reglab/housing_qa huggingface dataset:
NJ Rev Stat § 17B:27-74 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27-74 - Filing of form required for delivery, issuance of group life insurance.

17B:27-74 Filing of form required for delivery, issuance of group life insurance.  7. a. No group life insurance policy, or application, if a written application is required and is to be made a part of the policy, certificate, printed rider or endorsement for use with the policy, shall be delivered or issued for delivery in this State unless the form has been filed with the Commissioner of Banking and Insurance for approval in accordance with the provisions of section 16 of P.L.1995, c.73 (C.17B:25-18.2). b. If a form is disapproved for filing by the commissioner during the 60-day period provided in section 16 of P.L.1995, c.73 (C.17B:25-18.2), it may not be delivered or issued for delivery unless it is resubmitted and approved in accordance with the provisions of subsections b., c., and d., of section 16 of P.L.1995, c.73 (C.17B:25-18.2). Such disapproval shall be subject to review in accordance with the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.). c. Any form which is filed by the commissioner or deemed filed may be so delivered or issued for delivery until such time as any subsequent withdrawal of the filing by the commissioner, following an opportunity for a hearing held in accordance with the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), becomes final in accordance therewith. d. This section shall not apply to documents which relate only to the manner of distribution of benefits or to the reservation of rights and benefits under group life insurance policies and which are used at the request of the individual insured or policyholder. e. The disapproval by the commissioner of any form may be on the grounds that the form contains provisions which are unjust, unfair, inequitable, misleading, or contrary to law or to the public policy of this State. L.2005,c.190,s.7.
NJ Rev Stat § 17B:27-75 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27-75 - Payment of benefits.

17B:27-75 Payment of benefits.  8. a. Notwithstanding any policy provision to the contrary, benefits under a group life insurance policy subject to this act shall become payable by reason of the death of the insured within 60 days after the receipt of due proof of death and, at the insurer's option, proof of the interest of the claimant. b. If a claim or a portion of a claim for benefits under a policy requires additional investigation or is denied by the insurer, the claimant shall be notified in writing no later than 45 days following receipt by the insurer of due proof of death, proof of the interest of the claimant, or any other document or information requested by the insurer under the terms of the policy, that the claim, or a portion thereof, is subject to additional investigation or denied, and the reason the claim is being investigated or denied. Notwithstanding the provisions of this subsection b. to the contrary, the notice to the claimant for any claim which the insurer concludes, based upon its investigation and which conclusion is reasonably based upon the contents of the insurer's claim file, constitutes probable cause for fraud shall not be required to contain the specific reasons for the investigation. A conclusion of fraud that is not reasonably based upon the contents of the insurer's claim file shall be a violation of section 1 of P.L.1975, c.101 (C.17B:30-13.1), notwithstanding that the violation did not occur with such frequency as to indicate a general business practice. Any uncontested portion of a claim shall be paid no later than 60 days following receipt of due proof of death, proof of the interest of the claimant, or any other document or information requested by the insurer under the terms of the policy. c. The insurer, upon receipt of any document or information requested relating to a claim or portion of a claim under investigation, shall pay the benefits for which the claim is made, or deny the claim no later than 90 days following the receipt of the document or information. d. Payment of a claim or a portion thereof that is not under investigation by the insurer shall be overdue if not remitted to the claimant by the insurer on or before 60 days following receipt of due proof of death, proof of the interest of the claimant, or any other document or information requested by the insurer pursuant to the policy. Payment of a claim, or a portion of a claim under investigation, or denied, that becomes eligible for payment shall be overdue if not remitted to the claimant by the insurer on or before 90 days following receipt of due proof of death, proof of the interest of the claimant, or any other document or information requested by the insurer. Overdue payments shall bear an annual rate of interest equal to the average rate of return of the State of New Jersey Cash Management Fund, established pursuant to section 1 of P.L.1977, c.281 (C.52:18A-90.4), for the preceding fiscal year, rounded to the nearest one-half percent. L.2005,c.190,s.8.
NJ Rev Stat § 17B:27A-2.1 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27A-2.1 - Regulations.

17B:27A-2.1 Regulations.  36. The Commissioner of Banking and Insurance shall, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), adopt regulations necessary to implement sections 9 through 25 and sections 29 through 34 of this act. L.2008, c.38, s.36.
NJ Rev Stat § 17B:27A-2.2 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27A-2.2 - Effective date.

