reglab/housing_qa huggingface dataset:
NJ Rev Stat § 26:2J-25 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-25 - Statutory construction and relationship to other laws.

26:2J-25 Statutory construction and relationship to other laws.  25. Statutory construction and relationship to other laws. a. Except as otherwise provided in this act, provisions of the insurance law and provisions of hospital, medical or health service corporation laws shall not be applicable to any health maintenance organization granted a certificate of authority under this act. This provision shall not apply to an insurer or hospital, medical or health service corporation licensed and regulated pursuant to the insurance laws or the hospital, medical or health service corporation laws of this State except with respect to its health maintenance organization activities authorized and regulated pursuant to this act. Charges paid by or on behalf of enrollees of a health maintenance organization with respect to health care services shall not be subject to taxation by the State or any of its political subdivisions, except as otherwise provided in section 3 of P.L.2004, c.49 (C.26:2J-47). b. Solicitation of enrollees by a health maintenance organization granted a certificate of authority, or its representatives, shall not be construed to violate any provision of law relating to solicitation or advertising by health professionals. c. Any health maintenance organization authorized under this act shall not be deemed to be practicing medicine and shall be exempt from the provisions of chapter 9 of Title 45, Medicine and Surgery, of the Revised Statutes relating to the practice of medicine. d. Except as provided in P.L.2001, c.187 (C.2A:53A-30 et al.), no person participating in the arrangements of a health maintenance organization other than the actual provider of health care services or supplies directly to enrollees and their families shall be liable for negligence, misfeasance, nonfeasance or malpractice in connection with the furnishings of such services and supplies. The provisions of this subsection shall not be construed to eliminate any cause of action against a health maintenance organization otherwise provided by law. e. A health maintenance organization shall be subject to the provisions of P.L.1970, c.22 (C.17:27A-1 et seq.), including those relating to merger or acquisition of control. L.1973,c.337,s.25; amended 2001, c.2, s.1; 2001, c.187, s.8; 2004, c.49, s.4; 2005, c.129, s.1.
NJ Rev Stat § 26:2J-26 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-26 - Filings and reports as public documents.

26:2J-26 Filings and reports as public documents.  26. Filings and reports as public documents.  All applications, filings and reports required under this act shall be treated as public documents and, except for any examination being conducted pursuant to section 20 of P.L.1997, c.192 (C.26:2J-18.1), any matter pertaining to a change in capital or surplus pursuant to the provisions of P.L.2005, c.65 (C.26:2J-18.2 et al.) and contracts referred to in paragraphs (4) and (5) of subsection c. of section 3 of P.L.1973, c. 337 (C.26:2J-3), shall not be considered to be confidential. L.1973,c.337,s.26; amended 2005, c.65, s.6.
NJ Rev Stat § 26:2J-27 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-27 - Confidentiality of medical information

26:2J-27. Confidentiality of medical information  Any data or information pertaining to the diagnosis, treatment, or health of any enrollee or applicant obtained from such enrollee or from any provider by any health maintenance organization shall be held in confidence and shall not be disclosed to any person except to the extent that it may be necessary to carry out the purposes of this act; or upon the express consent of the enrollee or applicant; or pursuant to statute or court order for the production of evidence or the discovery thereof; or in the event of claim or litigation between such enrollee and the health maintenance organization wherein such data or information is pertinent. A health maintenance organization shall be entitled to claim any statutory privileges against such disclosure which the provider who furnished such information to the health organization is entitled to claim. L.1973, c. 337, s. 27, eff. Dec. 27, 1973.
NJ Rev Stat § 26:2J-28 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-28 - Commissioner of health's authority to contract

26:2J-28. Commissioner of health's authority to contract  The commissioner or where applicable the Commissioner of Insurance, in carrying out his obligations under sections 4 a. (2), and 18 a. hereof, may contract with qualified persons to make recommendations concerning the determinations required to be made by him. Such recommendations may be accepted in full or in part by the commissioner or Commissioner of Insurance. L.1973, c. 337, s. 28, eff. Dec. 27, 1973.
NJ Rev Stat § 26:2J-29 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-29 - Enrollment of State employees

26:2J-29. Enrollment of State employees  Any employee of the State or any subdivision of the State or any institution supported in whole or in part by the State may elect to enroll in a health maintenance organization and have all deductions from his salary or wages and all contributions being paid by his employer to any health insurer paid instead to a health maintenance organization; provided, however, in no event, shall an employer under this section make a contribution to any alternative health benefits program greater than the contribution being made to any health plan pursuant to a contract in existence on the effective date of this act. Any such employee shall at least annually be allowed to choose an alternative health benefits program made available through his employer. L.1973, c. 337, s. 29, eff. Dec. 27, 1973.
NJ Rev Stat § 26:2J-30 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-30 - Severability

26:2J-30. Severability  If any section, term, or provision of this act shall be adjudged invalid for any reason, such judgment shall not affect, impair, or invalidate any other section, term, or provision of this act, but the remaining sections, terms, and provisions shall be and remain in full force and effect. L.1973, c. 337, s. 30, eff. Dec. 27, 1973.
NJ Rev Stat § 26:2J-31 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-31 - Definitions

