reglab/housing_qa huggingface dataset:
NJ Rev Stat § 26:2J-10.1 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-10.1 - Coverage provided by health maintenance organization for subscriber's child.

26:2J-10.1 Coverage provided by health maintenance organization for subscriber's child.  13. a. A health maintenance organization contract or certificate in which dependent coverage is available shall continue to make that coverage available for an adult child until the child turns 26 years of age. A contract or certificate shall not deny coverage for an enrollee's child for health care services on the grounds that: (1) The child was born out of wedlock; (2) The child is not claimed as a dependent on the enrollee's federal tax return; (3) The child does not reside with the enrollee or in the health maintenance organization's service area, provided that the child complies with the terms and conditions of the coverage with respect to the use of specified providers; (4) The child is married; (5) The child has or adopts a child; or (6) The child starts or leaves school. b. If a child has coverage through a health maintenance organization plan of a noncustodial parent, the health maintenance organization shall: (1) Provide such information to the custodial parent as may be necessary for the child to obtain health care services through the child's noncustodial parent's coverage; (2) Permit the custodial parent, or the health care provider with the authorization of the custodial parent, to submit claims for health care services without the approval of the noncustodial parent; and (3) Make payments on claims submitted in accordance with paragraph (2) of this subsection directly to the custodial parent, the health care provider or the Division of Medical Assistance and Health Services in the Department of Human Services which administers the State Medicaid program, as appropriate. c. When a parent who is the enrollee is eligible for dependent coverage and is required by a court or administrative order to provide health insurance coverage for his child, the health maintenance organization shall: (1) Permit the parent to enroll his child as a dependent, without regard to any open enrollment restrictions; (2) Permit the child's other parent, or the Division of Medical Assistance and Health Services as the State Medicaid agency or the Division of Family Development as the State IV-D agency, in the Department of Human Services, to enroll the child if the parent who is the enrollee fails to enroll the child; and (3) Not terminate coverage of the child unless the parent who is the enrollee provides the health maintenance organization with satisfactory written evidence that: the court or administrative order is no longer in effect; or the child is or will be enrolled in a comparable health benefits plan whose coverage will be effective on the date of the termination of coverage. L.1995, c.288, s.13; amended 2019, c.356, s.8.
NJ Rev Stat § 26:2J-10.2 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-10.2 - Requirements applicable to State Medicaid

26:2J-10.2. Requirements applicable to State Medicaid  14. A health maintenance organization shall not impose requirements on the Division of Medical Assistance and Health Services in the Department of Human Services which has been assigned the rights of an individual who is eligible for medical assistance under the State Medicaid program, that are different from requirements applicable to an agent or assignee of any other enrollee. L.1995,c.288,s.14.
NJ Rev Stat § 26:2J-11 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-11 - Annual open enrollment period

26:2J-11. Annual open enrollment period  a. After a health maintenance organization has been in operation 24 months, it shall have an annual open enrollment period of at least one month during which it accepts enrollees up to the limits of its capacity, as determined by the health maintenance organization, in the order in which they apply for enrollment. A health maintenance organization may apply to the commissioner for authorization to impose such underwriting restrictions upon enrollment as are necessary to preserve its financial stability, to prevent excessive adverse selection by prospective enrollees, or to avoid unreasonably high or unmarketable charges for enrollee coverage for health care services. The commissioner shall approve or deny such application within 30 days of the receipt thereof from the health maintenance organization. The Commissioner of Insurance shall certify to the commissioner the appropriateness of any requested underwriting restrictions.  b. Health maintenance organizations providing or arranging for services exclusively on a group contract basis may limit the open enrollment provided for in subsection a. to all members of the group or groups covered by such contracts.  c. A health maintenance organization shall notify its enrollees in writing at the time of enrollment, and include a notice in the promotional material which it distributes to prospective enrollees, that a person's choice of health benefits plan will determine his coverage until the next annual open enrollment period, regardless of the continued availability of a particular health care provider who contracts with that health maintenance organization, unless the enrollee moves his place of residence outside of the organization's designated service area.  L.1973, c.337, s.11; amended 1989,c.321,s.1.
NJ Rev Stat § 26:2J-11.1 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-11.1 - Failure to agree on terms; four-month extension; notification of options

