reglab/housing_qa huggingface dataset:
NJ Rev Stat § 17B:27A-10.9 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27A-10.9 - Application for waiver of ACA.

17B:27A-10.9 Application for waiver of ACA.  9. The commissioner shall apply to the United States Secretary of Health and Human Services under 42 U.S.C. s.18052 for a waiver of applicable provisions of the Affordable Care Act with respect to health insurance coverage in the State for a plan year beginning on or after January 1, 2019, to effectuate the provisions of this act. If the waiver is approved, the commissioner may accept the waiver so long as the commissioner determines that implementation of the plan: a. will be beneficial to policyholders; and b. is expected to stabilize or reduce premiums in the individual health insurance market through a reduction in what indicated premium rates would be without the plan. If the commissioner accepts the waiver, the commissioner and the board shall implement the plan to meet the waiver requirements in a manner consistent with federal and State law, as approved by the United States Secretary of Health and Human Services, and consistent with the provisions of this act. The commissioner may contract for actuarial services as necessary to implement the waiver application required pursuant to this section. L.2018, c.24, s.9.
NJ Rev Stat § 17B:27A-10.10 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27A-10.10 - New Jersey Health Insurance Premium Security Fund.

17B:27A-10.10 New Jersey Health Insurance Premium Security Fund.  10. a. The New Jersey Health Insurance Premium Security Fund is hereby created in the State Treasury for the purposes of this act. This fund shall be the repository for monies collected pursuant to this act and other monies received as grants in support of this act, or monies otherwise appropriated or directed to be remitted to the fund. The establishment of this fund, the funding sources contained herein, and the plan shall be contingent upon approval from the United States Secretary of Health and Human Services and the United States Secretary of the Treasury of a State Innovation Waiver application pursuant to section 1332 of the Affordable Care Act (42 U.S.C. s.18052) and the commissioner's acceptance of any approval as provided in section 9 of this act.  b. All interest earned on the moneys that have been deposited into the fund shall be retained in the fund and used for purposes consistent with the fund. c. The fund shall be funded to levels based upon actuarial analysis to stabilize or reduce premiums rates in the individual market achieving between a 10% and 20% reduction in what indicated rates would be for the applicable benefit year without the plan and to cover all necessary administrative costs of the reinsurance provided by the plan.  d. The fund shall be fully funded in accordance with this section by: (1) All funds collected by the State pursuant to P.L.2018, c.31 (C.54A:11-1 et seq.); (2) Federal payments received as a result of any waiver of requirements granted or other arrangements agreed to by the United States Secretary of Health and Human Services or other appropriate federal officials; and (3) For the purpose of providing the funds necessary to carry out the provisions of this act, and in amounts sufficient to ensure funding levels as required by this act after the monies received pursuant to paragraphs (1) and (2) of this subsection, there shall be appropriated annually out of the General Fund of the State an amount as the board, in consultation with the commissioner, determines necessary to fully fund the plan to accomplish the objectives of this act. The board, in consultation with the commissioner, shall calculate the amount necessary to cover the submitted reinsurance requests taking into account all federal waiver payments and other monies in the fund. The board shall issue an order memorializing those amounts and requesting the Legislature to appropriate that amount to the fund. e. Moneys in the fund shall only be used for the purposes established in this act. L.2018, c.24, s.10.
NJ Rev Stat § 17B:27A-10.11 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27A-10.11 - Annual report.

