reglab/housing_qa huggingface dataset:
NJ Rev Stat § 17B:26-45 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:26-45 - Minimum standards for form, content and sale of individual health insurance; regulations

17B:26-45. Minimum standards for form, content and sale of individual health insurance; regulations  a. The commissioner of insurance shall issue such regulations as he shall deem necessary or desirable to establish minimum standards, including standards for full and fair disclosure, for the form, content and sale of individual health insurance issued pursuant to chapter 26 of Title 17B of the New Jersey Statutes. Such regulations shall apply to all, any portion, or reasonable classifications of such insurance, other than conversion policies pursuant to a contractual conversion privilege. b. The purposes of such minimum standards shall include any or all of the following: (1) reasonable standardization and simplification of language, terms and coverages to facilitate understanding and comparisons; (2) elimination of provisions which may be misleading or unreasonably confusing in connection with either the purchase of such insurance or the settlement of claims; (3) elimination of deceptive practices in connection with the sale of such insurance; (4) elimination of provisions which may be contrary to the health care needs of the public; (5) elimination of coverages which are so limited in scope as to be of no substantial economic value to the holders thereof; and (6) elimination of unfair renewal practices which are contrary to the health care needs and economic well-being of the public. c. Any such regulations shall be promulgated in accordance with the Administrative Procedure Act (P.L.1968, c. 410, C. 52:14B-1 et seq.). d. The department shall transmit copies of all rules and regulations adopted pursuant to this act to the Senate and General Assembly on a day on which both houses shall be meeting in the course of a regular or special session. The provisions of the "Administrative Procedure Act" or any other law to the contrary notwithstanding no such rule or regulation shall take effect if, within 60 days of the date of its transmittal to the Senate and General Assembly, the legislature shall pass a concurrent resolution stating in substance that the Legislature does not favor such proposed rule or regulation. e. 120 days after the effective date of a regulation which has been adopted pursuant to this section, all policies of insurance previously filed with the commissioner which are not in compliance with the regulation shall be deemed to be withdrawn from filing and disapproved. No new policy of insurance shall be delivered or issued for delivery in this State until such new policy has been filed with the commissioner. L.1979, c. 78, s. 1, eff. April 15, 1979.
NJ Rev Stat § 17B:26-46 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:26-46 - Violations; penalty; collection and enforcement

17B:26-46. Violations; penalty; collection and enforcement  If, after notice and hearing, the commissioner finds that an insurance company, agent or broker or any other person has violated the provisions of this act or any regulation promulgated pursuant to this act, he may, in addition to any other penalty, impose a penalty not exceeding $2,000.00 for each such violation, which penalty shall be collected and enforced pursuant to the law (N.J.S. 2A:58-1 et seq.). L.1979, c. 78, s. 2, eff. April 15, 1979.
NJ Rev Stat § 17B:26-47 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:26-47 - Injunction

17B:26-47. Injunction  The commissioner may, through the Attorney General of this State, institute an action in the Superior Court to enjoin and restrain any insurer who has entered into a policy which does not conform to the regulations promulgated pursuant to this act or an insurer or any other person who has attempted to induce entry into any such policy or whose method of sale is in violation of the regulations promulgated pursuant to this act. The court may proceed in the action in a summary manner. L.1979, c. 78, s. 3, eff. April 15, 1979.
NJ Rev Stat § 17B:26A-1 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:26A-1 - Definitions

17B:26A-1. Definitions  1. For the purposes of this act: a. "Applicant" means: (1) In the case of an individual medicare supplement policy, the person who seeks to contract for insurance benefits, and  (2) In the case of a group medicare supplement policy, the proposed certificate holder.  b. "Certificate" means any certificate issued under a group medicare supplement policy, which certificate has been delivered or issued for delivery in this State.  c. "Commissioner" means the Commissioner of Insurance. d. "Medicare" means the program established by the "Health Insurance for the Aged Act," Title XVIII of the "Social Security Act," Pub.L. 89-97, as then constituted or later amended (42 U.S.C. s.1395 et seq.).  e. "Medicare supplement policy" means a group or individual insurance policy or certificate which is advertised, marketed, designed primarily as, or is otherwise held out to be, a supplement to reimbursements under medicare for the hospital, medical or surgical expenses of persons eligible for medicare, other than a policy issued pursuant to a contract under 42 U.S.C. s.1395l or 42 U.S.C. s.1395mm or a policy issued under a demonstration project authorized pursuant to the "Health Insurance for the Aged Act," 42 U.S.C. s.1395 et seq. The term does not include a policy issued to one or more employers or labor organizations, or to the trustees of a fund established by one or more employers or labor organizations, or combination thereof, for employees or former employees, or combination thereof, or for members or former members, or combination thereof, of the labor organizations.  L.1982,c.94,s.1; amended 1992,c.163,s.2.
NJ Rev Stat § 17B:26A-2 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:26A-2 - Regulations; medicare supplement policies