26:2J-11.1. Failure to agree on terms; four-month extension; notification of options  If a health maintenance organization authorized to operate in this State pursuant to P.L.1973, c.337 (C.26:2J-1 et seq.) and a general hospital licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.) with which the health maintenance organization has a contract to provide services to its enrollees, are unable to agree on the terms of a new contract upon the expiration of the current contract, the hospital and the health maintenance organization shall continue to abide by the terms of the most current contract for a period of four months from a severance date mutually agreed upon by both parties. In that event, the health maintenance organization shall promptly notify the health care providers with which it has contracted to provide services and provide notification within the four-month extension period to those of its enrollees who reside in the county in which the hospital is located or in an adjacent county in writing as to the extension of the terms of the most current contract, and shall in the notice to its enrollees advise them of the options available to them with respect to their health care coverage.  L.1989, c.321, s.2.
NJ Rev Stat § 26:2J-12 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-12 - Complaint system

26:2J-12. Complaint system  a. (1) Every health maintenance organization shall establish and maintain a complaint system to provide reasonable procedures for the resolution of written complaints initiated by enrollees concerning health care services. (2) Each health maintenance organization shall submit to the commissioner an annual report in a form prescribed by him which shall include: (a) a description of the procedures of such complaint system; (b) the total number of written complaints handled through such complaint system and a compilation of causes underlying the complaints filed; and (c) the number, amount, and disposition of malpractice claims settled during the year by the health maintenance organization and any of the providers used by it. b. The health maintenance organization shall maintain records of written complaints filed with it concerning other than health care services and shall submit to the commissioner a summary report at such times and in such format as the commissioner may require. c. The commissioner may examine such complaint system. L.1973, c. 337, s. 12, eff. Dec. 27, 1973.
NJ Rev Stat § 26:2J-13 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-13 - Investments

26:2J-13. Investments  With the exception of investments made in accordance with section 5 a. (1) and (3) hereof, the investable funds of a health maintenance organization shall be only in securities or other investments permitted by the laws of this State for the investment of assets constituting the legal reserves of life insurance companies or such other securities or investments as the commissioner may permit with the approval of the Commissioner of Insurance. L.1973, c. 337, s. 13, eff. Dec. 27, 1973.
NJ Rev Stat § 26:2J-14 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-14 - Protection against insolvency

26:2J-14. Protection against insolvency  Each health maintenance organization shall deposit cash or a form of guaranty or security in such amount as will assure that the obligations to the enrollees will be performed in such amount and for such time as prescribed by the commissioner, or where applicable by the Commissioner of Insurance. The commissioner may waive this requirement whenever satisfied that the assets of the organization or its contracts with insurers, hospital or medical service corporation governments, or other organizations are sufficient to reasonably assure the performance of its obligations. L.1973, c. 337, s. 14, eff. Dec. 27, 1973.
NJ Rev Stat § 26:2J-15.1 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-15.1 - Health care services contract, exclusion, rates, terms based on genetic information prohibited

26:2J-15.1. Health care services contract, exclusion, rates, terms based on genetic information prohibited  16. Every contract for health care services that is delivered, issued, executed or renewed in this State pursuant to P.L.1973, c.337 (C.26:2J-1 et seq.) or approved for issuance or renewal in this State 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.16.
NJ Rev Stat § 26:2J-16 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-16 - Regulation of agents

26:2J-16. Regulation of agents  The commissioner may, after notice and hearing, promulgate such reasonable rules and regulations, which have been approved by the Commissioner of Insurance, as are necessary to provide for the certification of agents. An agent as used herein means a person directly or indirectly associated with a health maintenance organization who engages in solicitation or enrollment for compensation. L.1973, c. 337, s. 16, eff. Dec. 27, 1973.
NJ Rev Stat § 26:2J-17 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-17 - Powers of insurers and hospital and medical service corporations

