reglab/housing_qa huggingface dataset:
NJ Rev Stat § 52:14-17.29r (2021)
2021 New Jersey Revised Statutes|Title 52 - State Government, Departments and Officers|Section 52:14-17.29r - SHBC to provide coverage for oral anticancer medications.

52:14-17.29r SHBC to provide coverage for oral anticancer medications.  9. a. The State Health Benefits Commission shall ensure that every contract purchased on or after the effective date of this act that provides hospital or medical expense benefits shall provide coverage for expenses for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells on a basis no less favorable than the contract provides for intravenously administered or injected anticancer medications.  b. Pursuant to subsection a. of this section, coverage for expenses for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells shall not be subject to any prior authorization, dollar limit, copayment, deductible or coinsurance provision that does not apply to intravenously administered or injected anticancer medications. c. A State Health Benefits Commission contract shall not achieve compliance with the provisions of this section by imposing an increase in patient cost sharing, including any copayment, deductible or coinsurance, for anticancer medications, whether intravenously administered or injected or orally administered, that are covered under the contract as of the effective date of this act. L.2011, c.188, s.9.
NJ Rev Stat § 52:14-17.29s (2021)
2021 New Jersey Revised Statutes|Title 52 - State Government, Departments and Officers|Section 52:14-17.29s - SHBC to provide coverage for prescription eye drops.

52:14-17.29s SHBC to provide coverage for prescription eye drops.  9. The State Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital or medical expense benefits that include coverage for prescription eye drops, shall provide coverage for expenses incurred for refills of prescription eye drops in accordance with the Guidance for Early Refill Edits of Topical Ophthalmic Products provided to Medicare Part D plan sponsors by the Centers for Medicare & Medicaid Services of the U.S. Department of Health and Human Services, provided that: (1) the prescribing health care practitioner indicates on the original prescription that additional quantities of the prescription eye drops are needed; and (2) the refill requested by the covered person does not exceed the number of additional quantities indicated on the original prescription by the prescribing health care practitioner. L.2013, c.50, s.9.
NJ Rev Stat § 52:14-17.29t (2021)
2021 New Jersey Revised Statutes|Title 52 - State Government, Departments and Officers|Section 52:14-17.29t - State Health Benefits Program, coverage for synchronization of prescribed medications.

52:14-17.29t State Health Benefits Program, coverage for synchronization of prescribed medications.  9. The State Health Benefits Commission shall ensure that every contract under the State Health Benefits Program purchased on or after the effective date of this act, which provides benefits for pharmacy services, prescription drugs, or for participation in a prescription drug plan, shall, on at least one occasion per year for each covered person: (1) apply a prorated daily cost-sharing rate to prescriptions that are dispensed by a network pharmacy for less than a 30 days' supply if the prescriber or pharmacist indicates the fill or refill is in the best interest of the covered person or is for the purpose of synchronizing the covered person's chronic medications; (2) provide coverage for a drug prescribed for the treatment of a chronic illness dispensed in accordance with a plan among the covered person, the prescriber and the pharmacist to synchronize the refilling of multiple prescriptions for the covered person; and (3) determine dispensing fees based exclusively on the total number of prescriptions dispensed; dispensing fees shall not be prorated or based on the number of the days' supply of medication prescribed or dispensed.  This section shall not apply to prescriptions for opioid analgesics. "Opioid analgesic" means a drug in the opioid analgesic drug class prescribed to treat moderate to severe pain or other conditions, whether in immediate release or extended release form, and whether or not combined with other drug substances to form a single drug product or dosage form. L.2015, c.206, s.9.
NJ Rev Stat § 52:14-17.29y (2021)
2021 New Jersey Revised Statutes|Title 52 - State Government, Departments and Officers|Section 52:14-17.29y - SHBC to cover digital tomosynthesis of the breast.

52:14-17.29y SHBC to cover digital tomosynthesis of the breast.  9. a. The State Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital and medical expense benefits shall provide coverage for expenses incurred in conducting digital tomosynthesis to detect or screen for breast cancer in women 40 years of age and over; and for diagnostic purposes in women of any age. b. In the case of digital tomosynthesis conducted to detect or screen for breast cancer in women 40 years of age and over, no deductible, coinsurance or other cost sharing shall be applied; and in the case of digital tomosynthesis conducted for diagnostic purposes in women of any age, the same deductibles, coinsurance, and other cost sharing as apply to similar services under the contract shall be applied.  L.2017, c.305, s.9.
NJ Rev Stat § 52:14-17.29z (2021)
2021 New Jersey Revised Statutes|Title 52 - State Government, Departments and Officers|Section 52:14-17.29z - SHBC to provide coverage for donated human breast milk.

