reglab/housing_qa huggingface dataset:
NJ Rev Stat § 17B:27A-33 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27A-33 - Formulation of five health benefits plans

17B:27A-33. Formulation of five health benefits plans  17. Subject to the approval of the commissioner, the board shall formulate the five health benefits plans to be made available by small employer carriers in accordance with the provisions of this act, and shall promulgate five standard forms pursuant thereto. The board may establish benefit levels, deductibles and co-payments, exclusions, and limitations for such health benefits plans in accordance with the law. The board shall ensure that the means exist for a carrier to offer high deductible health benefits plan options that are consistent with section 301 of Title III of the "Health Insurance Portability and Accountability Act of 1996," Pub.L. 104-191, regarding tax-deductible medical savings accounts. The board shall submit the forms so established to the commissioner for approval. The commissioner shall approve the forms if the commissioner finds them to be consistent with the provisions of section 3 of P.L.1992, c. 162 (C.17B:27A-19). Any form submitted to the commissioner by the board shall be deemed approved if not expressly disapproved in writing within 60 days of its receipt by the commissioner. Such forms may contain, but shall not be limited to, the following provisions: a. Utilization review of health care services, including review of medical necessity of hospital and physician services; b. Managed care systems, including large case management; c. Provisions for selective contracting with hospitals, physicians, and other participating and nonparticipating providers; d. Reasonable benefits differentials which are applicable to participating and nonparticipating providers; e. Notwithstanding the provisions of section 4 of P.L.1992, c.162 (C.17B:27A-20) to the contrary, the board may, from time to time, adjust coinsurance and deductibles; f. Such other provisions which may be quantifiably established to be cost containment devices; g. The department shall publish annually a list of the premiums charged for each of the five small employer health benefits plans and for any rider package by all carriers writing such plans. The department shall also publish the toll free telephone number of each such carrier. L.1992,c.162,s.17; amended 1993, c.162, s.8; 1997, c.146, s.13.
NJ Rev Stat § 17B:27A-41 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27A-41 - Violations, penalty

17B:27A-41. Violations, penalty  25. Any carrier which violates this act shall be subject to a penalty assessment, as determined by the commissioner. L.1992,c.162,s.25; amended 1995,c.298,s.9.
NJ Rev Stat § 17B:27A-43 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27A-43 - Violations, penalties

17B:27A-43. Violations, penalties  27. A carrier which violates any provision of this act shall be liable to a penalty of not less than $2,000 and not greater than $5,000 for each violation. The penalty shall be collected by the commissioner in the name of the State in a summary proceeding in accordance with "the penalty enforcement law," N.J.S.2A:58-1 et seq.  L.1992,c.162,s.27.
NJ Rev Stat § 17B:27A-44 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27A-44 - Assessments not charged to policyholders, public

17B:27A-44. Assessments not charged to policyholders, public  28. No assessment provided for under this act shall be charged, directly or indirectly, to policyholders or the public, provided that a carrier may charge such an assessment to policyholders to the extent that the charging of the assessment is necessary to enable the carrier to earn a constitutionally adequate rate of return.  L.1992,c.162,s.28.
NJ Rev Stat § 17B:27A-45 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27A-45 - Standard claim form

17B:27A-45. Standard claim form  29. The board, in conjunction with the board of the New Jersey Individual Health Coverage Program established pursuant to section 9 of P.L.1992, c.161 (C.17B:27A-10) shall promulgate one standard claim form.  In order to provide a standard system of payment for medical services, all claim forms for any claimant's use under a group health insurance policy issued or delivered in this State shall conform to the form adopted by the board.  L.1992,c.162,s.29; 1993,c.162,s.20.
NJ Rev Stat § 17B:27A-47 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27A-47 - Coverage obtained through out-of-State trust, compliance required

17B:27A-47. Coverage obtained through out-of-State trust, compliance required  12. Group hospital or medical coverage obtained through an out-of-State trust covering a group of 49 or fewer employees or participating persons who are residents of this State shall comply with the provisions of P.L.1992, c.162 (C.17B:27A-17 et seq.), regardless of the situs of delivery of the policy.  L.1993,c.162,s.12.
NJ Rev Stat § 17B:27A-48 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27A-48 - Multiple employer arrangement; requirements