26:2J-17. Powers of insurers and hospital and medical service corporations  a. An insurance company licensed in this State, or a hospital or medical service corporation authorized to do business in this State, may either directly or through a subsidiary or affiliate organize and operate a health maintenance organization under the provisions of this act. Notwithstanding any other law which may be inconsistent herewith, any two or more such insurance companies, hospital or medical service corporations, or subsidiaries or affiliates thereof, may jointly organize and operate a health maintenance organization. b. Notwithstanding any provision of Title 17 of the Revised Statutes and Title 17B of the New Jersey Statutes, an insurer or a hospital or medical service corporation may contract with a health maintenance organization to provide insurance or protection against the cost of care furnished through health maintenance organizations and to provide coverage in the event of the failure of health maintenance organization to meet its obligations. The enrollees of a health maintenance organization constitute a permissible group under such laws. Among other things, under such contracts, the insurer or hospital or medical service corporation may make benefit payments to health maintenance organizations for health care services rendered by providers. L.1973, c. 337, s. 17, eff. Dec. 27, 1973.
NJ Rev Stat § 26:2J-18 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-18 - Examinations

26:2J-18. Examinations  a. Not less frequently than once every 3 years the commissioner may make an examination concerning the quality of health care services and other affairs of the health maintenance organization and providers with whom such organization has contracts, agreements, or other arrangements. The commissioner may make such examination at any time. b. Every health maintenance organization and provider shall submit its books and records to such examinations. For the purpose of examinations, the commissioner may administer oaths to, and examine the officers and agents of the health maintenance organization and the principals of such providers concerning their business. c. The expenses of examinations under this section up to $1,000.00 annually shall be assessed against the organization being examined and such amount shall be remitted to the commissioner. d. In lieu of such examination, the commissioner may accept the report of an examination made by the Commissioner of Health or Commissioner of Insurance of another state. L.1973, c. 337, s. 18, eff. Dec. 27, 1973.
NJ Rev Stat § 26:2J-18.1 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-18.1 - Examination of HMO by Commissioner of Banking and Insurance.

26:2J-18.1 Examination of HMO by Commissioner of Banking and Insurance.  20. The Commissioner of Banking and Insurance may conduct an examination of a health maintenance organization in accordance with the procedures provided in P.L.1993, c.236 (C.17:23-20 et seq.) as often as he deems necessary in order to protect the interests of providers, contract holders, members, and the residents of this State. An organization shall make its relevant books and records available for examination by the Commissioner of Banking and Insurance, and retain its records in accordance with a schedule established by the Commissioner of Banking and Insurance by regulation. The reasonable expenses of the examination shall be borne by the organization being examined. In lieu of such examination, the Commissioner of Banking and Insurance may accept the report of an examination made by the commissioner of another state. L.1997,c.192,s.20; amended 2005, c.65, s.7.
NJ Rev Stat § 26:2J-18.2 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-18.2 - Definitions relative to risk based capital requirements for HMOs.

26:2J-18.2 Definitions relative to risk based capital requirements for HMOs.  1. As used in sections 1 through 5 of P.L.2005, c.65 (C.26:2J-18.2 et seq.): "Commissioner" means the Commissioner Banking and Insurance. "Health maintenance organization" means an entity authorized to transact business in this State pursuant to P.L.1973, c.337 (C.26:2J-1 et seq.). L.2005,c.65,s.1.
NJ Rev Stat § 26:2J-18.4 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-18.4 - Factors in determining change in capital, surplus.

26:2J-18.4 Factors in determining change in capital, surplus.  3. In determining any increase, revision or redetermination in the capital or surplus of a health maintenance organization pursuant to the provisions of section 2 of P.L.2005, c.65 (C.26:2J-18.3) the commissioner shall take into account the following factors: a. Methods and techniques used to measure risk exposure and variability; b. The information available relating to the magnitude of the various risks described in section 2 of P.L.2005, c.65 (C.26:2J-18.3); c. The extent to which risks described in section 2 of P.L.2005, c.65 (C.26:2J-18.3) are independent or interrelated, and whether any dependency is direct or inverse; d. The extent to which the health maintenance organization has provided protection against contingencies in ways other than the establishment of surplus, including, but not limited to: redundancy of premiums; margin in reserves and liabilities; adjustability of contracts pursuant to the terms of the contracts; voluntary or mandatory investment valuation reserves; reinsurance; the use of conservative actuarial assumptions to provide a margin of security; reserve adjustments after rate increases for policies written at earlier and less adequate rates; contingency or catastrophe reserves; and diversification of assets and underwriting risk; and e. Any other relevant factors, including the National Association of Insurance Commissioners' reports and independent judgments of the soundness of the health maintenance organization's financial condition, as evidenced by the rating and reports of reliable professional financial services. L.2005,c.65,s.3.
NJ Rev Stat § 26:2J-18.5 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-18.5 - Noncompliance, penalties.