52:14-17.29z SHBC to provide coverage for donated human breast milk.  9. a. The State Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital or medical expense benefits shall provide coverage for expenses incurred in the provision of pasteurized donated human breast milk, which may include human milk fortifiers if indicated by the prescribing licensed medical practitioner, provided that: (1) the covered person is an infant under the age of six months; (2) the milk is obtained from a human milk bank that meets quality guidelines established by the Department of Health ; and (3) a licensed medical practitioner has issued an order for an infant who is medically or physically unable to receive maternal breast milk or participate in breast feeding or whose mother is medically or physically unable to produce maternal breast milk in sufficient quantities or participate in breast feeding despite optimal lactation support; or (4) a licensed medical practitioner has issued an order for an infant who meets any of the following conditions:  (a) a body weight below healthy levels determined by the licensed medical practitioner; (b) a congenital or acquired condition that places the infant at a high risk for development of necrotizing enterocolitis; or  (c) a congenital or acquired condition that may benefit from the use of donor breast milk as determined by the Department of Health.b. Nothing in this section shall preclude the carrier from performing utilization review, including periodic review of the medical necessity of a particular service. c. The benefits shall be provided to the same extent as for any other prescribed items under the contract. d. If there is no supply of human breast milk that meets the requirements of paragraph (2) of subsection a. of this section, the carrier shall not be required to provide coverage of expenses pursuant to this section. L.2017, c.309, s.9.
NJ Rev Stat § 52:14-17.29aa (2021)
2021 New Jersey Revised Statutes|Title 52 - State Government, Departments and Officers|Section 52:14-17.29aa - SHBC not to provide coverage for certain early elective deliveries.

52:14-17.29aa SHBC not to provide coverage for certain early elective deliveries.  4. a. Notwithstanding any other law or regulation to the contrary, the State Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital and medical expense benefits shall not provide coverage for a non-medically indicated early elective delivery performed at a hospital on a pregnant woman earlier than the 39th week of gestation. b. As used in this section, "non-medically indicated early elective delivery" means the artificial start of the birth process through medical interventions or other methods, also known as labor induction, or the surgical delivery of a baby via a cesarean section for purposes or reasons that are not fully consistent with established standards of clinical care as provided by the American College of Obstetricians and Gynecologists. L.2019, c.87, s.4.
NJ Rev Stat § 52:14-17.29bb (2021)
2021 New Jersey Revised Statutes|Title 52 - State Government, Departments and Officers|Section 52:14-17.29bb - State Health Benefits Commission to provide coverage for standard fertility preservation services.

52:14-17.29bb State Health Benefits Commission to provide coverage for standard fertility preservation services.  6. a. The State Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital or medical expense benefits shall provide coverage for standard fertility preservation services when a medically necessary treatment may directly or indirectly cause iatrogenic infertility. For the purposes of this section:  "Iatrogenic infertility" means an impairment of fertility caused by surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or processes. "May directly or indirectly cause" means a medical treatment with a likely side effect of iatrogenic infertility as established by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or as defined by the New Jersey Department of Health. "Standard fertility preservation services" means procedures consistent with established medical practices and professional guidelines published by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or as defined by the New Jersey Department of Health. "Standard fertility preservation services" shall not include the storage of sperm or oocytes. The benefits shall be provided to the same extent as for any other medical condition under the contract. The same copayments, deductibles, and benefit limits shall apply to the provision of standard fertility preservation services pursuant to this section as those applied to other medical or surgical benefits under the contract. b. The State Health Benefits Commission shall not purchase a contract that determines the provision of standard fertility preservation services based on a covered person's expected length of life, present or predicted disability, degree of medical dependency, perceived quality of life, or other health conditions, or based on personal characteristics, including age, sex, sexual orientation, marital status, or gender identity. L.2019, c.306, s.6.
NJ Rev Stat § 52:14-17.29dd (2021)
2021 New Jersey Revised Statutes|Title 52 - State Government, Departments and Officers|Section 52:14-17.29dd - SHBC to cover preventive services.

