reglab/housing_qa huggingface dataset:
NJ Rev Stat § 17B:30-51 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:30-51 - Information required from payer.

17B:30-51 Information required from payer.  4. a. A payer shall provide the following information concerning utilization management and the processing and payment of claims in a clear and conspicuous manner through an Internet website no later than 30 calendar days before the information or policies or any changes in the information or policies take effect: (1) a description of the source of all commercially produced clinical criteria guidelines and a copy of all internally produced clinical criteria guidelines used by the payer or its agent to determine the medical necessity of health care services; (2) a list of the material, documents or other information required to be submitted to the payer with a claim for payment for health care services; (3) a description of claims for which the submission of additional documentation or information is required for the adjudication of a claim fitting that description; (4) the payer's policy or procedure for reducing the payment for a duplicate or subsequent service provided by a health care provider on the same date of service; and (5) any other information the commissioner deems necessary. b. Any changes in the information or policies required to be provided pursuant to subsection a. of this section shall be clearly noted on the Internet website. L.2005,c.352,s.4.
NJ Rev Stat § 17B:30-53 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:30-53 - Reimbursement for covered services, conditions.

17B:30-53 Reimbursement for covered services, conditions.  6. a. When a hospital or physician complies with the provisions set forth in section 5 of P.L.2005, c.352 (C.17B:30-52), no payer, or payer's agent, shall deny reimbursement to a hospital or physician for covered services rendered to a covered person on grounds of medical necessity in the absence of fraud or misrepresentation if the hospital or physician: (1) requested authorization from the payer and received approval for the health care services delivered prior to rendering the service;  (2) requested authorization from the payer for the health care services prior to rendering the services and the payer failed to respond to the hospital or physician within the time frames established pursuant to section 5 of P.L.2005, c.352 (C.17B:30-52); or (3) received authorization for the covered service for a patient who is no longer eligible to receive coverage from that payer and it is determined that the patient is covered by another payer, in which case the subsequent payer, based on the subsequent payer's benefits plan, shall accept the authorization and reimburse the hospital or physician. b. If the hospital is a network provider of the payer, health care services shall be reimbursed at the contracted rate for the services provided. c. No payer, or payer's agent, shall amend a claim by changing the diagnostic code assigned to the services rendered by a hospital or physician without providing written justification. L.2005,c.352,s.6.
NJ Rev Stat § 17B:30-54 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:30-54 - Reimbursement according to provider contract.

17B:30-54 Reimbursement according to provider contract.  7. A payer, or payer's agent, shall reimburse a hospital or physician according to the provider contract for all medically necessary emergency and urgent care health care services that are covered under the health benefits plan, including all tests necessary to determine the nature of an illness or injury. L.2005,c.352,s.7.
NJ Rev Stat § 17B:30-55 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:30-55 - Violations, penalties; rules, regulations.

17B:30-55 Violations, penalties; rules, regulations.  17. a. The Commissioner of Banking and Insurance shall enforce the provisions of sections 2 through 7 of P.L.2005, c.352 (C17B:30-49 through C.17B:30-54) and sections 2, 3, 4, 5, 6, 7 and 10 of P.L.1999, c.154 (C.17:48-8.4, 17:48A-7.12, 17:48E-10.1, 17B:26-9.1, 17B:27-44.2, 26:2J-8.1 and 17:48F-13.1) as amended by P.L.2005, c.352 (C.17B:30-48 et al.). A payer found in violation of those sections shall be liable for a civil penalty of not more than $10,000 for each day that the payer is in violation if reasonable notice in writing is given of the intent to levy the penalty and, at the discretion of the commissioner, the payer has 30 days, or such additional time as the commissioner shall determine to be reasonable, to remedy the condition which gave rise to the violation and fails to do so within the time allowed. 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 of 1999," P.L.1999, c.274 (C.2A:58-10 et seq.). The commissioner's determination shall be a final agency decision subject to review by the Appellate Division of the Superior Court. b. If the Commissioner of Banking and Insurance has reason to believe that a person is engaging in a practice or activity, for the purpose of avoiding or circumventing the legislative intent of sections 2, 3, 4, 5, 6, 7 and 10 of P.L.1999, c.154 (C.17:48-8.4, 17:48A-7.12, 17:48E-10.1, 17B:26-9.1, 17B:27-44.2, 26:2J-8.1 and 17:48F-13.1) as amended by P.L.2005, c.352 (C. 17B:30-48 et al.), the Commissioner of Banking and Insurance is authorized to promulgate rules or regulations necessary to prohibit that practice or activity and levy a civil penalty of not more than $10,000 for each day that person is in violation of that rule or regulation. c. For the purpose of administering the provisions of sections 2 through 7 of P.L.2005, c.352 (C.17B:30-49 through C.17B:30-54) and sections 2, 3, 4, 5, 6, 7 and 10 of P.L.1999, c.154 (C.17:48-8.4, 17:48A-7.12, 17:48E-10.1, 17B:26-9.1, 17B:27-44.2, 26:2J-8.1 and 17:48F-13.1) as amended by P.L.2005, c.352 (C.17B:30-48 et al.), 50% of the penalty monies collected pursuant to subsections a. and b. of this section shall be deposited into the General Fund. For the purpose of providing payments to hospitals in accordance with the formula used for the distribution of charity care subsidies that are provided pursuant to P.L.1992, c.160 (C.26:2H-18.51 et seq.), 50% of the penalty monies collected pursuant to subsections a. and b. of this section shall be deposited into the Health Care Subsidy Fund established pursuant to section 8 of P.L.1992, c.160 (C.26:2H-18.58). d. A penalty levied pursuant to this section against a payer that does not reserve the right to change the premium shall be credited towards a penalty levied against the payer by the Department of Human Services for the same violation. L.2005,c.352,s.17.
NJ Rev Stat § 17B:30-56 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:30-56 - Rules, regulations.