17B:27A-10.11 Annual report.  11. a. The board shall present an annual report to the Governor, and to the Legislature pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1), which contains a summary of the operations of the Health Insurance Premium Security Plan and the impact of the plan on health insurance premiums. The report shall be made available to the public upon request and by posting on the department's website. b. (1) The board shall engage and cooperate with an independent certified public accountant to perform an audit for each benefit year of the plan, in accordance with generally accepted auditing standards. The audit shall at a minimum: (a) assess compliance with the requirements of this act; and  (b) identify any material weaknesses or significant deficiencies and address manners in which to correct any such material weaknesses or deficiencies. (2) The board, after receiving the completed audit, shall: (a) provide the commissioner the results of the audit excluding any proprietary information; (b) identify to the commissioner any material weakness or significant deficiency identified in the audit and address in writing to the commissioner how the board recommends to correct any such material weakness or significant deficiency in compliance with this subsection; and (c) make available to the public a summary of the results of the audit by posting the summary on the department website and making the summary otherwise available, including any material weakness or significant deficiency and how the board intends to correct the material weakness or significant deficiency. c. Documents, materials or other information that are in the possession or control of the commissioner or the board and that are obtained by or disclosed to the commissioner, the board, or any other person in the course of an examination or investigation made pursuant to this act shall be confidential by law and privileged and shall not be subject to disclosure or dissemination under P.L.1963, c.71 (C.47:1A-1 et seq.), or any other act. However, the commissioner is authorized to use the documents, materials or other information in the furtherance of any regulatory or legal action brought as a part of the commissioner's official duties. The commissioner shall not otherwise make the documents, materials or other information public without the prior written consent of the carrier. L.2018, c.24, s.12.  17B:27A-10.12 Violations, penalties. 12. If a carrier violates any provision of this act, the commissioner may, upon notice and hearing, assess a civil administrative penalty in an amount not less than $1,000 nor more than $10,000 for each day the carrier is in violation of this act. The penalty may be recovered in a summary proceeding pursuant to the "Penalty Enforcement Law of 1999," P.L.1999, c.274 (C.2A:58-10 et seq.).
NJ Rev Stat § 17B:27A-10.13 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27A-10.13 - Rules, regulations.

17B:27A-10.13 Rules, regulations.  13. The board, pursuant to section 8 of P.L.1993, c.164 (C.17B:27A-16.1), and the commissioner, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) and in consultation with each other, shall each adopt such rules and regulations as may be necessary to effectuate the purposes of this act. L.2018, c.24, s.13.
NJ Rev Stat § 17B:27A-11 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27A-11 - Powers, authority of program, board.

17B:27A-11 Powers, authority of program, board.  10. The program shall have the general powers and authority granted under the laws of New Jersey to insurance companies, health service corporations and health maintenance organizations licensed or approved to transact business in this State, except that the program shall not have the power to issue health benefits plans directly to either groups or individuals. The board shall have the specific authority to: a. assess members their proportionate share of program losses and administrative expenses in accordance with the provisions of section 11 of this act, and make advance interim assessments, as may be reasonable and necessary for organizational and reasonable operating expenses and estimated losses. An interim assessment shall be credited as an offset against any regular assessment due following the close of the fiscal year;  b. establish rules, conditions, and procedures pertaining to the sharing of program losses and administrative expenses among the members of the program;  c. (Deleted by amendment, P.L.2008, c.38). d. define the provisions of individual health benefits plans in accordance with the requirements of this act;  e. enter into contracts which are necessary or proper to carry out the provisions and purposes of this act;  f. establish a procedure for the joint distribution of information on individual health benefits plans issued pursuant to section 3 of this act;  g. establish, at the board's discretion, standards for the application of a means test for individual health benefits plans issued pursuant to section 3 of this act;  h. establish, at the board's discretion, reasonable guidelines for the purchase of new individual health benefits plans by persons who already are enrolled in or insured by another individual health benefits plan;  i. establish minimum requirements for performance standards for carriers that are reimbursed for losses submitted to the program and provide for performance audits from time to time;  j. sue or be sued, including taking any legal actions necessary or proper for recovery of an assessment for, on behalf of, or against the program or a member;  k. appoint from among its members appropriate legal, actuarial, and other committees as necessary to provide technical and other assistance in the operation of the program, in policy and other contract design, and any other function within the authority of the program;  l. borrow money to effect the purposes of the program. Any notes or other evidence of indebtedness of the program not in default shall be legal investments for carriers and may be carried as admitted assets; and  m. contract for an independent actuary and any other professional services the board deems necessary to carry out its duties under P.L.1992, c.161 (C.17B:27A-2 et al.).  L.1992, c.161, s.10; amended 1993, c.164, s.6; 2008, c.38, s.17.
NJ Rev Stat § 17B:27A-12.1 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27A-12.1 - Exemption from liability, certain, for HMO formed by UMDNJ.