17B:26A-2. Regulations; medicare supplement policies  The commissioner shall issue regulations to establish specific standards for policy provisions of medicare supplement policies, which shall be in addition to and in accordance with applicable laws of this State, and may cover, but shall not be limited to: a. Terms of renewability; b. Initial and subsequent conditions of eligibility; c. Nonduplication of coverage; d. Probationary periods; e. Benefit limitations, exceptions and reductions; f. Elimination periods; g. Requirements for replacement; h. Recurrent conditions; and i. Definition of terms. L.1982, c. 94, s. 2.
NJ Rev Stat § 17B:26A-3 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:26A-3 - Prohibited provisions

17B:26A-3. Prohibited provisions  3. a. No medicare supplement policy shall contain benefits which duplicate any benefits provided by medicare.  b. The commissioner may issue regulations that specify prohibited policy provisions not otherwise specifically authorized by statute which, in the opinion of the commissioner, are unjust, unfair or unfairly discriminatory to any person insured or proposed for coverage under a medicare supplement policy.  L.1982,c.94,s.3; amended 1992,c.163,s.3.
NJ Rev Stat § 17B:26A-4 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:26A-4 - Preexisting condition; denial of claim for losses

17B:26A-4. Preexisting condition; denial of claim for losses  Notwithstanding any other provision of law of this State to the contrary, a medicare supplement policy may not deny a claim for losses incurred more than 6 months from the effective date of coverage for a preexisting condition. The policy may not define a preexisting condition more restrictively than a condition for which medical advice was given or treatment was recommended by or received from a physician within 6 months before the effective date of coverage. L.1982, c. 94, s. 4.
NJ Rev Stat § 17B:26A-5 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:26A-5 - Regulations

17B:26A-5. Regulations  5. The commissioner shall promulgate regulations to effectuate and enforce the provisions of P.L.1982, c.94 (C. 17B:26A-1 et seq.) and any regulations which are necessary to conform medicare supplement policies and certificates with federal law. These regulations shall include, but not be limited to:  a. Establishment of minimum standards for benefits, claim payments, marketing and reporting practices and compensation arrangements;  b. Establishment of a uniform methodology for calculating and reporting loss ratios, and requiring refunds or credits if the policies or certificates do not meet loss ratio requirements;  c. Establishment of a process for filing of all requests for premium increases and rate changes, which may include public hearings as determined appropriate by the commissioner prior to approval of any premium increases;  d. Assurance of access by the public to policy, premium and loss ratio information; and  e. Establishment of standards for Medicare Select policies and certificates at such time as this State is authorized under federal law to authorize Medicare Select policies and certificates.  L.1982,c.94,s.5; amended 1992,c.163,s.4.
NJ Rev Stat § 17B:26A-7 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:26A-7 - Outline of coverage, regulations

17B:26A-7. Outline of coverage, regulations  7. a. In order to provide for full and fair disclosure in the sale of medicare supplement policies, no medicare supplement policy or certificate shall be delivered or issued for delivery in this State unless an outline of coverage is delivered to the applicant at the time application is made.  b. The commissioner shall prescribe the format and content of the outline of coverage required by subsection a. of this section. For the purposes of this section, "format" means style, arrangement and overall appearance, including such items as the size, color and prominence of the font used, paper size and weight and the arrangement of text and captions. The outline of coverage shall include:  (1) A description of the principal benefits and coverage provided in the policy;  (2) (Deleted by amendment, P.L.1992, c.163). (3) A statement of the renewal provisions, including any reservation by the insurer of a right to change premiums, and disclosure of the existence of any automatic renewal premium increases based on the policyholder's age; and  (4) A statement that the outline of coverage is a summary of the policy issued or applied for and that the policy should be consulted to determine governing contractual provisions.  c. The commissioner may require by regulation the publication of forms and an informational brochure with a standardized format and content, to serve as an aid in the selection of appropriate coverage, if any, by those eligible for medicare, and to aid the consumer in improving his understanding of medicare benefits. Except in the case of direct response solicitation insurance policies, the commissioner may require by regulation that the informational brochure be provided, concurrently with delivery of the outline of coverage, to all prospective insureds eligible for medicare. With respect to direct response solicitation insurance policies, the commissioner may require by regulation that the prescribed brochure be provided upon request to any prospective insureds eligible for medicare, but in no event later than the time of policy delivery.  d. The commissioner may promulgate regulations for captions or notice requirements for all accident and sickness insurance policies sold to persons eligible for medicare, other than for medicare supplement policies, to inform those prospective insureds that the particular insurance coverage is not a medicare supplement policy.  e. The commissioner may further promulgate regulations to govern the full and fair disclosure of the information in connection with the replacement of insurance policies or certificates by persons eligible for medicare.  L.1982,c.94,s.7; amended 1992,c.163,s.6.
NJ Rev Stat § 17B:26A-8 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:26A-8 - 30-day examination period, refunds

