reglab/housing_qa huggingface dataset:
NJ Rev Stat § 26:2J-4.19 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-4.19 - Coverage for certain dental procedures for the severely disabled or child age five or under by HMO.

26:2J-4.19 Coverage for certain dental procedures for the severely disabled or child age five or under by HMO.  6. a. A certificate of authority to establish and operate a health maintenance organization in this State pursuant to P.L.1973, c.337 (C.26:2J-1 et seq.), shall not be issued or continued by the Commissioner of Banking and Insurance on or after the effective date of this amendatory and supplementary act unless the health maintenance organization provides health care services to an enrollee who is severely disabled or a child age five or under for: (1) general anesthesia and hospitalization for dental services; or (2) a medical condition covered by the enrollee agreement which requires hospitalization or general anesthesia for dental services rendered by a participating dentist regardless of where the dental services are provided. b. A health maintenance organization may require prior authorization of hospitalization for dental services in the same manner that prior authorization is required for hospitalization for other covered diseases or conditions. c. This section shall apply to all contracts for health care services in which the health maintenance organization has reserved the right to change the schedule of charges. L.1999, c.49, s.6; amended 2012, c.17, s.270.
NJ Rev Stat § 26:2J-4.20 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-4.20 - HMO to provide coverage for mental health conditions and substance use disorders.

26:2J-4.20 HMO to provide coverage for mental health conditions and substance use disorders.  8. a. (1) Every enrollee agreement 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 health care services for mental health conditions and substance use disorders under the same terms and conditions as provided for any other sickness under the agreement 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 health maintenance organization 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 health care services limits to mental health condition and substance use disorder services than those applied to substantially all other medical or surgical health care services.  "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 enrollee agreements in which the health maintenance organization has reserved the right to change the premium. d. Nothing in this section shall reduce the requirement for a health maintenance organization to provide benefits pursuant to section 8 of P.L.2017, c.28 (C.26:2J-4.39). L.1999, c.106, s.8; amended 2012, c.17, s.271; 2019, c.58, s.8.
NJ Rev Stat § 26:2J-4.21 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-4.21 - HMO to provide continuing nursing home care, certain.

26:2J-4.21 HMO to provide continuing nursing home care, certain.  1. a. A certificate of authority to establish and operate a health maintenance organization in this State shall not be issued or continued by the Commissioner of Banking and Insurance on or after the effective date of this act unless the health maintenance organization offers health care services in conformance with the provisions of subsection b. of this section. b. If an enrollee is a resident of a skilled nursing facility, continuing care retirement community, or a retirement community which operates a skilled nursing facility on the premises of the community, regardless of whether the health maintenance organization is under contract with the skilled nursing facility or the skilled nursing facility at the continuing care retirement community or retirement community, the enrollee's primary care physician shall refer the enrollee to the skilled nursing facility or the community's Medicare-certified skilled nursing unit, as applicable, rather than to a skilled nursing facility separate from the facility or the community of origin, if: (1) the skilled nursing facility or the continuing care retirement community or retirement community with a skilled nursing facility has the capacity to provide the services the enrollee needs; (2) the primary care physician, in consultation with the enrollee or a representative of the enrollee's family, determines that the referral is in the best interest of the enrollee; (3) the skilled nursing facility or the continuing care retirement community or retirement community with a skilled nursing facility agrees to be reimbursed at the same contract rate negotiated by the health maintenance organization with similar providers for the same services and supplies in the same geographic area; and (4) the skilled nursing facility or the continuing care retirement community or retirement community with a skilled nursing facility meets all applicable State licensing and certification requirements. c. For the purposes of this act, "continuing care retirement community" means a continuing care facility operating under a certificate of authority issued by the Department of Community Affairs pursuant to P.L.1986, c.103 (C.52:27D-330 et seq.), and "retirement community" means a retirement community which is registered with the Department of Community Affairs pursuant to P.L.1977, c.419 (C.45:22A-21 et seq.).  L.1999, c.332, s.1; amended 2012, c.17, s.272.
NJ Rev Stat § 26:2J-4.22 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-4.22 - Coverage for hemophilia services by HMO