17B:30-56 Rules, regulations.  20. The Commissioner of Banking and Insurance shall promulgate rules and regulations pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) necessary to carry out the purposes of this act. L.2005,c.352,s.20.
NJ Rev Stat § 17B:30-57 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:30-57 - Liberal construction.

17B:30-57 Liberal construction.  21. This act shall be liberally construed to effectuate the legislative purposes of the act. L.2005,c.352,s.21.
NJ Rev Stat § 17B:30-59 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:30-59 - Assignment of benefits to service provider of right to receive reimbursement for ambulance service.

17B:30-59 Assignment of benefits to service provider of right to receive reimbursement for ambulance service.  2. a. Notwithstanding any provision of law to the contrary, a covered person may, through an assignment of benefits, assign to a service provider his right to receive reimbursement for any ambulance service rendered by the service provider, regardless of whether the service provider is under contract with the carrier to provide services to the covered person. b. A service provider provided an assignment of benefits by a covered person, pursuant to subsection a. of this section, shall submit a copy of that assignment of benefits, or provide other notice of that assignment of benefits acceptable to the commissioner pursuant to regulation, to the payer with any claim for payment for any ambulance service rendered to the covered person. c. The payer, based upon the claim and notice of the assignment of benefits submitted by the service provider, shall remit payment of the claim directly to the service provider within the timeframe established by P.L.1999, c.154 (C.17B:30-23 et al.) for remitting payment on a claim submitted by electronic means, or by other than electronic means, as applicable, and provide written notice, within the same applicable timeframe, of the payment to the covered person. d. If a covered person executes an assignment of benefits, and the service provider submits notice of that assignment of benefits with its claim for payment pursuant to subsection b. of this section, but the payer remits payment of the claim to the covered person, rather than the service provider, the claim shall not be considered paid. The payer shall, notwithstanding the incorrect payment of the claim to the covered person, remain liable for remitting payment of the claim to the service provider pursuant to the assignment of benefits. e. Any overdue payment on the claim to the service provider pursuant to the assignment of benefits shall accrue interest at the rate established by P.L.1999, c.154 (C.17B:30-23 et al.) for an overdue payment. L.2007,c.194,s.2.
NJ Rev Stat § 17B:30-61 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:30-61 - Third party access.