17B:27A-12.1 Exemption from liability, certain, for HMO formed by UMDNJ.  2. Notwithstanding the provisions of any statute to the contrary, a health maintenance organization established by the University of Medicine and Dentistry of New Jersey pursuant to the provisions of P.L.1992, c.84 shall be exempt from liability for the assessment provided for in section 11 of P.L.1992, c.161 (C.17B:27A-12) for the 1999-2000 two-year calculation period. L.2001,c.349,s.2.
NJ Rev Stat § 17B:27A-13 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27A-13 - Statement of net paid losses

17B:27A-13. Statement of net paid losses  12. a. No later than March 1, 1993, any carrier issuing individual health benefits plans in the State shall file with the board a statement of any net paid losses for the calendar year ending December 31, 1992, as calculated pursuant to subsection a. of section 11 of this act, along with any supporting information required by the board.  b. The losses filed pursuant to subsection a. of this section shall be reimbursed in an amount up to $10,000,000 or 50% of the paid losses, whichever amount is less, to the carrier filing the losses. The assessment shall be made as a separate assessment from those required pursuant to section 11 of this act, but shall be assessed in the same manner and at the same time as the first assessment made after the effective date of this act as provided for in section 11 of this act, except that the carrier filing for the reimbursement shall not be subject to an assessment pursuant to this section.  L.1992,c.161,s.12.
NJ Rev Stat § 17B:27A-14 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27A-14 - Determination of disproportionate share of substandard risks

17B:27A-14. Determination of disproportionate share of substandard risks  13. The board shall determine whether any carrier has a disproportionate share of substandard risks insured or enrolled under its individual health benefits plans and shall make recommendations to the Governor and the Legislature for remedial action to minimize the losses sustained by the carrier as a result of insuring these risks.  L.1992,c.161,s.13.
NJ Rev Stat § 17B:27A-15 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27A-15 - Sale of health benefits plan

17B:27A-15. Sale of health benefits plan  14. A health benefits plan issued pursuant to section 3 of this act may be sold through an insurance producer licensed pursuant to P.L.1987, c.293 (C.17:22A-1 et seq.).  L.1992,c.161,s.14.
NJ Rev Stat § 17B:27A-16 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27A-16 - Submission of rate filings by health maintenance organization not required

17B:27A-16. Submission of rate filings by health maintenance organization not required  15. Notwithstanding the provisions of P.L.1973, c.337 (C.26:2J-1 et seq.) to the contrary, a health maintenance organization shall not be required to submit any rate filings with the commissioner for an individual health benefits plan that is subject to the provisions of this act, but shall be subject to the minimum loss ratio provisions of section 8 of this act.  L.1992,c.161,s.15.
NJ Rev Stat § 17B:27A-16.2 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27A-16.2 - Adoption of temporary plan of operation

17B:27A-16.2. Adoption of temporary plan of operation  9. a. The commissioner shall, under the procedures provided pursuant to section 7 of P.L.1993, c.164, adopt a temporary plan of operation prepared pursuant to section 9 of P.L.1992, c.161 (C.17B:27A-10), pending submission or approval of a plan of operation prepared by the board pursuant to that section 9.  b. Subsequent amendments to the plan of operation shall be reviewed and approved by the commissioner pursuant to the procedures provided in sections 7 and 8 of P.L.1993, c.164 (C.17B:27A-16.1), as applicable.  L.1993,c.164,s.9.
NJ Rev Stat § 17B:27A-16.3 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27A-16.3 - Purchase of other insurance coverage not required

17B:27A-16.3. Purchase of other insurance coverage not required  10. A carrier shall not require an eligible person to purchase any other insurance coverage, including, but not limited to, life insurance, accident insurance or disability insurance, as a condition of or in conjunction with the purchase of a health benefits plan pursuant to P.L.1992, c.161 (C.17B:27A-2 et al.).  L.1993,c.164,s.10.
NJ Rev Stat § 17B:27A-16.4 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27A-16.4 - Adoption of standard claim form