26:2J-4.22. Coverage for hemophilia services by HMO  10. Notwithstanding the provisions of P.L.1973, c.337 (C.26:2J-1 et seq.) to the contrary, a certificate of authority to establish and operate a health maintenance organization in this State shall not be issued or continued on or after the effective date of P.L.2000, c.121 (C.26:2S-10.1 et al.) unless the health maintenance organization meets the requirements of sections 1 and 2 of P.L.2000, c.121 (C.26:2S-10.1 and C.26:2S-10.2) and the regulations adopted thereto. The provisions of this section shall apply to all enrollee agreements in which the health maintenance organization has reserved the right to change the schedule of charges. L.2000,c.121,s.10.
NJ Rev Stat § 26:2J-4.24 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-4.24 - HMO agreement to provide coverage for colorectal cancer screening.

26:2J-4.24 HMO agreement to provide coverage for colorectal cancer screening.  8. Every enrollee agreement that provides hospital or medical expense benefits and 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 health care services to any enrollee or other person covered thereunder for expenses incurred in conducting colorectal cancer screening at regular intervals for persons age 50 and over and for persons of any age who are considered to be at high risk for colorectal cancer. The methods of screening for which benefits shall be provided shall include: a screening fecal occult blood test, flexible sigmoidoscopy, colonoscopy, barium enema, or any combination thereof; or the most reliable, medically recognized screening test available. The method and frequency of screening to be utilized shall be in accordance with the most recent published guidelines of the American Cancer Society and as determined medically necessary by the covered person's physician, in consultation with the covered person. As used in this section, "high risk for colorectal cancer" means a person has: a. a family history of: familial adenomatous polyposis; hereditary non-polyposis colon cancer; or breast, ovarian, endometrial, or colon cancer or polyps; b. chronic inflammatory bowel disease; or c. a background, ethnicity, or lifestyle that the physician believes puts the person at elevated risk for colorectal cancer. The health care services shall be provided to the same extent as for any other medical condition under the enrollee agreement. The provisions of this section shall apply to all enrollee agreements in which the health maintenance organization has reserved the right to change the schedule of charges. L.2001, c.295, s.8; amended 2012, c.17, s.273.
NJ Rev Stat § 26:2J-4.25 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-4.25 - Health maintenance organization prescription drug plans to cover certain infant formulas.

26:2J-4.25 Health maintenance organization prescription drug plans to cover certain infant formulas.  6. A certificate of authority to establish and operate a health maintenance organization in this State shall not be issued or continued on or after the effective date of this act for a health maintenance organization that provides health care services for prescription drugs under a contract, unless the health maintenance organization also provides health care services in the purchase of specialized non-standard infant formulas, when the covered infant's physician has diagnosed the infant as having multiple food protein intolerance and has determined such formula to be medically necessary, and when the covered infant has not been responsive to trials of standard non-cow milk-based formulas, including soybean and goat milk. The coverage may be subject to utilization review, including periodic review, of the continued medical necessity of the specialized infant formula. The health care services shall be provided to the same extent as for any other prescribed items under the contract. 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 for enrollee coverage. L.2001,c.361,s.6.
NJ Rev Stat § 26:2J-4.26 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-4.26 - HMO required to cover certain out-of-network services.

26:2J-4.26 HMO required to cover certain out-of-network services.  10. Notwithstanding the provisions of P.L.1973, c.337 (C.26:2J-1 et seq.) to the contrary, a certificate of authority to establish and operate a health maintenance organization in this State shall not be issued or continued on or after the effective date of this act unless the health maintenance organization meets the requirements of P.L.2001, c.367 (C.26:2S-6.1 et al.). The provisions of this section shall apply to all enrollee agreements in which the health maintenance organization has reserved the right to change the schedule of charges. L.2001,c.367,s.10.
NJ Rev Stat § 26:2J-4.27 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-4.27 - HMO to offer coverage for domestic partner.

