reglab/statecodes huggingface dataset:
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27A-24 - Reasonable specified minimum participation.

17B:27A-24 Reasonable specified minimum participation.
8. Any small employer carrier may require a reasonable specified minimum participation of eligible employees, which shall not exceed 75%, or reasonable minimum employer contributions in determining whether to accept a small group pursuant to this act. The standards so established by the carrier shall be first approved by the board and shall be applied uniformly to all small groups, except that in no event shall a carrier require an employer to contribute more than 10% to the annual cost of the policy or contract, or an amount as otherwise provided by the board, and any minimum participation standards established by the carrier shall be reasonable. In establishing the percentage of employee participation, a one-to-one credit shall be given for each employee covered by a spouse's health benefits coverage, Medicare, Medicaid, NJ FamilyCare or another group health benefits plan. In calculating an employer's participation, the carrier shall include all insured employees, regardless of whether the employees chose an indemnity plan or a health maintenance organization, or a combination thereof.
L.1992,c.162,s.8; amended 1993, c.162, s.10; 1994, c.11, s.3; 1995, c.298, s.3; 2001, c.346; 2005, c.166.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27A-25.1 - Findings, declarations relative to small employer health benefits purchasing alliances

17B:27A-25.1. Findings, declarations relative to small employer health benefits purchasing alliances
1. The Legislature finds and declares that:
a. Small employers, that is, employers that employ between two and 50 employees, have traditionally been at an economic disadvantage with respect to the purchase and provision of health benefits for their employees because certain administrative and premium rate savings that are available to larger employers are not available to them by virtue of their size;
b. Providing for the establishment of purchasing alliances comprised of groups of small employers would enable small employers to take advantage of the economies of scale in the delivery of health benefits currently available to large employer groups; and
c. Working within the framework of the Small Employer Health Benefits Program established by P.L.1992, c.162 (C.17B:27A-17 et seq.), small employer purchasing alliances, with the voluntary participation of insurance carriers, would have access to the standard health benefits plans developed under that law at a reduced premium, along with the protections afforded under that law, including: guaranteed access to health benefits coverage for their employees; guaranteed renewability of health plans regardless of the health status of employees or their dependents; and prohibitions against the use of certain rating factors such as health status, prior claims history or occupation.
L.2001,c.225,s.1.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27A-25.2 - Definitions relative to small employer benefits purchasing alliances

17B:27A-25.2. Definitions relative to small employer benefits purchasing alliances
2. As used in this act:
"Board" means a small employer purchasing alliance board of directors provided for in section 4 of this act.
"Carrier" means a small employer carrier as defined in section 1 of P.L.1992, c.162 (C.17B:27A-17).
"Commissioner" means the Commissioner of Banking and Insurance.
"Dependent" means the same as defined in section 1 of P.L.1992, c.162 (C.17B:27A-17).
"Eligible employee" means the same as defined in section 1 of P.L.1992, c.162 (C.17B:27A-17).
"Eligible group of small employers" means a group of small employers which: (1) are engaged in the same or similar type of trade or business; (2) are members of a common trade association, professional association, or other association; or (3) are located in a common geographic area.
"Health benefits plan" means a small employer health benefits plan approved by the commissioner pursuant to section 17 of P.L.1992, c.162 (C.17B:27A-33).
"Health status-related factor" means the same as defined in section 1 of P.L.1992, c.162 (C.17B:27A-17).
"Member" means a small employer who is a member of a purchasing alliance as provided for in section 3 of this act.
"Small Employer Purchasing Alliance," "purchasing alliance" or "alliance" means a small employer purchasing alliance as established pursuant to section 3 of this act.
"Small employer" means the same as defined in section 1 of P.L.1992, c.162 (C.17B:27A-17).
L.2001,c.225,s.2.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27A-25.3 - Small Employer Purchasing Alliance, formation

17B:27A-25.3. Small Employer Purchasing Alliance, formation
3. Any eligible group of small employers may join together, by means of a joint contract under the procedures established by this act, to form a "Small Employer Purchasing Alliance" for the purpose of negotiating a reduced premium for its members purchasing a small employer health benefits plan or plans for their eligible employees and the employees' dependents. The joint contract shall be executed by all members of the purchasing alliance.
L.2001,c.225,s.3.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27A-25.4 - Board of directors