17B:27A-48. Multiple employer arrangement; requirements  13. A multiple employer arrangement covering a group of 49 or fewer employees or participating persons of an individual employer who are residents of this State shall register with the board of directors established pursuant to section 13 of P.L.1992, c.162 (C.17B:27A-29).  The multiple employer arrangement shall be required to offer the health benefits plans established by the board. The premium rates charged for the multiple employer arrangement health benefits plan shall conform to the requirements of section 9 of P.L.1992, c.162 (C.17B:27A-25) and the coverage shall comply with the provisions of subsection b. of section 3 and sections 6 and 7 of P.L.1992, c.162 (C.17B:27A-19, 22 and 23), regardless of the situs of delivery of the multiple employer arrangement.  L.1993,c.162,s.13.
NJ Rev Stat § 17B:27A-49 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27A-49 - Notification to commissioner by carrier of multiple employer arrangement

17B:27A-49. Notification to commissioner by carrier of multiple employer arrangement  14. A carrier shall notify the commissioner by December 31 of each year of any health care coverage or benefits, stop-loss coverage or administrative services only contracts it provides or enters into with a multiple employer arrangement that provides health care benefits to employees and their dependents in this State.  L.1993,c.162,s.14.
NJ Rev Stat § 17B:27A-50 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27A-50 - Change of coverage by small employer; restrictions

17B:27A-50. Change of coverage by small employer; restrictions  15. a. A small employer who purchases a health benefits plan or rider pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.) shall not be permitted to purchase a health benefits plan or rider with a greater actuarial value until the first anniversary date of the small employer's existing health benefits plan.  b. If, after the first anniversary date of a small employer's health benefits plan, the small employer purchases a health benefits plan or rider of greater actuarial value than the existing health benefits plan or rider, the small employer shall not be permitted to change his health benefits plan or rider to one of lesser actuarial value until the anniversary date of the small employer's existing health benefits plan.  c. Nothing in this section shall be construed to prohibit a small employer who has purchased a health benefits plan or rider pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.) from purchasing a health benefits plan or rider of lesser actuarial value prior to the anniversary date of the existing health benefits plan or rider, if the existing plan or rider was purchased at least 12 months prior to the latest anniversary date of the plan or rider.  L.1993,c.162,s.15.
NJ Rev Stat § 17B:27A-53 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27A-53 - Other insurance purchases not required

17B:27A-53. Other insurance purchases not required  21. A carrier shall not require a small employer to purchase any other insurance coverage, including, but not limited to, life insurance, accident insurance or disability insurance, as a condition of or in conjunction with the purchase of a health benefits plan pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.).  L.1993,c.162,s.21.
NJ Rev Stat § 17B:27A-54 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27A-54 - Commissioner authorized to approve establishment of arrangement; rules, regulations

17B:27A-54. Commissioner authorized to approve establishment of arrangement; rules, regulations  22. Notwithstanding any other law to the contrary, the commissioner is authorized to approve the establishment of an arrangement by an insurance company operating pursuant to Title 17B of the New Jersey Statutes and authorized to issue health benefits plans in this State, that is entered into on or after June 1, 1993 and which provides for selective contracting with health care providers and reasonable benefit differentials applicable to participating and nonparticipating health care providers.  The agreement for an arrangement shall be filed and approved by the commissioner before it becomes effective. The commissioner shall approve the agreement if he determines, in consultation with the Commissioner of Health, that the arrangement promotes health care cost containment while adequately preserving quality of care. The commissioner may adopt regulations pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) necessary to enforce and administer the arrangements.  L.1993,c.162,s.22.
NJ Rev Stat § 17B:27A-56 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27A-56 - Provision of biannual surveys to DOBI by health insurers.

17B:27A-56 Provision of biannual surveys to DOBI by health insurers.  19. a. Any health insurer, as a condition of transacting business in this State, offering a contract, policy, or plan that qualifies as a high deductible health plan for which qualified medical expenses are paid using a health savings account established pursuant to section 223 of the federal Internal Revenue Code of 1986 (26 U.S.C. s.223), shall provide biannual surveys to the Department of Banking and Insurance, based upon information requested and collected from subscribers, insureds, enrollees, and covered persons covered by qualifying high deductible health plans. Each survey shall request, but is not limited to requesting, information concerning: the income levels of the subscribers, insureds, enrollees, or covered persons, covered by qualifying high deductible health plans; the type of contract, policy, or plan which previously provided coverage to those individuals; the amount of out-of-pocket expenses incurred by those individuals; and the percentage of income used by those individuals to pay deductibles. b. All disclosures made pursuant to this section shall be made in accordance with section 2713 of the "Health Insurance Portability and Accountability Act of 1996," Pub.L.104-191 (42 U.S.C. s.300gg-13). L.2005,c.248,s.19.
NJ Rev Stat § 17B:27A-59 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27A-59 - Rules, regulations.

17B:27A-59 Rules, regulations.  4. The Department of Banking and Insurance shall adopt rules and regulations pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), to effectuate the purposes of this act. L.2019, c.141, s.4.
NJ Rev Stat § 17B:27A-61 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27A-61 - Carrier seeking rate increase.