26:2J-4.27 HMO to offer coverage for domestic partner.  52. Every health maintenance organization contract 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 P.L.2003, c.246 (C.26:8A-1 et al.), under which dependent coverage is available, shall offer dependent coverage to an enrollee for an enrollee's domestic partner. For the purposes of this section, "domestic partner" means a domestic partner as defined in section 3 of P.L.2003, c.246 (C.26:8A-3). The provisions of this section shall apply to contracts in which the health maintenance organization has reserved the right to change the schedule of charges. L.2003,c.246,s.52.
NJ Rev Stat § 26:2J-4.28 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-4.28 - HMO, high deductible, coverage for preventive care.

26:2J-4.28 HMO, high deductible, coverage for preventive care.  11. A certificate of authority to establish and operate a health maintenance organization, which organization offers a contract that qualifies as a high deductible health plan for which qualified medical expenses are paid using a health savings account established pursuant to section 223 of the federal Internal Revenue Code of 1986 (26 U.S.C. s.223), shall not be issued or continued by the Commissioner of Banking and Insurance on or after the effective date of P.L.2005, c.248 (C.17:48E-35.27 et al.), unless the health maintenance organization offers health care services to any enrollee which include services provided in-network which represent medically necessary preventive care as permitted by that federal law. The services provided pursuant to this section shall be provided to the same extent as for any other medical condition under the contract, except that a deductible shall not be applied for services provided pursuant to this section. This section shall apply to all contracts under which the health maintenance organization has reserved the right to change the schedule of charges for enrollee coverage. L.2005, c.248, s.11; amended 2012, c.17, s.274.
NJ Rev Stat § 26:2J-4.29 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-4.29 - Health service corporation, coverage for prescription female contraceptives.

26:2J-4.29 Health service corporation, coverage for prescription female contraceptives.  12. Notwithstanding the provisions of section 4 of P.L.1995, c.316 (C.26:2J-4.10) regarding deductibles for a high deductible health plan, a contract offered by a health maintenance organization, which certificate of authority to establish and operate is issued or continued by the Commissioner of Banking and Insurance on or after the effective date of P.L.2005, c.248 (C.17:48E-35.27 et al.), that qualifies as a high deductible health plan for which qualified medical expenses are paid using a health savings account established pursuant to section 223 of the federal Internal Revenue Code of 1986 (26 U.S.C. s.223), shall not apply a deductible for any benefits in which a deductible is not applicable pursuant to any law enacted after the effective date of P.L.2005, c.248 (C.17:48E-35.27 et al.). This section shall apply to all contracts under which the health maintenance organization has reserved the right to change the schedule of charges for enrollee coverage. L.2005, c.248, s.12; amended 2012, c.17, s.275.
NJ Rev Stat § 26:2J-4.31 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-4.31 - HMOs to provide benefits for orthotic and prosthetic appliances.

26:2J-4.31 HMOs to provide benefits for orthotic and prosthetic appliances.  8. a. A certificate of authority to establish and operate a health maintenance organization in this State pursuant to P.L.1973, c.337 (C.26:2J-1 et seq.) shall not be issued or continued by the Commissioner of Banking and Insurance on or after the effective date of this act unless the health maintenance organization provides health care services for any person covered thereunder for expenses incurred in obtaining an orthotic or prosthetic appliance from any licensed orthotist or prosthetist, or any certified pedorthist, as determined medically necessary by the covered person's physician. As used in this section, "orthotic appliance," "prosthetic appliance," "licensed orthotist," and "licensed prosthetist" have the meaning assigned to them in section 3 of P.L.1991, c.512 (C.45:12B-3) and "certified pedorthist" has the meaning assigned to it in subsection j. of section 18 of P.L.1991, c.512 (C.45:12B-18). b. On and after the effective date of this act, a health maintenance organization shall reimburse for orthotic and prosthetic appliances at the same rate as reimbursement for such appliances under the federal Medicare reimbursement schedule. c. The benefits shall be provided to the same extent as for any other medical condition under the enrollee agreement. d. The provisions of this section shall apply to all enrollee agreements in which the health maintenance organization has reserved the right to change the schedule of charges. L.2007, c.345, s.8; amended 2012, c.17, s.276.
NJ Rev Stat § 26:2J-4.32 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-4.32 - Health maintenance organization to provide coverage for hearing aids for certain persons aged 15 or younger.