17B:27A-25.4. Board of directors
4. The purchasing alliance, which may be a corporation, shall be governed by a board of directors, elected by the members of the purchasing alliance. No person may serve as an officer or director of an alliance who has a prior record of administrative, civil or criminal violations within the financial services industry. The directors shall serve for terms of three years, and shall serve until their successors are elected and qualified. The directors shall serve without compensation, except for reimbursement for actual expenses.
L.2001,c.225,s.4.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27A-25.5 - Bylaws, contents

17B:27A-25.5. Bylaws, contents
5. The board shall adopt by-laws for the operation of the purchasing alliance, which shall be effective upon ratification by a two-thirds majority of the members. The by-laws shall include, but not be limited to:
a. The establishment of procedures for the organization and administration of the alliance.
b. Procedures for the qualifications and admission of the members of the alliance. The bases for denial of membership shall include, but not be limited to:
(1) Performance of an act or practice that constitutes fraud or intentional misrepresentation of material fact;
(2) Previous denial of membership in the alliance; or
(3) Previous expulsion from the alliance.
c. Procedures for the withdrawal of members from the alliance.
d. Procedures for the expulsion of members from the alliance. The bases for expulsion shall include, but not be limited to:
(1) Failure to pay membership or other fees required by the purchasing alliance;
(2) Failure to pay premiums in accordance with the terms of the health benefits plan or the terms of the joint contract; or
(3) Performance of an act or practice that constitutes fraud or intentional misrepresentation of material fact.
e. Procedures for the termination of the alliance.
L.2001,c.225,s.5.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27A-25.6 - Further authority of alliance

17B:27A-25.6. Further authority of alliance
6. In addition to the powers authorized under this act, a purchasing alliance shall have the authority to:
a. Set reasonable fees for membership in the alliance that will finance reasonable and necessary costs incurred in administering the purchasing alliance;
b. Negotiate premium rates with carriers on behalf of the members of the alliance; and
c. Contract with third parties for any services necessary to carry out the powers and duties authorized or required pursuant to this act.
L.2001,c.225,s.6.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27A-25.7 - Restrictions on alliances

17B:27A-25.7 Restrictions on alliances
7. A purchasing alliance established pursuant to the provisions of this act shall not:
a. Purchase health care services, assume risk for the cost or provision of health care services or otherwise contract with health care providers for the provision of health care services to eligible employees or their dependents;
b. Exclude a small employer, eligible employee or dependent from membership in the purchasing alliance who agrees to pay fees for membership and the premium for health benefits coverage and who abides by the by-laws and rules of the purchasing alliance;
c. Engage in any act or practice that results in the selection of member small employers or eligible employees based on any health status-related factor; or
d. Engage in any trade practice or activity prohibited pursuant to chapter 30 of Title 17B of the New Jersey Statutes.
L.2001,c.225,s.7.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27A-25.8 - Certificate from alliance to commissioner

17B:27A-25.8. Certificate from alliance to commissioner
8. a. Within 30 days after its organization, the purchasing alliance board shall file with the commissioner a certificate which shall list the members of the alliance, the names of the board of directors and the chairman, treasurer, and secretary of the purchasing alliance, and the address at which communications for the purchasing alliance are to be received, a copy of the certificate of incorporation of the purchasing alliance, if any, and a copy of the joint contract executed by all of the members. Any change in the information required by the provisions of this section shall be filed with the commissioner within 30 days of the change.
b. If the commissioner determines that the premium reduction, permitted pursuant to subsection k. of section 9 of P.L.1992, c.162 (C.17B:27A-25) and filed by a carrier in the informational filing required pursuant to subsection f. of that section, results in rates that are excessive, inadequate or unfairly discriminatory, the commissioner may disapprove or deny the premium reduction. If, after notice and a hearing pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14b-1 et seq.), a carrier or purchasing alliance is found by the commissioner to be in violation of any provision of this act, the commissioner may disapprove or deny the premium reduction permitted pursuant to subsection k. of section 9 of P.L.1992, c.162 (C.17B:27A-25).
L.2001,c.225,s.8.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27A-25.9 - Rules, regulations