17B:30-61 Third party access.  2. a. A contracting entity shall not grant to a third party access to a provider network contract, or a provider's dental services or contractual discounts, or both, pursuant to a provider network contract, unless the contracting entity meets the requirements of subsections b. and c. of this section. b. A dental carrier may grant access to its provider network contract to a third party if, at the time the contract is entered into, and at any time the contract is renewed, the dental carrier allows any provider which is part of the carrier's provider network to choose not to participate in third party access to the contract. The third party access provision of any provider contract shall be clearly identified in the provider contract. A dental carrier shall not grant third party access to the contract of any provider that does not participate in third party access. c. A contracting entity may grant a third party access to a provider network contract, or services or discounts pursuant to a provider network contract, if: (1) The contract specifically states that the contracting entity may enter into an agreement with third parties allowing the third parties to obtain the contracting entity's rights and responsibilities as if the third party were the contracting entity, and when the contracting entity is a dental carrier, the provider chose to participate in third party access at the time the provider network contract was entered into or renewed; (2) The third party accessing the contract agrees to comply with all of the contract's terms; (3) The contracting entity identifies, in writing or electronic form to the provider, all third parties in existence as of the date the contract is entered into or renewed; (4) The contracting entity includes on its website a listing, updated no less frequently than every 90 days, identifying all third parties; (5) The contracting entity requires each third party to identify the source of the discount on all remittance advices or explanations of payment under which a discount is taken , except this requirement shall not apply to electronic transactions mandated under the "Health Insurance Portability and Accountability Act of 1996," Pub.L.104-191; (6) The contracting entity notifies the third party of the termination of a provider network contract no later than 30 days from the termination date with the contracting entity; (7) A third party ceases its right to a provider's discounted rate as of the date of termination of the provider's contract with the contracting entity; and (8) The contracting entity delivers to participating providers a copy of the provider network contract relied on in the adjudication of a claim within 30 days after the date of a request from the provider. d. No provider shall be bound by or required to perform dental treatment or services under a provider network contract that has been granted to a third party in violation of this act. L.2019, c.254, s.2.
NJ Rev Stat § 17B:30-62 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:30-62 - Inapplicability.

17B:30-62 Inapplicability.  3. This act shall not apply to: a. a provider network contract for dental services provided to beneficiaries of the Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.), the Medicare program established pursuant to the federal Social Security Act, (42 U.S.C. s.1395 et seq.), the State Health Benefits Program, the School Employees' Health Benefits Program, or the NJ FamilyCare Program established pursuant to P.L.2005, c.156 (C.30:4J-8 et al.); and b. situations in which access to a provider network contract is granted to a contracting entity or dental carrier operating under the same brand licensee program as the contracting entity or to an entity that is an affiliate of the contracting entity. A listing of all affiliates of the contracting entity shall be made available to the provider, in writing or electronic form, prior to access being granted as provided in subsection b. of section 2 of this act. L.2019, c.254, s.3.
NJ Rev Stat § 17B:30-63 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:30-63 - Rules, regulations.

17B:30-63 Rules, regulations.  4. The Commissioner of Banking and Insurance shall, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), adopt rules and regulations necessary to effectuate the purpose of this act. The commissioner shall ensure the rules and regulations for this act include penalty provisions for contracting entities and dental carriers that violate the provisions of this act. L.2019, c.254, s.4.
NJ Rev Stat § 17B:30B-1 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:30B-1 - Short title.

17B:30B-1 Short title.  1. This act shall be known and may be cited as the "Viatical Settlements Act." L.2005,c.229,s.1.
NJ Rev Stat § 17B:30B-4 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:30B-4 - Refusal to issue, suspension, revocation, refusal to renew license.

17B:30B-4 Refusal to issue, suspension, revocation, refusal to renew license.  4. a. The commissioner may refuse to issue, suspend, revoke or refuse to renew the license of a viatical settlement provider, if the commissioner finds that: (1) There was any material misrepresentation in the application for the license; (2) The licensee or any officer, partner, member or key management personnel has been convicted of fraudulent or dishonest practices, is subject to a final administrative action or is otherwise shown to be untrustworthy or incompetent to act as a licensee; (3) The licensee demonstrates a pattern of unreasonable payments to viators; (4) The licensee or any officer, partner, member or key management personnel has been found guilty of, or has pleaded guilty or nolo contendere to, any felony, or to a misdemeanor involving fraud or moral turpitude, regardless of whether a judgment of conviction has been entered by the court; (5) The licensee has entered into any settlement contract that has not been approved pursuant to this act; (6) The licensee has failed to honor contractual obligations set out in a viatical settlement contract; (7) The licensee no longer meets the requirements for initial licensure; (8) The licensee has assigned, transferred or pledged a viaticated policy to a person other than a viatical settlement provider licensed in this State, an accredited investor or qualified institutional buyer as defined respectively in Regulation D, Rule 501 (17 C.F.R. 230.501 through 230.508) or Rule 144A (17 C.F.R. 230.144A) of the federal "Securities Act of 1933" (15 U.S.C. s.77a et seq.), as amended, financing entity, special purpose entity or related provider trust; or (9) The licensee or any officer, partner, member or key management personnel has violated any provision of this act. b. The commissioner may suspend, revoke or refuse to renew the license of a life insurance producer if the commissioner finds that the life insurance producer has violated the provisions of this act. c. Before the commissioner denies a license application or suspends, revokes or refuses to renew the license of a viatical settlement provider or suspends, revokes or refuses to renew the license of a life insurance producer pursuant to this act, the commissioner shall conduct a hearing in accordance with the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.). L.2005,c.229,s.4.
NJ Rev Stat § 17B:30B-5 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:30B-5 - Approval of viatical settlement forms by commissioner.