17B:27A-2.2 Effective date.  37. Sections 1 through 8, 26 through 28, 36 and this section of this act shall take effect immediately and sections 9 through 25 and 29 through 35 of this act shall take effect on the 180th day after enactment, except that the 80 percent minimum loss ratio requirements in sections 16, 19, and 24 of this act shall take effect on January 1 next following the date of enactment. Sections 9 through 25 and 29 through 35 shall apply to all contracts and policies that are delivered, issued, executed or renewed or approved for issuance or renewal in this State on or after the effective date provided herein, but the Commissioner of Banking and Insurance may take such anticipatory administrative action in advance thereof as shall be necessary for the implementation of this act. L.2008, c.28, s.37.
NJ Rev Stat § 17B:27A-4 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27A-4 - Offering of individual health benefits required by issuer of small employer health benefits plans.

17B:27A-4 Offering of individual health benefits required by issuer of small employer health benefits plans.  3. a. No later than 180 days after the effective date of this section of P.L.2008, c.38, a carrier shall, as a condition of issuing small employer health benefits plans in this State, also offer individual health benefits plans. The plans shall be offered on an open enrollment, modified community rated basis, pursuant to the provisions of this act and P.L.2008, c.38. Every carrier that issues small employer health benefits plans pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.) shall make a good faith effort to market individual health benefits plans.  b. A carrier shall offer to an eligible person a choice of at least three individual health benefits plans established by the board pursuant to section 6 of P.L.1992, c.161 (C.17B:27A-7).  c. (1) (Deleted by amendment, P.L.2019, c.359). (2) (Deleted by amendment, P.L.2019, c.359).  (3) (Deleted by amendment, P.L.2019, c.359).  (4) (Deleted by amendment, P.L.2019, c.359). (5) The provisions of section 13 of P.L.1985, c.236 (C.17:48E-13), N.J.S.17B:26-1, and section 8 of P.L.1973, c.337 (C.26:2J-8) with respect to the filing of policy forms shall not apply to health plans issued on or after the effective date of this act.  (6) The provisions of section 27 of P.L.1985, c.236 (C.17:48E-27) and section 7 of P.L.1988, c.71 (C.17:48E-27.1) with respect to rate filings shall not apply to individual health plans issued on or after the effective date of this act.  d. Every group conversion contract or policy issued after the effective date of this act shall be issued pursuant to this section; except that this requirement shall not apply to any group conversion contract or policy in which a portion of the premium is chargeable to, or subsidized by, the group policy from which the conversion is made.  e. (Deleted by amendment, P.L.2008, c.38). f. (Deleted by amendment, P.L.2019, c.359) L.1992, c.161, s.3; amended 1993, c.164, s.3; 1994, c.102, s.1; 2008, c.38, s.11; 2019, c.359, s.2.
NJ Rev Stat § 17B:27A-4.1 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27A-4.1 - Individual policy, contract for hospital, medical expense benefits, coverage of subscriber's child.

17B:27A-4.1 Individual policy, contract for hospital, medical expense benefits, coverage of subscriber's child.  7. a. A policy or contract 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 or contract shall not deny coverage for a policy or contract holder'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 policy or contract holder's federal tax return; (3) The child does not reside with the policy or contract holder or in the carrier's service area, provided that, in the case of a managed care plan, the child complies with the terms and conditions of the policy or contract 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 policy or contract of a noncustodial parent, the carrier 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 policy or contract holder is eligible for dependent coverage and is required by a court or administrative order to provide health insurance coverage for his child, the carrier 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 policy or contract if the parent who is the policy or contract holder fails to enroll the child; and (3) Not terminate coverage of the child unless the parent who is the policy or contract holder provides the carrier 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.7; amended 2019, c.356, s.6.
NJ Rev Stat § 17B:27A-4.2 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27A-4.2 - Requirements applicable to State Medicaid

17B:27A-4.2. Requirements applicable to State Medicaid  8. A carrier shall not impose requirements on the Division of Medical Assistance and Health Services in the Department of Human Services which has been assigned the rights of an individual who is eligible for medical assistance under the State Medicaid program, that are different from requirements applicable to an agent or assignee of any other policy or contract holder. L.1995,c.288,s.8.
NJ Rev Stat § 17B:27A-4.3 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27A-4.3 - Eligibility for enrollment in individual health benefits plan

17B:27A-4.3. Eligibility for enrollment in individual health benefits plan  4. Notwithstanding any other provision of law to the contrary, a carrier shall not consider a person's eligibility for medical assistance pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.), or the equivalent statute in another state, when determining the person's eligibility for enrollment in, or the provision of benefits under, an individual health benefits plan delivered, issued or executed in this State. L.1995,c.291,s.4.
NJ Rev Stat § 17B:27A-5 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27A-5 - Laws not applicable to managed care health benefits plans.