17B:27A-25.9. Rules, regulations
10. The commissioner shall promulgate rules and regulations pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) necessary to effectuate the provisions of this act.
L.2001, c.225, s.10.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27A-26 - Health maintenance organization coverage; exceptions

17B:27A-26. Health maintenance organization coverage; exceptions
10. a. No health maintenance organization shall be required to offer coverage or accept applications pursuant to section 3 of this act to a small employer if the small employer does not have eligible individuals who live, work, or reside in the service area for such plan, or if the health maintenance organization reasonably anticipates and demonstrates to the satisfaction of the commissioner that it will not have the capacity in its network of providers within the service area to deliver service adequately to the members of such groups because of its obligations to existing group contract holders and enrollees. Upon denying health insurance coverage in any service area as a result of insufficient network capacity in accordance with this subsection, the health maintenance organization shall not offer coverage in the small employer market within such service area for a period of at least 180 days after the date the coverage is denied.
b. No small employer carrier shall be required to offer coverage or accept applications pursuant to this act for any period of time in which the commissioner determines that the requiring of the issuing of policies or contracts pursuant to this act would place the carrier in a financially impaired position.
c. A health maintenance organization which complies with the basic health benefits, underwriting and rating standards established by the federal government pursuant to subchapter XI of Pub.L.93-222 (42.U.S.C. s.300e et seq.), and which also provides the comprehensive health benefit plans coverage required by subsection f. of section 3 of P.L.1992, c.162 (C.17B:27A-19), shall be deemed in compliance with this act.
L.1992,c.162,s.10; amended 1993, c.162, s.11; 1997, c.146, s.12.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27A-28 - New Jersey Small Employer Health Benefits Program created

17B:27A-28. New Jersey Small Employer Health Benefits Program created
12. There is created a nonprofit entity to be known as the New Jersey Small Employer Health Benefits Program. All carriers issuing health benefits plan policies and contracts in this State shall be members of this program. The program shall be administered by the board of directors established pursuant to section 13 of P.L.1992, c.162 (C.17B:27A-29).
L.1992,c.162,s.12; 1993,c.162,s.6.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27A-29 - Meetings, organization of board; terms.

17B:27A-29 Meetings, organization of board; terms.
13. a. The board shall consist of 13 public members appointed by the Governor who shall include:
(1) Two carriers that sell plans in the small employer market;
(2) One carrier that sells plans in the individual market or the small employer market;
(3) Two representatives of or individuals employed by businesses that purchase in small employer health benefits plans;
(4) Two health care provider representatives;
(5) Two insurance producers licensed to sell health insurance pursuant to P.L.1987, c.293 (C.17:22A-1 et seq.);
(6) One representative of organized labor;
(7) One representative of an association representing small businesses in the State; and
(8) Two persons with knowledge or expertise in New Jersey regulated health insurance markets who represent the general public.
The Commissioner of Health and the commissioner, or the commissioner's designee, shall serve on the board as ex officio members. No carrier shall have more than one representative on the board.
The public members shall be appointed for a term of three years, except that of the members first appointed, five shall be appointed for a term of one year, four for a term of two years and four for a term of three years.
A vacancy in the membership of the board shall be filled for an unexpired term in the manner provided for the appointment.
The board shall continue in its existing form until there is established a quorum of members newly appointed pursuant to the provisions of P.L.2023, c.194 (C.17B:27A-33.1 et al.).
b. (Deleted by amendment, P.L.2023, c.194).
c. (Deleted by amendment, P.L.1995, c.298).
d. All meetings of the board shall be subject to the requirements of the "Open Public Meetings Act," P.L.1975, c.231 (C.10:4-6 et seq.).
e. At least two copies of the minutes of every meeting of the board shall be delivered forthwith to the commissioner.
f. To the extent that any provision of P.L.2023, c.194 (C.17B:27A-33.1 et al.) is in conflict with any provision of section 2 of P.L.2019, c.141 (C.17B:27A-58), the provisions of section 2 of P.L.2019, c.141 (C.17B:27A-58) shall govern.
L.1992, c.162, s.13; amended 1994, c.97; 1995, c.196, s.7; 1995, c.298, s.6; 1999, c.367, s.2; 2001, c.131, s.22; 2012, c.17, s.60; 2023, c.194, s.6.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27A-29.1 - Immunity from liability for board