26:2J-31. Definitions  1. As used in this act: "Applicant" means any individual who seeks enrollment with a health maintenance organization for the purpose of obtaining medicare supplement health care services.  "Commissioner" means the Commissioner of Insurance. "Department" means the Department of Insurance. "Enrollee" means an individual who is enrolled with a health maintenance organization.  "Evidence of coverage" means any booklet, certificate, agreement or contract issued to an enrollee setting out the services and other benefits to which he is entitled.  "Health care services" means those services, including, but not limited to, inpatient hospital and physician care, and outpatient medical services, as set forth in the evidence of coverage.  "Health maintenance organization" means any person which, directly or through contracts with providers, furnishes health care services on a prepaid basis to enrollees in a designated geographic area in this State pursuant to the provisions of P.L.1973, c.337 (C.26:2J-1 et seq.).  "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.).  "Medicare supplement contract" means a group or individual contract or plan which is advertised, marketed or designed primarily as providing, or is otherwise held out to provide, medicare supplement health care services and under which an individual is enrolled, other than a contract issued pursuant to a contract under 42 U.S.C. s.1395l or 42 U.S.C. s.1395mm or a contract 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 health care services provided pursuant to a contract or plan 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 of the employers, or a combination thereof, or for members or former members, or a combination thereof, of the labor organizations.  "Medicare supplement evidence of coverage" means an evidence of coverage delivered to an enrollee who has medicare supplement health care services coverage under a medicare supplement contract.  "Medicare supplement health care services" means health care services which supplement medicare, provided under a medicare supplement contract as set forth in a medicare supplement evidence of coverage.  "Provider" means any physician, hospital or other person which is licensed or otherwise authorized in this State to furnish health care services.  L.1992,c.164,s.1.
NJ Rev Stat § 26:2J-32 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-32 - Applicability of act

26:2J-32. Applicability of act  2. Except as otherwise specifically provided: a. This act shall apply to all medicare supplement health care services provided pursuant to a medicare supplement contract or evidence of coverage delivered or issued for delivery in this State.  b. This act shall not apply to any health maintenance organization contract or evidence of coverage, including group conversion plans, provided to medicare eligible persons that are not advertised, marketed, designed primarily as or otherwise held out to provide medicare supplement health care services.  L.1992,c.164,s.2.
NJ Rev Stat § 26:2J-33 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-33 - Avoidance of duplication of benefits, regulations

26:2J-33. Avoidance of duplication of benefits, regulations  3. a. No medicare supplement contract or evidence of coverage shall provide for health care services which duplicate any benefits provided by medicare.  b. The commissioner shall promulgate regulations to establish specific standards for the provisions to be contained in any medicare supplement contract or evidence of coverage, which shall be in addition to and in accordance with the applicable laws of this State. The regulations may provide, but shall not be limited to:  (1) Terms of renewability; (2) Initial and subsequent conditions of eligibility; (3) Non-duplication of coverage; (4) Probationary periods; (5) Benefit limitations, exceptions and reductions; (6) Elimination periods; (7) Requirements for replacement; (8) Recurrent conditions; and (9) Definition of terms. c. The commissioner may promulgate regulations that specify prohibited medicare supplement contract or evidence of coverage provisions not otherwise specifically authorized by statute which, in the opinion of the commissioner, are unjust, unfair or unfairly discriminatory to any applicant for, or enrollee with, medicare supplement health care services coverage.  L.1992,c.164,s.3.
NJ Rev Stat § 26:2J-34 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-34 - Coverage for preexisting condition

26:2J-34. Coverage for preexisting condition  4. Notwithstanding any other provision of law to the contrary, a medicare supplement contract or evidence of coverage shall not deny medicare supplement health care services for losses incurred more than six months from the effective date of enrollment for a preexisting condition. The contract or evidence of coverage shall 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 six months of the effective date of enrollment.  L.1992,c.164,s.4.
NJ Rev Stat § 26:2J-35 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-35 - Regulations

26:2J-35. Regulations  5. The commissioner shall promulgate regulations to effectuate and enforce the provisions of this act and any regulations which are necessary to conform medicare supplement health care services provided under a medicare supplement contract or evidence of coverage 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 medicare supplement contracts 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 contracts at such time as this State is authorized under federal law to authorize Medicare Select contracts.  L.1992,c.164,s.5.
NJ Rev Stat § 26:2J-36 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-36 - Authorization for health maintenance organization to offer, provide medicare supplement health care services

26:2J-36. Authorization for health maintenance organization to offer, provide medicare supplement health care services  6. No health maintenance organization shall offer or provide medicare supplement health care services in this State without authorization by the commissioner. The commissioner shall grant authorization if he determines that the health maintenance organization has the financial and operational capability to provide such services. In making a determination, the commissioner may consider, but shall not be limited to, the following:  a. The number of enrollees; b. The geographic area to be serviced; c. The current and prospective financial condition of the health maintenance organization;  d. The anticipated impact on the health maintenance organization of providing medicare supplement health care services in addition to other services which it provides.  L.1992,c.164,s.6.
NJ Rev Stat § 26:2J-39 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-39 - 30-day return provision, refunds