17B:27A-5 Laws not applicable to managed care health benefits plans.  4. The following provisions shall not apply to managed care health benefits plans issued pursuant to section 3 of this act:  Sections 12, 32 through 35, inclusive, of P.L.1985, c.236 (C.17:48E-12 and C.17:48E-32 through C.17:48E-35, inclusive); section 2 of P.L.1987, c.62 (C.17:48E-35.1); sections 3, 4 and 6 of P.L.1991, c.279 (C.17:48E-35.4, 17B:26-2.1e and 26:2J-4.4); section 1 of P.L.1977, c.118 (C.17B:26-2.1); section 1 of P.L.1983, c.53 (C.17B:26-2.1a); section 1 of P.L.1987 c.64 (C.17B:26-2.1c); P.L.1979, c.328 (C.17B:26-2.2 et seq.); and sections 1 and 2 of P.L.1979, c.161 (C.17B:26-44.1 and C.17B:26-44.2). L.1992, c.161, s.4; amended 2019, c.359, s.3.
NJ Rev Stat § 17B:27A-6.1 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27A-6.1 - Individual Health Coverage Program, open enrollment period established.

17B:27A-6.1 Individual Health Coverage Program, open enrollment period established.  1. Notwithstanding the provisions of any other law, rule or regulation to the contrary, the board of the New Jersey Individual Health Coverage Program established pursuant to section 9 of P.L.1992, c.161 (C.17B:27A-10) shall establish, by regulation, an annual open enrollment period during which time individuals are permitted to enroll in an individual health benefits plan and individuals who already have coverage may replace current coverage. During any plan year in which the State is on the federally-facilitated exchange, the annual open enrollment period shall conform to federal requirements, unless the State is permitted to offer a longer open enrollment period. During any plan year in which the State operates a State-based exchange, the open enrollment period shall be set by New Jersey's State-based exchange and shall not be less than 90 days.  L.2019, c.357, s.1.
NJ Rev Stat § 17B:27A-7.1 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27A-7.1 - Coverage for birth and natal care; individual health policy

17B:27A-7.1. Coverage for birth and natal care; individual health policy  5. a. Every policy that provides maternity benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1992, c.161 (C.17B:27A-2 et seq.) or approved for issuance or renewal in this State by the Commissioner of Insurance on or after the effective date of this act shall provide benefits for a minimum of 48 hours of in-patient care following a vaginal delivery and a minimum of 96 hours of in-patient care following a cesarean section for a mother and her newly born child in a health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.). The provisions of this section shall apply to all policies in which the insurer has reserved the right to change the premium.  b. Notwithstanding the provisions of subsection a. of this section, a policy that provides coverage for post-delivery care to a mother and her newly born child in the home shall not be required to provide for a minimum of 48 hours and 96 hours, respectively, of in-patient care unless such in-patient care is determined to be medically necessary by the attending physician or is requested by the mother. For the purposes of this section, attending physician shall include the attending obstetrician, pediatrician or other physician attending the mother or newly born child.  c. Every insurer shall provide notice to policyholders regarding the coverage required by this section in accordance with this subsection and regulations promulgated by the Commissioner of Health pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.). The notice shall be in writing and prominently positioned in any literature or correspondence and shall be transmitted at the earliest of: (1) the next mailing to the policyholder; (2) the yearly informational packet sent to the policyholder; or (3) January 1, 1996.  L.1995,c.138,s.5.
NJ Rev Stat § 17B:27A-7.2 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27A-7.2 - Coverage for minimum inpatient care following mastectomy by individual health benefits plan