17B:27A-29.1 Immunity from liability for board
11. A member of the board and an employee of the board shall not be liable in an action for damages to any person for any action taken or recommendation made by him within the scope of his functions as a member or employee, if the action or recommendation was taken or made without malice. The members of the board shall be indemnified and their defense of any action provided for in the same manner and to the same extent as employees of the State under the "New Jersey Tort Claims Act," P.L.1972, c.45 (C.59:1-1 et seq.) on account of acts or omissions in the scope of their employment.
L.1995,c.298,s.11.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27A-29.2 - Rules, regulations for voluntary risk pooling arrangement

17B:27A-29.2 Rules, regulations for voluntary risk pooling arrangement
12. The board may, if necessary, adopt rules and regulations pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) to establish a voluntary risk pooling arrangement for program members.
If the board determines that such an arrangement is necessary, it shall submit the proposed rules and regulations to the Legislature for review on a day that the Legislature is in session and to the commissioner for his approval. If the Legislature does not take action in 30 days to amend or otherwise change the rules and regulations, the rules and regulations shall be effective upon approval by the commissioner or upon such later date as the board determines.
L.1995,c.298,s.12.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27A-30 - Submission of plan of operation

17B:27A-30. Submission of plan of operation
14. Within 90 days after the election of the initial board, the board shall submit to the commissioner a plan of operation which shall establish the administration of the program pursuant to the provisions of this act. The plan of operation and any subsequent amendments thereto shall be submitted to the commissioner who shall, after notice and hearing, approve the plan if he finds that it is reasonable and equitable and sufficiently carries out the provisions of this act. The plan of operation shall become effective after the commissioner has approved it in writing. The plan or any subsequent amendments thereto shall be deemed approved if not expressly disapproved by the commissioner in writing within 90 days of receipt by the commissioner.
L.1992,c.162,s.14.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27A-31 - Contents of plan of operation

17B:27A-31. Contents of plan of operation
15. The plan of operation shall constitute a public record and shall include, but not be limited to, the following:
a. A method of handling and accounting for assets and moneys of the program and an annual fiscal reporting to the commissioner;
b. A means of providing for the filling of vacancies on the board, subject to the approval of the commissioner; and
c. (Deleted by amendment, P.L.1993, c.162).
d. (Deleted by amendment, P.L.1995, c.298).
e. (Deleted by amendment, P.L.1995, c.298).
f. (Deleted by amendment, P.L.1995, c.298).
g. Any additional matters which are appropriate to effectuate the provisions of this act.
L.1992,c.162,s.15; amended 1993,c.162,s.7; 1994,c.11,s.5; 1995,c.298,s.7.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27A-32 - Authority of board

17B:27A-32. Authority of board
16. The board shall have the authority to:
a. Enter into contracts as are necessary or proper to carry out the provisions and purposes of this act;
b. Sue or be sued, including taking any legal actions as may be necessary for recovery of any assessments due to the program or to avoid paying any improper claims;
c. Establish rules, conditions, and procedures pertaining to the assessment of members by the program;
d. Assess members in accordance with the provisions of this act, including such interim assessments as may be reasonable and necessary for organizational and reasonable operating expenses. Such interim assessments shall be credited as offsets against any regular assessments due following the close of the fiscal year;
e. Appoint from among its members appropriate legal, actuarial, and other committees as necessary to provide technical assistance in the operation of the program, policy and other contract design, and any other function within the authority of the program; and
f. Contract for an independent actuary or any other professional services the board deems necessary to carry out its duties under P.L.1992, c.162 (C.17B:27A-17 et seq.).
L.1992,c.162,s.16; amended 1993,c.162,s.19; 1995,c.298,s.8.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27A-33 - Formulation of five health benefits plans