26:2J-39. 30-day return provision, refunds  9. Notice shall be prominently printed on the first page of each medicare supplement contract and evidence of coverage stating in substance that the applicant shall have the right to return the contract or evidence of coverage within 30 days of its delivery and to have any premium or other fee refunded if, after examination of the contract or evidence of coverage, 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.1992,c.164,s.9.
NJ Rev Stat § 26:2J-40 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-40 - Filing of copy of advertising materials, regulations

26:2J-40. Filing of copy of advertising materials, regulations  10. a. Every health maintenance organization shall file with the department a copy of all advertising materials to be used in promoting medicare supplement health care services to which residents of this State will have access, and through which the health maintenance organization intends, or by implication purports to the reasonable, targeted consumer its intent, to make such services available for 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 health care services 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 representations, false or fraudulent statements or otherwise violates any applicable law of this State or regulation promulgated thereunder.  L.1992,c.164,s.10.
NJ Rev Stat § 26:2J-41 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-41 - Additional remedies

26:2J-41. Additional remedies  11. In addition to any other applicable penalties for violation of the relevant provisions of law, the commissioner may require a health maintenance organization violating the provisions of this act to cease marketing any medicare supplement contract or evidence of coverage in this State which is related directly or indirectly to the violation, require the health maintenance organization to take such action as is necessary to comply with the provisions of this act, or both.  L.1992,c.164,s.11.
NJ Rev Stat § 26:2J-42 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-42 - Health maintenance organization contract; compliance

26:2J-42. Health maintenance organization contract; compliance  24. No health maintenance organization contract, evidence of coverage, or other form subject to the filing requirements of P.L.1973, c.337 (C.26:2J-1 et seq.) or application for that coverage, if a written application is required and is to be made a part of that contract or evidence of coverage, or a printed rider or an endorsement for use with that contract or evidence of coverage, shall be delivered or issued for delivery in this State unless its provisions comply with all of the requirements of P.L.1973, c.337 (C.26:2J-1 et seq.) and any regulations adopted or guidelines published by the Commissioner of Insurance consistent with the requirements thereof. Any contract, evidence of coverage, application, rider, or endorsement issued or delivered in this State that is not in compliance with that law or regulations or guidelines shall be deemed to be in compliance with the requirements and shall be interpreted by the courts and among the persons affected by the contract or evidence of coverage as if that form were in compliance with the requirements; except that this provision shall not relieve the health maintenance organization from any penalty that may be imposed for violation of this act or any provision of P.L.1973, c.337 (C.26:2J-1 et seq.).  L.1995,c.73,s.24.
NJ Rev Stat § 26:2J-47 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-47 - Annual assessment on HMOs.

26:2J-47 Annual assessment on HMOs.  3. a. (1) For the fiscal years 2005 and 2006, the Commissioner of Banking and Insurance shall issue, in accordance with the provisions of this section, a special interim assessment of one percent, and in fiscal year 2007 and each fiscal year thereafter through fiscal year 2019, an annual assessment in the amount of two percent, in fiscal year 2020, an annual assessment in the amount of three percent, and in fiscal year 2021 and each fiscal year thereafter, an annual assessment in the amount of five percent on the net written premiums received by each health maintenance organization granted a certificate of authority to operate in this State pursuant to P.L.1973, c.337 (C.26:2J-1 et seq.), to be allocated to the Health Care Subsidy Fund established pursuant to section 8 of P.L.1992, c.160 (C.26:2H-18.58) for the purpose of providing charity care 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 al.). (2) "Net written premiums received" means direct premiums as reported on the annual financial statement submitted pursuant to section 9 of P.L.1973, c.337 (C.26:2J-9), and to the commissioner on a quarterly basis. b. The commissioner shall certify the amount of the annual assessment issued to each health maintenance organization as calculated pursuant to subsection a. of this section. Each health maintenance organization shall remit the amount so certified on a quarterly basis in each fiscal year to the Department of Banking and Insurance in accordance with the procedures established in P.L.1995, c.156 (C.17:1C-19 et seq.), and as prescribed by the commissioner, who may adjust the quarterly payments from time to time as necessary to meet the current and estimated assessment obligation of each health maintenance organization in each fiscal year. c. Amounts collected by the commissioner shall be allocated to the Health Care Subsidy Fund established pursuant to section 8 of P.L.1992, c.160 (C.26:2H-18.58) and used solely for the purpose of providing charity care 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 al.). d. (1) A health maintenance organization shall not impose any additional premium, fee or surcharge on its premium or enrollee charge to recoup any assessment paid pursuant to this section. (2) The provisions of paragraph (1) of this subsection shall not apply to a health maintenance organization with respect to any federally funded program underwritten by that health maintenance organization. L.2004, c.49, s.3; amended 2005, c.129, s.2; 2006, c.43, s.1; 2019, c.148; 2020, c.96.