52:14-17.29dd SHBC to cover preventive services.  9. a. The State Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital or medical expense benefits shall provide coverage, without requiring any cost sharing, for the following preventive services: (1) evidence-based items or services that have in effect a rating of "A" or "B" in the current recommendations of the United States Preventive Services Task Force; (2) immunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention;  (3) with respect to infants, children, and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration; and (4) with respect to women, any additional preventive care and screenings not described in paragraph (1) as provided for in the comprehensive guidelines supported by the Health Resources and Services Administration.b. (1) Except as provided in paragraph (2) of this subsection, nothing in this section shall: (a) require a contract which has a network of providers to provide benefits for items or services described in subsection a. of this section that are delivered by an out-of-network provider; or (b) preclude a contract which has a network of providers from imposing cost-sharing requirements for items or services described in subsection a. of this section that are delivered by an out-of-network provider. (2) If a contract does not have in its network a provider who can provide an item or service described in subsection a. of this section, the contract shall cover the item or service when performed by an out-of-network provider, and shall not impose cost sharing with respect to that item or service. c. (1) A contract shall provide coverage for an item or service described in subsection a. of this section for plan years that begin on or after the date that is one year after the date the recommendation or guideline is issued. (2) (a) Except as provided in subparagraph (b) of this paragraph, a contract that is required to provide coverage for an item or service described in subsection a. of this section on the first day of a plan year shall provide coverage for that item or service through the last day of the plan year.  (b) The commissioner may remove a coverage requirement for an item or service during a plan year if the recommendation or guideline changes or is no longer described in subsection a. of this section. L.2019, c.360, s.9.
NJ Rev Stat § 52:14-17.29ee (2021)
2021 New Jersey Revised Statutes|Title 52 - State Government, Departments and Officers|Section 52:14-17.29ee - State Health Benefit Commission to cover adolescent depression screenings.

52:14-17.29ee State Health Benefit Commission to cover adolescent depression screenings.  9. The State Health Benefits Commission shall ensure that every contract purchased by the commission, on or after the effective date of this act, that provides hospital or medical expense benefits shall provide coverage for expenses incurred in screening adolescents between the ages of 12 and 18 for major depressive disorder, so long as screening for major depressive disorder in adolescents continues to receive a rating of "A" or "B" from the United States Preventative Services Task Force. Coverage shall not be denied solely on the basis that the screening is provided in conjunction with any other health care evaluation, treatment, or service. The benefits shall be provided to the same extent as for any other condition under the contract, except that the contract shall not impose on covered persons receiving these services any form of cost sharing, including, but not limited to, copayments, deductibles, or coinsurance. L.2021, c.73, s.9.
NJ Rev Stat § 52:14-17.29ff (2021)
2021 New Jersey Revised Statutes|Title 52 - State Government, Departments and Officers|Section 52:14-17.29ff - State Health Benefits Program, opioid antidote coverage.

52:14-17.29ff State Health Benefits Program, opioid antidote coverage.  3. a. Notwithstanding any law or regulation to the contrary, the State Health Benefits Commission and the School Employees' Health Benefits Commission shall ensure that every contract under the State Health Benefits Program shall provide coverage for an opioid antidote to eligible members of the State Health Benefits Program and the School Employees' Health Benefits Program. The coverage shall be provided without the imposition of any prior authorization or other utilization management requirements, provided that the treatment is: (1) prescribed or administered to the eligible member by a licensed medical practitioner who is authorized to prescribe or administer that treatment pursuant to State and federal law; or (2) dispensed to the eligible member by a licensed pharmacist under a standing order to dispense an opioid antidote pursuant to section 1 of P.L.2017, c.88 (C.45:14-67.2). b. The provisions of this section shall not be construed to limit the coverage of an opioid antidote only when administered by a medical practitioner. c. Each commission shall develop and issue guidelines to ensure the safety and efficacy of benefits provided pursuant to this section.  d. As used in this section: "Opioid antidote" means naloxone hydrochloride, or any other similarly acting drug approved by the United States Food and Drug Administration for self-administration for the treatment of an opioid overdose. L.2021, c.157, s.3.
NJ Rev Stat § 52:14-17.30a (2021)
2021 New Jersey Revised Statutes|Title 52 - State Government, Departments and Officers|Section 52:14-17.30a - Findings, declarations relative to health care costs.