26:2J-18.5 Noncompliance, penalties.  4. The commissioner may suspend or revoke the authority to do business in this State of any health maintenance organization that does not comply with the provisions of P.L.2005, c.65 (C.26:2J-18.2 et al.). L.2005,c.65,s.4.
NJ Rev Stat § 26:2J-18.6 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-18.6 - Regulations.

26:2J-18.6 Regulations.  5. The commissioner may 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 P.L.2005, c.65 (C.26:2J-18.2 et al.). L.2005,c.65,s.5.
NJ Rev Stat § 26:2J-21 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-21 - Regulation

26:2J-21. Regulation  The commissioner may, upon notice and hearing, promulgate reasonable rules and regulations, as are necessary or proper to carry out the provisions of this act. Where applicable, such rules and regulations shall be promulgated after consultation with the Commissioner of Insurance. Such rules and regulations shall specify those determinations in this act which are to be made by the Commissioner of Insurance and shall be subject to review in accordance with the Administrative Procedure Act, P.L.1968, c. 410 (C. 52:14B-1 et seq.). L.1973, c. 337, s. 21, eff. Dec. 27, 1973.
NJ Rev Stat § 26:2J-22 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-22 - Administrative procedures

26:2J-22. Administrative procedures  a. When the commissioner has cause to believe that grounds for the denial of an application for a certificate of authority exist, or that grounds for the suspension or revocation of a certificate of authority exist, he shall notify the health maintenance organization and the Commissioner of Insurance in writing specifically stating the grounds for denial, suspension, or revocation and fixing a time of at least 20 days thereafter for a hearing on the matter. b. The Commissioner of Insurance, or his designated representative, shall be in attendance at the hearing and shall participate in the proceedings. The recommendation and findings of the Commissioner of Insurance with respect to matters relating to the doing of an insurance business or contract with an insurer or hospital or medical services corporation, provided in connection with any decision regarding denial, suspension, or revocation of a certificate of authority, shall be conclusive and binding upon the commissioner. After such hearing, or upon the failure of the health maintenance organization to appear at such hearing, the commissioner shall take action as is deemed advisable on written findings which shall be mailed to the health maintenance organization with a copy thereof to the Commissioner of Insurance. The action of the commissioner and the recommendation and findings of the Commissioner of Insurance and the levy of any administrative penalty shall be subject to judicial review in accordance with chapter 34 of Title 17B of the New Jersey Statutes. c. The provisions of the Administrative Procedure Act, P.L.1968, c. 410 (C. 52:14B-1 et seq.) of this State shall apply to proceedings under this section to the extent they are not in conflict with subsections a. and b. of this section. L.1973, c. 337, s. 22, eff. Dec. 27, 1973.
NJ Rev Stat § 26:2J-23 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-23 - Fees.

26:2J-23 Fees.  23. Every health maintenance organization subject to this act shall pay to the commissioner the following fees: a. for filing an application for a certificate of authority or amendment thereto, $100.00; b. for filing each annual report, $10.00; and c. for the purpose of supporting the activities of the Department of Banking and Insurance associated with the regulation of health maintenance organizations, $1.50 per life per year, with payment being made annually no later than July 15 for the preceding calendar year. Payments made by a health maintenance organization pursuant to this act shall not in any way reduce payments that may be owed by a health maintenance organization pursuant to P.L.1995, c.156 (C.17:1C-19 et seq.) and subsequent amendments thereto. No such payment shall be required for any per life per year that is funded through the Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.) or the NJ FamilyCare Program established pursuant to P.L.2005, c.156 (C.30:4J-8 et al.). In accordance with the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), the commissioner may promulgate rules and regulations directing that additional fees be paid. From fees collected under the provisions of subsection c. of this section, the Legislature shall in each fiscal year appropriate to the community health law project the sum of $100,000 to fund a grant in support of a program to provide any senior citizen resident of this State who is covered as an enrollee in or beneficiary of a health plan administered by a health maintenance organization with information concerning the person's rights under the program and assistance with the procedures for receiving the benefits to which the person is entitled under the program. L.1973, c.337, s.23; amended 2002, c.34, s.18; 2012, c.17, s.277.