17B:26A-8. 30-day examination period, refunds  8. Medicare supplement policies or certificates shall have a notice prominently printed on the first page of the policy or certificate or attached thereto stating in substance that the applicant shall have the right to return the policy or certificate within 30 days of its delivery and to have the premium refunded if, after examination of the policy or certificate, the applicant is not satisfied for any reason. Refunds made pursuant to this section shall be made in a timely manner and shall be paid directly to the applicant.  L.1982,c.94,s.8; amended 1992,c.163,s.7.
NJ Rev Stat § 17B:26A-9 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:26A-9 - Applicability

17B:26A-9. Applicability  1. Except as otherwise specifically provided: a. The provisions of P.L.1982, c.94 (C.17B:26A-1 et seq.) shall apply to all medicare supplement policies delivered or issued for delivery in this State and all certificates issued under group medicare supplement policies, which certificates are delivered or issued for delivery in this State.  b. The provisions of P.L.1982, c.94 (C.17B:26A-1 et seq.) shall not apply to health insurance policies, including group conversion policies, provided to medicare eligible persons that are not advertised, marketed, designed primarily as or otherwise held out to be medicare supplement policies.  L.1992,c.163,s.1.
NJ Rev Stat § 17B:26A-10 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:26A-10 - Filing of copies of advertising materials, regulations

17B:26A-10. Filing of copies of advertising materials, regulations  8. a. Every insurer shall file with the Department of Insurance a copy of all advertising materials to be used in promoting medicare supplement policies to which residents of this State will have access, and through which the insurer intends, or by implication purports to the reasonable, targeted consumer its intent, to make such policies available for purchase or enrollment in this State. The requirements of this section shall apply to all advertisements in any medium, whether in print or by means of television or radio broadcast. Filings shall be made at least 30 days prior to the date on which the advertisement is to be used in this State, or made accessible to residents of this State.  b. The commissioner may, in the public interest, promulgate regulations governing medicare supplement policy advertising including, but not limited to, specific filing procedures, standards upon which review may be based, celebrity endorsements, unfair practices and review and disapproval procedures.  c. Notwithstanding the provisions of subsection b. of this section, the commissioner may disapprove any advertisement for use in this State at any time if he determines that the advertisement misrepresents the product, misleads the targeted consumer, uses a strategy which involves scare tactics, unnecessarily confusing data or representation, false or fraudulent statements or otherwise violates any applicable laws of this State or regulations promulgated thereunder.  L.1992,c.163,s.8.
NJ Rev Stat § 17B:26A-11 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:26A-11 - Additional remedies

17B:26A-11. Additional remedies  9. In addition to any other applicable penalties for violation of the provisions of Title 17B of the New Jersey Statutes, the commissioner may require any health insurer violating the provisions of P.L.1982, c.94 (C.17B:26A-1 et seq.) to cease marketing any medicare supplement policy or certificate in this State which is related directly or indirectly to the violation, require that insurer to take such action as is necessary to comply with the provisions of that act, or both.  L.1992,c.163,s.9.
NJ Rev Stat § 17B:26A-16 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:26A-16 - Audit required, conditions