17B:27A-16.4. Adoption of standard claim form  11. The board, in conjunction with the board of the New Jersey Small Employer Health Benefits Program established pursuant to section 12 of P.L.1992, c.162 (C.17B:27A-28), shall adopt one standard claim form.  In order to provide a standard system of payment for medical services, all claim forms for a claimant's use under an individual health benefits plan issued or delivered in this State shall conform to the form adopted by the board.  L.1993,c.164,s.11.
NJ Rev Stat § 17B:27A-16.5 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27A-16.5 - Hospital, medical insurance policy renewals; filing of rates.

17B:27A-16.5 Hospital, medical insurance policy renewals; filing of rates.  5. A domestic mutual insurer which has converted from a health service corporation pursuant to the provisions of sections 2 through 4 of P.L.1995, c.196 (C.17:48E-46 through C.17:48E-48) shall not renew individual hospital or medical insurance policies or health service contracts originally issued prior to November 30, 1992, until it has made an informational filing with the commissioner. The rates shall be formulated so that the anticipated minimum loss ratio for such policy or contract form shall not be less than 80% of the premium. Such domestic mutual insurer shall submit with its rate filing supporting data and a certification that the insurer is in compliance with the anticipated loss ratio requirement. The content and form of the supporting data and certification required pursuant to subsection e. of section 8 of P.L.1992, c.161 (C.17B:27A-9) shall satisfy the requirements of this section. Any other insurer may irrevocably elect to become subject to the provisions of this section by written notice to the commissioner in a format specified by the commissioner. L.1995, c.196, s.5; amended 2008, c.38, s.19.
NJ Rev Stat § 17B:27A-18 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27A-18 - Providers of health benefits, services subject to provisions of act

17B:27A-18. Providers of health benefits, services subject to provisions of act  2. Every health insurer, health service corporation, medical service corporation, hospital service corporation, and health maintenance organization licensed or authorized to provide health benefits or services in this State which offers health insurance policies or coverages to small employers shall be subject to the provisions of this act. Carriers shall offer coverage to all eligible employees of small employers and their dependents and shall not exclude any employee or eligible dependent on the basis of a health status-related factor. L.1992,c.162,s.2; amended 1997, c.146, s.8.
NJ Rev Stat § 17B:27A-18.1 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27A-18.1 - Provision of benefits to subscriber's child under small employer policy, contract.

17B:27A-18.1 Provision of benefits to subscriber's child under small employer policy, contract.  9. 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 covered employee'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 covered employee's federal tax return; (3) The child does not reside with the covered employee 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 covered employee 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 covered employee fails to enroll the child; and (3) Not terminate coverage of the child unless the parent who is the covered employee 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.9; amended 2019, c.356, s.7.
NJ Rev Stat § 17B:27A-18.2 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27A-18.2 - Requirements applicable to State Medicaid

17B:27A-18.2. Requirements applicable to State Medicaid  10. 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 covered employee. L.1995,c.288,s.10.
NJ Rev Stat § 17B:27A-19a (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:27A-19a - Small employer carrier, offering of high deductible plan.

17B:27A-19a Small employer carrier, offering of high deductible plan.  17. A small employer carrier, as a condition of transacting business in this State, may offer, on or after the effective date of P.L.2005, c.248 (C.17:48E-35.27 et al.), a health benefits plan pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.) 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), if that health benefits plan is offered to an eligible small employer that: a. is a policy or contract holder prior to and on or after the effective date of P.L.2005, c.248 (C.17:48E-35.27 et al.) under a small employer health benefits plan issued pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.) which does not qualify 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); b. is not a policy or contract holder on or after the effective date of P.L.2005, c.248 (C.17:48E-35.27 et al.) under a small employer health benefits plan issued pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.) which does not qualify 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) for a period of five years; or c. was not a policy or contract holder under a small employer health benefits plan issued pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.) prior to the effective date of P.L.2005, c.248 (C.17:48E-35.27 et al.). L.2005,c.248,s.17.