17B:27A-33. Formulation of five health benefits plans
17. Subject to the approval of the commissioner, the board shall formulate the five health benefits plans to be made available by small employer carriers in accordance with the provisions of this act, and shall promulgate five standard forms pursuant thereto. The board may establish benefit levels, deductibles and co-payments, exclusions, and limitations for such health benefits plans in accordance with the law. The board shall ensure that the means exist for a carrier to offer high deductible health benefits plan options that are consistent with section 301 of Title III of the "Health Insurance Portability and Accountability Act of 1996," Pub.L. 104-191, regarding tax-deductible medical savings accounts.
The board shall submit the forms so established to the commissioner for approval. The commissioner shall approve the forms if the commissioner finds them to be consistent with the provisions of section 3 of P.L.1992, c. 162 (C.17B:27A-19). Any form submitted to the commissioner by the board shall be deemed approved if not expressly disapproved in writing within 60 days of its receipt by the commissioner. Such forms may contain, but shall not be limited to, the following provisions:
a. Utilization review of health care services, including review of medical necessity of hospital and physician services;
b. Managed care systems, including large case management;
c. Provisions for selective contracting with hospitals, physicians, and other participating and nonparticipating providers;
d. Reasonable benefits differentials which are applicable to participating and nonparticipating providers;
e. Notwithstanding the provisions of section 4 of P.L.1992, c.162 (C.17B:27A-20) to the contrary, the board may, from time to time, adjust coinsurance and deductibles;
f. Such other provisions which may be quantifiably established to be cost containment devices;
g. The department shall publish annually a list of the premiums charged for each of the five small employer health benefits plans and for any rider package by all carriers writing such plans. The department shall also publish the toll free telephone number of each such carrier.
L.1992,c.162,s.17; amended 1993, c.162, s.8; 1997, c.146, s.13.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27A-33.1 - Short title.

17B:27A-33.1 Short title.
7. Sections 7 through 11 of P.L.2023, c.194 (C.17B:27A-33.1 et al.) shall be known and may be cited as the "Small Business Health Insurance Affordability Act."
L.2023, c.194, s.7.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27A-33.2 - Annual review, small-employer health benefits plans, publish findings, report, Department of Banking and Insurance website.

17B:27A-33.2 Annual review, small-employer health benefits plans, publish findings, report, Department of Banking and Insurance website.
8. a. The board shall annually review the small employer health benefits plans offered pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.) to ensure that each plan meets the requirements of section 2 of P.L.2019, c.354 (C.17B:27A-19.30), provides consumer choice and affordability, and maintains a relative level of consistency compared to previous years and to other plans in the small employer market. The board shall publish the findings of its review on the website of the Department of Banking and Insurance.
b. The board shall annually adjust the design of the small employer health benefits plans, including the out-of-pocket limits under those plans, to ensure premium affordability and to align the plans with the requirements of section 2 of P.L.2019, c.354 (C.17B:27A-19.30). The adjustment shall be based on the annual review conducted pursuant to subsection a. of this section. The board may consider proposals for adjustments to plan design to improve affordability from carriers offering small employer health benefits plans pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.).
c. The board shall annually review the appropriateness of geographic rating areas and may adjust, by rule, as needed to achieve the goals of this subsection.
d. The board shall examine and, to the extent practicable, track where small employers who do not continue coverage through a small employer health benefits plan offered pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.) elect to purchase coverage. The board shall have the authority to develop a sample survey that insurance producers shall provide to clients. Insurance producers shall report to the board all information received through the survey, which shall be de-identified by the insurance producer. The sample survey shall include, but may not be limited to, information concerning where small employers purchase health benefits coverage. The board shall publish a report on the results of the surveys received from insurance producers pursuant to this subsection on the website of the Department of Banking and Insurance.
L.2023, c.194, s.8.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27A-43 - Violations, penalties

17B:27A-43. Violations, penalties
27. A carrier which violates any provision of this act shall be liable to a penalty of not less than $2,000 and not greater than $5,000 for each violation. The penalty shall be collected by the commissioner in the name of the State in a summary proceeding in accordance with "the penalty enforcement law," N.J.S.2A:58-1 et seq.
L.1992,c.162,s.27.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27A-44 - Assessments not charged to policyholders, public