52:14-17.30a Findings, declarations relative to health care costs.  1. The Legislature finds and declares that:  a. The cost of health care in this country has been increasing at a pace that will make our current system of health care delivery unsustainable on its present trajectory.  b. As health care costs continue to rise more quickly than the average annual income, those costs displace other priorities for individuals, such as saving for retirement or their children's education, and even discourage people from obtaining recommended health care. The litany of research in this area has demonstrated that all necessary action must be taken to reduce costs wherever possible. c. One way to reduce costs is to increase the oversight that a self-insured employer, such as the State, exercises over health care programs, as occurs when hiring a third-party medical claims reviewer to examine claims processing.  d. Hiring a third-party medical claims reviewer to provide regular, frequent, and ongoing review and oversight of the claims process, which process includes, but is not limited to, the receipt, management, adjudication, and payment of claims, serves the best interests of the State, participating employers, and the thousands of employees and their dependents covered under the State Health Benefits Program and the School Employees' Health Benefits Program. A third-party medical claims reviewer would act in the best interests of the State, participating employers, and program participants, work toward identifying and eliminating systemic errors, recover overpayments, and ensure that only the required and appropriate amounts due and owing on claims are paid as a result of proper adjudication. e. For the purpose of facilitating greater efficiency and transparency in the adjudication of health benefits claims to State employees, their eligible family members, and participating local government and education employees and their eligible family members, the State of New Jersey deems it fitting and crucial to procure a third-party medical claims reviewer expeditiously, with a goal for implementation in the plan year beginning in January of 2020.  L.2019, c.143, s.1.
NJ Rev Stat § 52:14-17.32a1 (2021)
2021 New Jersey Revised Statutes|Title 52 - State Government, Departments and Officers|Section 52:14-17.32a1 - Funding of health care benefits for retired State employees under C.52:14-17.25 et seq.

52:14-17.32a1 Funding of health care benefits for retired State employees under C.52:14-17.25 et seq.  48. Effective July 1, 2007, health care benefits for retired State employees and their dependents for which the State is required to pay the premiums or periodic charges under the "New Jersey State Health Benefits Program Act," P.L.1961, c.49 (C.52:14-17.25 et seq.), shall be funded and paid by the State through a separate fund established in the Department of the Treasury. Beginning with the valuation period ending June 30, 2007, the Director of the Division of Pensions and Benefits shall annually compute a contribution to fund these health care benefits which shall be the amount necessary to pay the anticipated premiums or periodic charges for the benefits for the following valuation period and to provide that the balance in the fund as of the end of the following valuation period shall be increased by 3/5 of 1% of the salary of the active members for the valuation period. If the assets in the fund are insufficient to pay the premiums or periodic charges for the benefits, they shall be paid directly by the State. Nothing herein above shall alter health care benefits for qualified retirees and their dependents or relieve the State from its acknowledged obligation to fund the benefits. L.2007, c.103, s.48.
NJ Rev Stat § 52:14-17.32b (2021)
2021 New Jersey Revised Statutes|Title 52 - State Government, Departments and Officers|Section 52:14-17.32b - Cessation of active full-time employment; payment of premiums

52:14-17.32b. Cessation of active full-time employment; payment of premiums  The cessation of active full-time employment shall be deemed to occur on the last day of the coverage period for which premiums have been paid and such premiums will be required if the employee receives payment for any service rendered in the coverage period. L.1970, c. 231, s. 8, eff. Oct. 22, 1970.
NJ Rev Stat § 52:14-17.32c (2021)
2021 New Jersey Revised Statutes|Title 52 - State Government, Departments and Officers|Section 52:14-17.32c - Coverage for employee paid on 10-month basis pursuant to annual contract

52:14-17.32c. Coverage for employee paid on 10-month basis pursuant to annual contract  For purposes of State and local employer coverage, an employee paid on a 10-month basis, pursuant to an annual contract, and who terminates his service with the employer at the end of the contract year, having served during all of the months of the year as prescribed by his contract, shall be entitled to coverage comparable to that of an employee paid on a 12-month basis. Coverage for these employees and their dependents will continue during the 2 months of the year in which they are not paid provided that proper payment is made for dependent coverage as may be required by the State or participating employer. L.1970, c. 231, s. 9, eff. Oct. 22, 1970.
NJ Rev Stat § 52:14-17.32d (2021)
2021 New Jersey Revised Statutes|Title 52 - State Government, Departments and Officers|Section 52:14-17.32d - Leave of absence for illness without pay; continuance of coverage; payment of premium

52:14-17.32d. Leave of absence for illness without pay; continuance of coverage; payment of premium  Notwithstanding any other regulation or statutory authority pertaining to the continuation of coverage for those on an approved leave of absence, the coverage of any eligible State employee and of his dependents, if any, during any period of authorized leave of absence for illness without pay, shall be continued for a period of as much as 3 months or the equivalent number of payroll periods for those not reported on a monthly basis; such period shall commence following the last payroll period or month for which the employee receives a salary payment. The premium for the coverage extended for such period of leave of absence shall be paid for by the State. L.1974, c. 192, s. 1, eff. Dec. 27, 1974.