17B:30B-5 Approval of viatical settlement forms by commissioner.  5. A person shall not use a viatical settlement contract form or provide a disclosure statement or application form to a viator in this State unless it has been filed with and approved by the commissioner. The commissioner shall disapprove a viatical settlement contract form or disclosure statement form if, in the commissioner's opinion, the contract form, disclosure form, or provisions contained therein are unreasonable, contrary to the interests of the public, or otherwise misleading or unfair to the viator. The commissioner may require the submission of advertising material used in connection with a viatical settlement contract. L.2005,c.229,s.5.
NJ Rev Stat § 17B:30B-6 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:30B-6 - Filing of annual statement.

17B:30B-6 Filing of annual statement.  6. a. Each viatical settlement provider licensee shall file with the commissioner on or before March 1 of each year an annual statement containing that information which the commissioner by regulation may prescribe. This information is limited to only those transactions in which the viator is a resident of this State and shall not include individual transaction data or data which compromises the privacy of personal, financial, and health information of the viator or insured. b. Except as otherwise allowed or required by law, a viatical settlement provider, insurance company, life insurance producer, information bureau, rating agency or company, or any other person with actual knowledge of the identity of the insured, shall not disclose that identity, or the insured's financial or medical information, to any other person unless the disclosure: (1) Is necessary to effect a viatical settlement contract between the viator and a viatical settlement provider and the viator and insured have provided prior written consent to the disclosure; (2) Is provided in response to an investigation or examination by the commissioner or any other governmental officer or agency or pursuant to the requirements of subsection e. of section 12 of this act;  (3) Is a term of or condition to the transfer of a policy by one viatical settlement provider to another viatical settlement provider; (4) Is necessary to permit a financing entity, related provider trust or special purpose entity to finance the purchase of policies by a viatical settlement provider and the viator and insured have provided prior written consent to the disclosure; (5) Is necessary to allow the viatical settlement provider or its authorized representative to make contacts for the purpose of determining health status; or (6) Is required to purchase stop loss coverage. c. In addition to the information required in this section, the commissioner may require that either or both viatical settlement providers and life insurance producers provide to the commissioner that information the commissioner determines by regulation, regarding the amount and method of compensation paid to life insurance producers for negotiating a viatical settlement contract pursuant to this act. L.2005,c.229,s.6.
NJ Rev Stat § 17B:30B-10 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:30B-10 - Two-year period required between issuance of policy and viatical settlement; exceptions.

17B:30B-10 Two-year period required between issuance of policy and viatical settlement; exceptions.  10. a. It is a violation of this act for any person to enter into a viatical settlement contract within a two-year period commencing with the date of issuance of the insurance policy unless the viator certifies to the viatical settlement provider that one or more of the following conditions have been met within the two-year period: (1) The policy was issued upon the viator's exercise of conversion rights arising out of a group or individual life insurance policy, so long as the total amount of time covered under the conversion policy plus the time covered under the prior policy is at least 24 months. The time covered under a group policy shall be calculated without regard to any change in insurance carriers, provided the coverage has been continuous and under the same group sponsorship;  (2) The viator submits independent evidence to the viatical settlement provider that within the two-year period: (a) the viator or insured was terminally ill or chronically ill; or (b) the viator or insured disposed of his ownership interests in a closely held corporation pursuant to a buyout or other similar agreement in effect at the time the insurance policy was initially issued; or (c) both. b. Copies of the independent evidence described in paragraph (2) of subsection a. of this section and documents required by subsection a. of section 9 of this act shall be submitted to the insurer when the viatical settlement provider submits a request to the insurer for verification of coverage. The copies shall be accompanied by a letter of attestation from the viatical settlement provider that the copies are true and correct copies of the documents received by the viatical settlement provider. c. If the viatical settlement provider submits to the insurer a copy of the owner or insured's certification described in subsection a. of this section when the provider submits a request to the insurer to effect the transfer of the policy to the viatical settlement provider, the copy shall be deemed to conclusively establish that the viatical settlement contract satisfies the requirements of this section and the insurer shall timely respond to the request. L.2005,c.229,s.10.
NJ Rev Stat § 17B:30B-14 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:30B-14 - Violation considered unfair trade practice; penalties.

17B:30B-14 Violation considered unfair trade practice; penalties.  14. A violation of this act shall be considered an unfair trade practice pursuant to N.J.S.17B:30-1 et seq. and shall be subject to the penalties contained in N.J.S.17B:30-17. L.2005,c.229,s.14.