reglab/housing_qa huggingface dataset:
NJ Rev Stat § 26:2J-4.37 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-4.37 - Health maintenance organization to provide coverage for prescription eye drops.

26:2J-4.37 Health maintenance organization to provide coverage for prescription eye drops.  8. a. A health maintenance organization contract which provides hospital or medical expense benefits that include coverage for prescription eye drops, issued or continued in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act, 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 enrollee or covered person does not exceed the number of additional quantities indicated on the original prescription by the prescribing health care practitioner. b. The provisions of this section shall apply to those contracts for health care services by health maintenance organizations under which the health maintenance organization has reserved the right to change the schedule of charges. L.2013, c.50, s.8.
NJ Rev Stat § 26:2J-4.38 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-4.38 - Health maintenance organization, coverage for synchronization of prescribed medications.

26:2J-4.38 Health maintenance organization, coverage for synchronization of prescribed medications.  6. a. Every certificate of authority to establish and operate a health maintenance organization in this State issued, continued or renewed in this State, or approved for issuance, continuation or renewal in this State 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.  b. This section shall apply to all enrollee agreements in which the health maintenance organization has reserved the right to change the schedule of charges.  c. 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.6.
NJ Rev Stat § 26:2J-4.41 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-4.41 - HMO to cover digital tomosynthesis of the breast.

26:2J-4.41 HMO to cover digital tomosynthesis of the breast.  8. a. A health maintenance organization contract for health care services that is delivered, issued, executed, or renewed in this State pursuant to P.L.1973, c.337 (C.26:2J-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, 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.  c. This section shall apply to those contracts for health care services under which the health maintenance organization has reserved the right to change the schedule of charges for enrollee coverage. L.2017, c.305, s.8.
NJ Rev Stat § 26:2J-4.42 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-4.42 - HMO to provide coverage for donated human breast milk.

26:2J-4.42 HMO to provide coverage for donated human breast milk.  8. a. A health maintenance organization contract that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, 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. The provisions of this section shall apply to those contracts for health care services by health maintenance organizations under which the health maintenance organization has reserved the right to change the schedule of charges.c. Nothing in this section shall preclude the health maintenance organization from performing utilization review, including periodic review of the medical necessity of a particular service. d. The benefits shall be provided to the same extent as for any other prescribed items under the contract. e. If there is no supply of human breast milk that meets the requirements of paragraph (2) of subsection a. of this section, the health maintenance organization shall not be required to provide coverage of expenses pursuant to this section. L.2017, c.309, s.8.
NJ Rev Stat § 26:2J-4.43 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-4.43 - Health maintenance organization to provide coverage for standard fertility preservation services.

26:2J-4.43 Health maintenance organization to provide coverage for standard fertility preservation services.  5. a. A health maintenance organization contract that provides hospital or medical expense benefits for groups with more than 50 persons and is delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, 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. A health maintenance organization providing coverage under this section shall not determine the provision of standard fertility preservation services based on an enrollee'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.  c. This section shall apply to those health maintenance organization contracts in which the health maintenance organization has reserved the right to change the premium. L.2019, c.306, s.5.
NJ Rev Stat § 26:2J-4.45 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-4.45 - Health maintenance organization to cover preventive services.

26:2J-4.45 Health maintenance organization to cover preventive services.  8. a. A health maintenance organization contract that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, 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. d. The provisions of this section shall apply to those contracts in which the health maintenance organization has reserved the right to change the premium. L.2019, c.360, s.8.
NJ Rev Stat § 26:2J-4.46 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-4.46 - Health maintenance organization to provide certain coverage for prescription drugs.

26:2J-4.46 Health maintenance organization to provide certain coverage for prescription drugs.  8. a. Notwithstanding any other provision of law to the contrary, a health maintenance organization that offers a contract that provides benefits for expenses incurred in the purchase of prescription drugs and is delivered, issued, executed, or renewed in this State, shall ensure that at least 25 percent of all plans, or at least one plan if the organization offers less than four plans, offered by the organization in each rating area and in each of the bronze, silver, gold, and platinum levels of coverage, in the individual market pursuant to P.L.1992, c.161 (C.17B:27A-2 et seq.), and in the small employer market pursuant to P.L.1992, c.162 (C.17B:27A-17), shall conform with the following:  (1) (a) an agreement that provides a silver, gold, or platinum level of coverage, as defined in 45 C.F.R. s.156.140, shall limit a covered person's cost-sharing, including any copayment or coinsurance, for prescription drugs, including specialty drugs, to no more than $150 per month for each prescription drug for up to a 30-day supply of any single drug; (b) an agreement that provides a bronze level of coverage, as defined in 45 C.F.R. s.156.140, shall ensure that any required covered person's cost-sharing, including any copayment or coinsurance, does not exceed $250 per month for each prescription drug for up to a 30-day supply of any single drug;  (c) an agreement that meets the requirements of a catastrophic plan, as defined in 45 C.F.R. s.156.155, shall be exempt from the requirements of subparagraphs (a) and (b) of this paragraph; (2) except as provided in paragraph (3) of this subsection, the limits described in paragraph (1) of this subsection shall apply at any point in the benefit design, including before and after any applicable deductible is reached; and (3) for prescription drug benefits offered in conjunction with a high-deductible health plan, the plan shall not provide prescription drug benefits until the expenditures applicable to the deductible under the plan have met the amount of the minimum annual deductibles in effect for self-only and family coverage under section 223(c)(2)(A)(i) of the federal Internal Revenue Code (26 U.S.C. s.223(c)(2)(A)(i)) for self-only and family coverage, respectively. Once the foregoing expenditure amount has been met under the plan, coverage for prescription drug benefits shall begin, and the limit on out-of-pocket expenditures for prescription drug benefits shall be as specified in paragraph (1) of this subsection. b. The provisions of this section shall apply to all agreements in which the health maintenance organization has reserved the right to change the premium. L.2019, c.471, s.8.
NJ Rev Stat § 26:2J-4.47 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-4.47 - Health maintenance organization to cover adolescent depression screenings.