17B:27A-44. Assessments not charged to policyholders, public
28. No assessment provided for under this act shall be charged, directly or indirectly, to policyholders or the public, provided that a carrier may charge such an assessment to policyholders to the extent that the charging of the assessment is necessary to enable the carrier to earn a constitutionally adequate rate of return.
L.1992,c.162,s.28.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27A-45 - Standard claim form

17B:27A-45. Standard claim form
29. The board, in conjunction with 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 promulgate one standard claim form.
In order to provide a standard system of payment for medical services, all claim forms for any claimant's use under a group health insurance policy issued or delivered in this State shall conform to the form adopted by the board.
L.1992,c.162,s.29; 1993,c.162,s.20.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27A-47 - Coverage obtained through out-of-State trust, compliance required

17B:27A-47. Coverage obtained through out-of-State trust, compliance required
12. Group hospital or medical coverage obtained through an out-of-State trust covering a group of 49 or fewer employees or participating persons who are residents of this State shall comply with the provisions of P.L.1992, c.162 (C.17B:27A-17 et seq.), regardless of the situs of delivery of the policy.
L.1993,c.162,s.12.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27A-48 - Multiple employer arrangement; requirements

17B:27A-48. Multiple employer arrangement; requirements
13. A multiple employer arrangement covering a group of 49 or fewer employees or participating persons of an individual employer who are residents of this State shall register with the board of directors established pursuant to section 13 of P.L.1992, c.162 (C.17B:27A-29).
The multiple employer arrangement shall be required to offer the health benefits plans established by the board. The premium rates charged for the multiple employer arrangement health benefits plan shall conform to the requirements of section 9 of P.L.1992, c.162 (C.17B:27A-25) and the coverage shall comply with the provisions of subsection b. of section 3 and sections 6 and 7 of P.L.1992, c.162 (C.17B:27A-19, 22 and 23), regardless of the situs of delivery of the multiple employer arrangement.
L.1993,c.162,s.13.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27A-49 - Notification to commissioner by carrier of multiple employer arrangement

17B:27A-49. Notification to commissioner by carrier of multiple employer arrangement
14. A carrier shall notify the commissioner by December 31 of each year of any health care coverage or benefits, stop-loss coverage or administrative services only contracts it provides or enters into with a multiple employer arrangement that provides health care benefits to employees and their dependents in this State.
L.1993,c.162,s.14.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27A-50 - Change of coverage by small employer; restrictions

17B:27A-50. Change of coverage by small employer; restrictions
15. a. A small employer who purchases a health benefits plan or rider pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.) shall not be permitted to purchase a health benefits plan or rider with a greater actuarial value until the first anniversary date of the small employer's existing health benefits plan.
b. If, after the first anniversary date of a small employer's health benefits plan, the small employer purchases a health benefits plan or rider of greater actuarial value than the existing health benefits plan or rider, the small employer shall not be permitted to change his health benefits plan or rider to one of lesser actuarial value until the anniversary date of the small employer's existing health benefits plan.
c. Nothing in this section shall be construed to prohibit a small employer who has purchased a health benefits plan or rider pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.) from purchasing a health benefits plan or rider of lesser actuarial value prior to the anniversary date of the existing health benefits plan or rider, if the existing plan or rider was purchased at least 12 months prior to the latest anniversary date of the plan or rider.
L.1993,c.162,s.15.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27A-53 - Other insurance purchases not required

17B:27A-53. Other insurance purchases not required
21. A carrier shall not require a small employer 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.162 (C.17B:27A-17 et seq.).
L.1993,c.162,s.21.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27A-54 - Commissioner authorized to approve establishment of arrangement; rules, regulations

17B:27A-54. Commissioner authorized to approve establishment of arrangement; rules, regulations
22. Notwithstanding any other law to the contrary, the commissioner is authorized to approve the establishment of an arrangement by an insurance company operating pursuant to Title 17B of the New Jersey Statutes and authorized to issue health benefits plans in this State, that is entered into on or after June 1, 1993 and which provides for selective contracting with health care providers and reasonable benefit differentials applicable to participating and nonparticipating health care providers.
The agreement for an arrangement shall be filed and approved by the commissioner before it becomes effective. The commissioner shall approve the agreement if he determines, in consultation with the Commissioner of Health, that the arrangement promotes health care cost containment while adequately preserving quality of care. The commissioner may adopt regulations pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) necessary to enforce and administer the arrangements.
L.1993,c.162,s.22.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27A-56 - Provision of biannual surveys to DOBI by health insurers.