17B:27A-7.2. Coverage for minimum inpatient care following mastectomy by individual health benefits plan  6. a. Every individual health benefits plan that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1992, c.161 (C.17B:27A-2 et seq.) or approved for issuance or renewal in this State on or after the effective date of this act shall provide benefits for a minimum of 72 hours of inpatient care following a modified radical mastectomy and a minimum of 48 hours of inpatient care following a simple mastectomy. The health benefits plan shall not require a health care provider to obtain authorization from the carrier for prescribing 72 or 48 hours as appropriate, of inpatient care as provided for in this section. The provisions of this section shall not be construed to: require a patient to receive inpatient care for 72 or 48 hours, as appropriate, if the patient in consultation with the patient's physician determines that a shorter length of stay is medically appropriate; or relieve a patient or a patient's physician, if appropriate, of any notification requirements to the carrier under the health benefits plan. The benefits shall be provided to the same extent as for any other sickness under the health benefits plan. The provisions of this section shall apply to all health benefit plans in which the carrier has reserved the right to change the premium. b. The New Jersey Individual Health Coverage Program Board shall adopt regulations pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) to implement the provisions of this section.  L.1997,c.149,s.6.
NJ Rev Stat § 17B:27A-7.3 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27A-7.3 - Applicability of Health Care Quality Act

17B:27A-7.3 Applicability of Health Care Quality Act  24. Notwithstanding the provisions of P.L.1992, c.161 (C.17B:27A-2 et seq.) to the contrary, no policy or contract shall be delivered, issued, executed or renewed on or after the effective date of this act unless the policy or contract meets the requirements of P.L.1997, c.192 (C.26:2S-1 et al.) and regulations adopted thereto. The provisions of this section shall apply to all policies or contracts in which the carrier has reserved the right to change the premium. L.1997,c.192,s.24.
NJ Rev Stat § 17B:27A-7.4 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27A-7.4 - Coverage for treatment of inherited metabolic diseases by individual health benefits plan.

17B:27A-7.4 Coverage for treatment of inherited metabolic diseases by individual health benefits plan.  6. No individual health benefits plan subject to the provisions of P.L.1992, c.161 (C.17B:27A-2 et seq.) shall be delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State on or after the effective date of this act, unless the health benefits plan provides benefits to each person covered thereunder for expenses incurred in the therapeutic treatment of inherited metabolic diseases, including the purchase of medical foods and low protein modified food products, when diagnosed and determined to be medically necessary by the covered person's physician. For the purposes of this section, "inherited metabolic disease" means a disease caused by an inherited abnormality of body chemistry for which testing is mandated pursuant to P.L.1977, c.321 (C.26:2-110 et seq.); "low protein modified food product" means a food product that is specially formulated to have less than one gram of protein per serving and is intended to be used under the direction of a physician for the dietary treatment of an inherited metabolic disease, but does not include a natural food that is naturally low in protein; and "medical food" means a food that is intended for the dietary treatment of a disease or condition for which nutritional requirements are established by medical evaluation and is formulated to be consumed or administered enterally under direction of a physician. The benefits shall be provided to the same extent as for any other medical condition under the health benefits plan. The provisions of this section shall apply to all health benefits plans in which the carrier has reserved the right to change the premium. L.1997,c.338,s.6.
NJ Rev Stat § 17B:27A-7.5 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27A-7.5 - Individual health benefits plan to provide coverage for mental health conditions and substance use disorders.

17B:27A-7.5 Individual health benefits plan to provide coverage for mental health conditions and substance use disorders.  6. a. (1) Every individual health benefits plan that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1992, c.161 (C.17B:27A-2 et seq.) or approved for issuance or renewal in this State on or after the effective date of this act shall provide benefits for mental health conditions and substance use disorders under the same terms and conditions as provided for any other sickness under the health benefits plan and shall meet the requirements of the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, 42 U.S.C. s.18031(j), and any amendments to, and federal guidance or regulations issued under that act, including 45 C.F.R. Parts 146 and 147 and 45 C.F.R. s.156.115(a)(3).  (2) As used in this section: "Mental health condition" means a condition defined to be consistent with generally recognized independent standards of current medical practice referenced in the current version of the Diagnostic and Statistical Manual of Mental Disorders. "Same terms and conditions" means that the plan cannot apply more restrictive non-quantitative limitations, such as utilization review and other criteria or more quantitative limitations such as copayments, deductibles, aggregate or annual limits or benefit limits to mental health condition and substance use disorder benefits than those applied to substantially all other medical or surgical benefits.  "Substance use disorder" means a disorder defined to be consistent with generally recognized independent standards of current medical practice referenced in the most current version of the Diagnostic and Statistical Manual of Mental Disorders.  b. (Deleted by amendment, P.L.2019, c.58) c. The provisions of this section shall apply to all health benefits plans in which the carrier has reserved the right to change the premium. d. Nothing in this section shall reduce the requirement for a plan to provide benefits pursuant to section 6 of P.L.2017, c.28 (C.17B:27A-7.21). L.1999, c.106, s.6; amended 2019, c.58, s.6.