17B:26A-16. Audit required, conditions  5. a. Whenever the contracting carrier reports a net loss to the commissioner pursuant to paragraph (2) of subsection a. of section 4 of this act, the related operations of the contracting carrier and any losses incurred by the contracting carrier regarding Medicare supplement insurance policies or contracts issued pursuant to subsection a. of section 3 of this act shall be subject to an audit conducted by a qualified independent certified public accountant prior to the imposition of any assessment pursuant to subsection b. of section 4 of this act. b. The auditor shall be selected and approved by the governing board of the plan through a competitive bidding process of certified public accountants qualified in New Jersey to perform such audits. The audit shall include: (1) a review of the handling and accounting of assets and monies of the contracting carrier; (2) a determination that administrative expenses have been properly allocated and are reasonable; (3) a review of the internal financial controls of the contracting carrier; (4) a review of the annual financial report of the contracting carrier; and (5) a review of the calculation by the commissioner of any assessments for net losses. c. A copy of the audit and related management letters shall be delivered to the governing board of the plan, to the commissioner and to each carrier and health maintenance organization to which the provisions of this act apply. The audit report shall be reviewed by the governing board of the plan. Upon recommendation of the governing board, the contracting carrier shall implement any recommendations made by the auditor. L.1995,c.229,s.5.
NJ Rev Stat § 17B:26A-17 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:26A-17 - Definitions.

17B:26A-17 Definitions.  6. As used in this act: "Carrier" means an insurance company or service corporation authorized to issue health benefits plans in this State. "Financially impaired" means a carrier or health maintenance organization which, after the effective date of P.L.1995, c.229 (C.17B:26A-12 et seq.), is not insolvent, but is deemed by the commissioner to be potentially unable to fulfill its contractual obligations, or a carrier or health maintenance organization which is under an order of rehabilitation or conservation by a court of competent jurisdiction. "Health benefits plan" means a hospital and medical expense insurance policy; hospital service corporation contract, medical service corporation contract or health service corporation contract delivered or issued for delivery in this State. "Newly eligible" means first eligible for Medicare benefits by reason of age or disability on or after January 1, 2020, in accordance with 42 U.S.C. s.426 or 426-1. L.1995, c.229, s.6; amended 2019, c.139, s.4.
NJ Rev Stat § 17B:27-26 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27-26 - Definitions and requirements

17B:27-26. Definitions and requirements  Any policy or contract of health insurance which covers more than one person, other than a blanket insurance policy, or a policy issued pursuant to section 17B:26-2a(3), shall be deemed a group health insurance policy. No group health insurance policy may be delivered or issued for delivery in this State unless it conforms to one of the descriptions set forth in sections 17B:27-27 to 17B:27-29, inclusive. L.1971, c. 144, s. 17B:27-26.
NJ Rev Stat § 17B:27-27 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27-27 - Employer, trustee, labor union, association groups

17B:27-27. Employer, trustee, labor union, association groups  A policy issued to an employer or to the trustees of a fund established by one or more employers, or issued to a labor union, or issued to an association formed for purposes other than obtaining such insurance, or issued to the trustees of a fund established by one or more labor unions or by one or more employers and one or more labor unions, insuring employees and members of associations or labor unions. L.1971, c. 144, s. 17B:27-27.
NJ Rev Stat § 17B:27-28 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27-28 - Other groups as permitted under group life insurance

17B:27-28. Other groups as permitted under group life insurance  Group health insurance may also be provided under a policy issued to cover such other groups as may be covered for group life insurance. L.1971, c. 144, s. 17B:27-28.
NJ Rev Stat § 17B:27-29 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27-29 - Discretionary groups

17B:27-29. Discretionary groups  A policy issued to insure any other group which, in the opinion of the commissioner, may be insured for group health insurance in accordance with sound underwriting principles. L.1971, c. 144, s. 17B:27-29.
NJ Rev Stat § 17B:27-30.1 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27-30.1 - Benefits provided by group policy to subscriber's child.

17B:27-30.1 Benefits provided by group policy to subscriber's child.  11. a. A policy which provides hospital or medical expense benefits under 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 policy shall not deny coverage for an insured's child on the grounds that: (1) The child was born out of wedlock; (2) The child is not claimed as a dependent on the insured's federal tax return; (3) The child does not reside with the insured or in the insurer's service area, provided that, in the case of a managed care plan, the child complies with the terms and conditions of the policy 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 insurance policy of a noncustodial parent, the insurer shall: (1) Provide such information to the custodial parent as may be necessary for the child to obtain benefits 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 covered 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 insured is eligible for dependent coverage and is required by a court or administrative order to provide health insurance coverage for his child, the insurer 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 under the health insurance policy if the parent who is the insured fails to enroll the child; and (3) Not terminate coverage of the child unless the parent who is the insured provides the insurer 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.11; amended 2019, c.356 s.4.