26:2J-4.47 Health maintenance organization to cover adolescent depression screenings.  8. A health maintenance organization contract for health care services that is delivered, issued, executed, or renewed in this State pursuant to P.L.1973, c.337 (C.26:2J-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, 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 health care services shall be provided to the same extent as for any other condition under the contract, except that the health maintenance organization shall not impose on covered persons receiving these services any form of cost sharing, including, but not limited to, copayments, deductibles, or coinsurance. This section shall apply to those contracts for health care services under which the right to change the schedule of charges for enrollee coverage is reserved. L.2021, c.73, s.8.
NJ Rev Stat § 26:2J-5 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-5 - Powers of health maintenance organizations

26:2J-5. Powers of health maintenance organizations  a. The powers of a health maintenance organization include the following: (1) the purchase, lease, construction, renovation, operation, or maintenance of health care facilities, and their ancillary equipment, and such property as may reasonably be required for its principal office or for such other purposes as may be necessary in the transaction of the business of the organization; (2) the receiving of funds by loan or otherwise; (3) the making of loans to a medical group under contract with it in furtherance of its program or the making of loans to a corporation or corporations under its control for the purpose of acquiring or constructing health care facilities or in furtherance of a program providing health care services to enrollees; (4) the assumption of responsibility for the furnishing of health care services through providers which are under contract with or employed by the health maintenance organization to persons including but not limited to enrollees; (5) the contracting with any person for the performance on its behalf of certain functions such as marketing, enrollment and administration; (6) the contracting with an insurance company licensed in this State, or with a hospital or medical service corporation authorized to do business in this State, for the provision of insurance, indemnity, or reimbursement against the cost of health care services provided by the health maintenance organization which may include provisions for reasonable classifications for the purpose of establishing rates and reasonable restrictions based on underwriting consideration; and (7) the offering, in addition to basic health care services, of: (a) additional health care services; (b) indemnity benefits covering out-of-area or emergency services; and (c) indemnity benefits, in addition to those relating to out-of-area and emergency services, provided through insurers or hospital or medical service corporations. b. (1) A health maintenance organization shall file notice, with adequate supporting information, with the commissioner prior to the exercise of any power granted in subsection a. (1) or (2) of this section. The commissioner shall disapprove such exercise of power if in his opinion it would substantially and adversely affect the financial soundness of the health maintenance organization and endanger its ability to meet its obligations. If the commissioner does not disapprove within 30 days of filing, it shall be deemed approved. (2) The commissioner may promulgate rules and regulations exempting from the filing requirements of paragraph (1) of this subsection those activities having a de minimis effect. L.1973, c. 337, s. 5, eff. Dec. 27, 1973.
NJ Rev Stat § 26:2J-6 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-6 - Governing body

26:2J-6. Governing body  a. The governing body of any health maintenance organization may include providers, other individuals, or both. b. Such governing body shall establish a mechanism to afford the enrollees an opportunity to participate in matters of policy and operation through the establishment of advisory panels, by the use of advisory referenda on major policy decisions, or through the use of other mechanisms. L.1973, c. 337, s. 6, eff. Dec. 27, 1973.
NJ Rev Stat § 26:2J-7 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-7 - Protection against wrongful acts

26:2J-7. Protection against wrongful acts  Any director, officer employee or partner of a health maintenance organization who receives, collects, disburses, or invests funds in connection with the activities of such organization shall be bonded in an amount to be determined by the commissioner. L.1973, c. 337, s. 7, eff. Dec. 27, 1973.
NJ Rev Stat § 26:2J-9 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-9 - Annual report

26:2J-9. Annual report  a. Every health maintenance organization shall annually, on or before March 1, file a report verified by at least two principal officers with the commissioner, with a copy to the Commissioner of Insurance covering the preceding calendar year. b. Such report shall be on forms prescribed by the commissioner and shall include: (1) a financial statement of the organization, including its balance sheet and receipts and disbursements for the preceding year certified by an independent public accountant; (2) any material changes in the information submitted pursuant to section 3 c. hereof; (3) the number of persons enrolled during the year, the number of enrollees as of the end of the year and the number of enrollments terminated during the year; (4) a summary of information compiled pursuant to section 4 a. (2)(c) hereof in such form as required by the commissioner"; and (5) such other information relating to the performance of the health maintenance organization as is necessary to enable the commissioner to carry out his duties under this act. L.1973, c. 337, s. 9, eff. Dec. 27, 1973.
NJ Rev Stat § 26:2J-10 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-10 - Information to enrollees

26:2J-10. Information to enrollees  a. Every health maintenance organization shall annually provide to its enrollees: (1) a summary of any material changes since the issuance of the last report; (2) a description of the available health care services and information as to where and how to secure them; and (3) a clear and understandable description of the health maintenance organization's method for resolving enrollee complaints. b. Every health maintenance organization shall make available to its enrollees the most recent annual statement of financial condition. L.1973, c. 337, s. 10, eff. Dec. 27, 1973.