separate accounts and to issue separate account contracts, whether or not contracts on a variable basis, with the approval of the commissioner, and the issuance or delivery of such contracts in this State by any foreign or alien insurer shall be subject to like approval. The commissioner, in granting or withholding any such approval, shall consider in addition to the matters referred to in N.J.S.17B:28-2, 17B:28-5, and 17B:28-15, if applicable, the following:  a. The type or types of contracts the funds from which will be placed in the separate accounts; b. The extent to which, if any, the dollar amount of benefits or other contractual payments or values under such contracts will be guaranteed; c. The investment limitations that will be applicable to the separate account; d. The manner of valuing the assets of the account and the method or methods to be used to compute the liabilities arising from the contracts described in subsection a. of this section; e. If such contracts are annuity contracts, whether or not they will be participating; and f. Such other matters as the commissioner shall deem relevant. Any such approval by the commissioner may be subject to such conditions as he may impose as being necessary for the protection of the public or of such insurer's policyholders. Any approval by the commissioner pursuant to this section may be granted with respect to a single separate account or a class of separate accounts having common characteristics.  For any separate account established and maintained solely for one or more employer group contracts sold to fund an employee benefit plan, which contracts constitute group contracts for the purposes of paragraph (v) of subsection a. of N.J.S.17B:28-9, an insurer may establish and maintain such account 45 days after filing its request for the commissioner's approval, unless within that time the commissioner shall have approved or disapproved the account, provided that neither the insurer nor any such contract shall provide a guaranty, including any index guaranty, of the dollar amount of benefits or other contractual payments or values under such contract. Any disapproval shall state in writing the grounds therefor in such detail as reasonable to inform the insurer thereof. The disapproval by the commissioner of any such account may be on the ground that the account is contrary to law or the public policy of this State. Any disapproval shall be subject to review in accordance with the procedure set forth in the "Administrative Procedure Act," P.L.1968, C.410 (C.52:14B-1 et seq.), and any rules or regulations adopted thereunder.  L.1971, c.144; amended 1977, c.37, s.5; 1989,c.267,s.4.