17B:27A-61 Carrier seeking rate increase.  1. In addition to any other applicable laws or regulations, a carrier that seeks a rate increase as part of an informational filing for an individual or small employer health benefits plan shall comply with all of the provisions of this act. The Department of Banking and Insurance shall review informational filings that are subject to this act in the manner set forth in the provisions of this act.  L.2019, c.355, s.1.
NJ Rev Stat § 17B:27A-62 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27A-62 - Information to support, justify rate requests.

17B:27A-62 Information to support, justify rate requests.  2. a. An informational rate filing by a carrier for an individual or small employer health benefits plan offered in this State shall contain information to support and justify rate requests. A rate increase shall be subject to expanded review by the department pursuant to the provisions of this act if the informational rate filing requests a rate increase of 10 percent or more annually. b. A rate increase meets or exceeds 10 percent annually if the average increase for all enrollees weighted by premium volume for any plan within the product meets or exceeds the 10 percent threshold. c. With respect to small employer plans, rate increases submitted on a quarterly basis shall be considered both for each specific quarter and in combination with any previous quarterly rate increase or increases applicable to the same calendar year when determining whether the rate increase meets or exceeds the 10 percent threshold for expanded review. d. For the purposes of this act, "informational filing" means a submission, by a carrier to the department, of rate-filings which specify the plans offered, premium rates, all factors to be used in the calculation of premium rates, and a detailed actuarial memorandum supporting the calculation of the rates including a certification by a qualified member of the American Academy of Actuaries, the Society of Actuaries, or the Casualty Actuarial Society, all supporting data for the premium rates and such other information as required by the department. L.2019, c.355, s.2.
NJ Rev Stat § 17B:27A-63 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27A-63 - Additional information requested by department.

17B:27A-63 Additional information requested by department.  3. a. If the department determines that a carrier's requested rate increase exceeds the 10 percent threshold for expanded rate review set forth in section 2 of this act, the department shall require the carrier to submit to the department, in addition to any other information required to be filed, a written description justifying the rate increase that complies with all of the provisions of this section.  b. The carrier shall include in its written description all information prescribed by the department, including: (1) a simple and brief narrative describing the data and assumptions that were used to develop the rate increase; (2) an explanation of the most significant factors causing the rate increase, including a brief description of the relevant claims and non-claims expense increases reported in the rate increase summary;  (3) a brief description of the overall experience of the plan, including historical and projected expenses, and loss ratios; and (4) an actuarial memorandum that contains the reasoning and assumptions supporting the data. c. (1) Upon completion of the department's review of the rate filing, the department shall promptly make available to the public a consumer-friendly version of the written description justifying the rate increase as provided by the carrier, excluding information that is a trade secret or that is confidential commercial or financial information. (2) The department shall include on its website, along with each written description posted on the website, information that explains:  (a) the purpose and role of the expanded rate review process; and (b) how the public can submit comments to the department on the written description justifying the rate increase. L.2019, c.355, s.3.
NJ Rev Stat § 17B:27A-64 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27A-64 - Disclosure of information.

17B:27A-64 Disclosure of information.  4. a. Any information filed with the department pursuant to this act may be disclosed in accordance with P.L.1963, c.73 (C.47:1A-1 et seq.), except that confidential information shall not be disclosed by the department to any person other than employees and representatives of the department. b. A carrier shall separately identify any confidential information filed with the department pursuant to this act. Any information that is not identified as confidential information shall be considered public information and subject to disclosure. c. As used in this section, "confidential information" means information contained in an actuarial memorandum filed with the department pursuant to this act that has been certified by the actuary preparing the memorandum as confidential or proprietary information. L.2019, c.355, s.4.
NJ Rev Stat § 17B:27A-65 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27A-65 - Definitions relative to certain assessments.