26:2J-4.32 Health maintenance organization to provide coverage for hearing aids for certain persons aged 15 or younger.  9. 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 health care services for medically necessary expenses incurred in the purchase of a hearing aid for an enrollee 15 years of age or younger, as provided in this section. The health care services shall include the purchase of a hearing aid for each ear, when medically necessary and as prescribed or recommended by a licensed physician or audiologist. A health maintenance organization may limit the health care services provided in this section to $1,000 per hearing aid for each hearing-impaired ear every 24 months. An enrollee may choose a hearing aid that is priced higher than the health care services payable under this section and may pay the difference between the price of the hearing aid and the health care services payable under this section, without financial or contractual penalty to the provider of the hearing aid. The health care services shall be provided to the same extent as for any other condition under the contract. 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.2008, c.126, s.9.
NJ Rev Stat § 26:2J-4.33 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-4.33 - Health maintenance organization to provide installment payments to obstetrical provider for maternity services.

26:2J-4.33 Health maintenance organization to provide installment payments to obstetrical provider for maternity services.  8. a. Every certificate of authority to establish and operate a health maintenance organization issued or continued 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, for a health maintenance organization which provides benefits for maternity services, shall provide for reimbursement in installments to an obstetrical provider licensed in New Jersey for maternity services rendered during the term of a covered person's pregnancy.  b. For the purposes of this section, "obstetrical provider licensed in New Jersey" means:  (1) an obstetrician/gynecologist licensed by the State Board of Medical Examiners; or  (2) a midwife licensed by the State Board of Medical Examiners as a certified midwife or a certified nurse midwife. c. This section shall apply to all enrollee agreements in which the health maintenance organization has reserved the right to change the schedule of charges. L.2009, c.113, s.8.
NJ Rev Stat § 26:2J-4.35 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-4.35 - HMO to provide coverage for oral anticancer medications.

26:2J-4.35 HMO to provide coverage for oral anticancer medications.  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 health care services for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells on a basis no less favorable than the contract provides for covered intravenously administered or injected anticancer medications.  b. Pursuant to subsection a. of this section, coverage for expenses for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells shall not be subject to any prior authorization, dollar limit, copayment, deductible or coinsurance provision that does not apply to intravenously administered or injected anticancer medications. c. A health maintenance organization contract shall not achieve compliance with the provisions of this section by imposing an increase in patient cost sharing, including any copayment, deductible or coinsurance, for anticancer medications, whether intravenously administered or injected or orally administered, that are covered under the contract as of the effective date of this act. d. 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.2011, c.188, s.8.
NJ Rev Stat § 26:2J-4.36 (2021)
2021 New Jersey Revised Statutes|Title 26 - Health and Vital Statistics|Section 26:2J-4.36 - HMO to provide coverage for sickle cell anemia.

26:2J-4.36 HMO to provide coverage for sickle cell anemia.  6. Every health maintenance organization contract that provides health care services and 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 health care services to an enrollee for the medical treatment of sickle cell anemia and, if the contract provides health care services for outpatient prescription drugs, then the contract shall provide health care services to an enrollee for prescription drugs for the treatment of sickle cell anemia. The health care services shall be provided to the same extent as for any other medical condition under the contract. The provisions of this section shall apply to those contracts for health care services by health maintenance organizations under which the right to change the schedule of charges for enrollee coverage is reserved. L.2011, c.210, s.6.