17B:27A-65 Definitions relative to certain assessments.  1. As used in this act: "Commissioner" means the Commissioner of Banking and Insurance. "Entity subject to this act" or "entity" means an insurance company, health service corporation, hospital service corporation, medical service corporation, health maintenance organization, or dental plan organization authorized to issue health benefits or dental benefits plans in this State. "Entity" shall include a multiple employer welfare arrangement that is initially registered pursuant to the "Self-Funded Multiple Employer Welfare Arrangement Regulation Act," P.L.2001, c.352 (C.17B:27C-1 et seq.) after the date of enactment of this act. "Entity" shall not include a dental service corporation or a multiple employer welfare arrangement that is registered pursuant to the "Self-Funded Multiple Employer Welfare Arrangement Regulation Act," P.L.2001, c.352 (C.17B:27C-1 et seq.) as of the date of enactment of this act.  "Health benefits plan" means a benefits plan which pays or provides hospital and medical expense benefits for covered services, and is delivered or issued for delivery in this State by or through an entity subject to this act, including a vision or dental plan as defined pursuant to section 1 of P.L.2014, c.70 (C.26:2S-26). For the purposes of this act, "health benefits plan" shall not include the following plans, policies or contracts: Medicaid, Medicare, Medicare Advantage, Medicare supplement, accident only, credit, disability, long-term care, TRICARE supplement coverage, coverage arising out of a workers' compensation or similar law, automobile medical payment insurance, personal injury protection insurance issued pursuant to P.L.1972, c.70 (C.39:6A-1 et seq.), small employer health benefits plans issued pursuant to P.L.1992, c.162 (C.17B:27A-17),and hospital confinement indemnity coverage. "Net written premiums" means the premiums earned in this State on health benefits plans, less return premiums thereon and dividends paid or credited to policy or contract holders on the health benefits plan business. Net earned premium shall include the aggregate premiums earned on the entity's insured group and individual business, excluding premiums from any Medicaid or NJ FamilyCare contracts. L.2020, c.61, s.1.
NJ Rev Stat § 17B:27A-66 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27A-66 - Filing of net written premiums.

17B:27A-66 Filing of net written premiums.  2. a. An entity subject to this act shall annually file with the commissioner its net written premiums for the preceding year, no later than April 1 of each year. b. The commissioner shall calculate and issue to the entity a certified assessment, which shall be 2.5% of the entity's net written premiums.  c. An entity shall annually pay the assessment issued pursuant to subsection b. of this section to the State Treasurer no later than May 1 of each year, as prescribed by the commissioner. d. If the commissioner determines that the amount of the assessment calculated pursuant to this section shall reduce the State's total revenue, the commissioner may reduce the assessment. L.2020, c.61, s.2.
NJ Rev Stat § 17B:27B-1 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27B-1 - Definitions relative to third party administrators, billing services.

17B:27B-1 Definitions relative to third party administrators, billing services.  1. As used in this act: "Benefits payer" means an insurer authorized to issue health or dental benefits plans in this State, or any other person who undertakes to provide and assumes financial risk for the payment of health or dental benefits and is obligated to pay claims for health or dental benefits to providers or other claimants. "Client" means a health care provider that contracts with a third party billing service to remit claims to benefits payers on behalf of the provider or other claimant. "Commissioner" means the Commissioner of Banking and Insurance. "Enrollee" means a person entitled to receive benefits under a health benefits plan. "Health benefits plan" means a benefits plan which pays or provides hospital and medical expense or dental benefits for covered services.  "Health care provider" or "provider" means an individual or entity which provides a covered benefit or service. "Insurer" means a licensed health insurer, health, hospital or medical service corporation, health maintenance organization, dental service corporation or dental plan organization. "Third party administrator" means a person or entity that: processes claims and pays claims on behalf of a benefits payer without the assumption of financial risk for the payment of health or dental benefits. Third party administrator shall include: (1) an entity not licensed as an insurer that is not an affiliate or subsidiary of an insurer, that processes claims on behalf of a benefits payer; (2) an entity that is a subsidiary or affiliate of an insurer that processes claims on behalf of the insurer; and (3) an entity that is a subsidiary or affiliate of an insurer that only processes claims on behalf of benefits payers other than insurers. Third party administrator shall not include an employee, affiliate or subsidiary of a benefits payer formed for the purpose of processing and paying claims solely on behalf of the benefits payer, nor shall it include a collection agency or bureau or pharmacy benefits manager. "Third party billing service" means a person or entity that is paid by a health care provider to process claims or claims payments on behalf of the health care provider. L.2001,c.267,s.1.
NJ Rev Stat § 17B:27B-3 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27B-3 - Additional information required for licensure, registration.

17B:27B-3 Additional information required for licensure, registration.  3. In addition to the information required by section 2 of this act, the applicant for licensure or registration shall file with the commissioner: a. a description of the applicant's proposed method of marketing its services; b. a statement setting forth the means by which the applicant is to be compensated; c. a description of the complaint and appeals procedures instituted by the applicant; and d. a description of the quality assurance procedures established by the applicant.  An applicant shall make available for inspection by the commissioner copies of all standard contracts with benefits payers or other persons with whom it does business, including subcontractors and reinsurers. In the case of an applicant for registration, the information required to be filed with the commissioner shall apply only to services provided to benefits payers other than an insurer. L.2001,c.267,s.3.