17B:27A-56 Provision of biannual surveys to DOBI by health insurers.
19. a. Any health insurer, as a condition of transacting business in this State, offering a contract, policy, or plan 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 provide biannual surveys to the Department of Banking and Insurance, based upon information requested and collected from subscribers, insureds, enrollees, and covered persons covered by qualifying high deductible health plans. Each survey shall request, but is not limited to requesting, information concerning: the income levels of the subscribers, insureds, enrollees, or covered persons, covered by qualifying high deductible health plans; the type of contract, policy, or plan which previously provided coverage to those individuals; the amount of out-of-pocket expenses incurred by those individuals; and the percentage of income used by those individuals to pay deductibles.
b. All disclosures made pursuant to this section shall be made in accordance with section 2713 of the "Health Insurance Portability and Accountability Act of 1996," Pub.L.104-191 (42 U.S.C. s.300gg-13).
L.2005,c.248,s.19.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27A-59 - Rules, regulations.

17B:27A-59 Rules, regulations.
4. The Department of Banking and Insurance shall adopt rules and regulations pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), to effectuate the purposes of this act.
L.2019, c.141, s.4.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27A-59.1 - Definitions.

17B:27A-59.1 Definitions.
1. As used in this act:
"Commissioner" means the Commissioner of Banking and Insurance.
"Department" means the Department of Banking and Insurance.
"Insurance affordability assistance" means:
(1) the State Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.);
(2) the NJ FamilyCare Program established pursuant to P.L.2005, c.156 (C.30:4J-8 et al.);
(3) premium tax credits; or
(4) cost-sharing reductions.
"Premium tax credits" means the tax credits described in section 36B of the Internal Revenue Code.
"Program" means the New Jersey Easy Enrollment Health Insurance Program established pursuant to this act.
"Individual" means an individual who is identified through a State income tax return under section 6 of this act as not having minimum essential coverage.
L.2022, c.39, s.1.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27A-59.2 - "New Jersey Easy Enrollment Health Insurance Program" established.

17B:27A-59.2 "New Jersey Easy Enrollment Health Insurance Program" established.
2. a. The Department of Banking and Insurance shall establish and have the authority to operate the New Jersey Easy Enrollment Health Insurance Program. The department shall integrate the program with the State-based exchange established pursuant to P.L.2019, c.141 (C.17B:27A-57 et seq.), and may enter into an agreement with a third party for operation of the program. The purpose of the program shall be to:
(1) establish a State-based reporting system to provide information about the health insurance status of State residents through the use of State income tax returns and approved eFile vendors to identify individuals without minimum essential coverage and determine whether the individual is interested in obtaining minimum essential coverage;
(2) determine or assess, as feasible, whether an individual who is interested in obtaining minimum essential coverage qualifies for insurance affordability assistance;
(3) proactively contact an individual who is interested in obtaining minimum essential coverage to assist in enrolling the individual in insurance affordability assistance and minimum essential coverage; and
(4) maximize enrollment of eligible individuals in insurance affordability assistance and minimum essential coverage to improve access to care and reduce insurance costs for all residents of the State.
b. The Commissioner of Banking and Insurance, in coordination with the Commissioner of Human Services, the Commissioner of Labor and Workforce Development, and the State Treasurer, shall develop and implement systems, policies, and practices that encourage, facilitate, and streamline determination of eligibility for insurance affordability assistance and enrollment in minimum essential coverage to achieve the purposes of the program.
c. To facilitate the most efficient implementation of the program, the Commissioner of Banking and Insurance, the Commissioner of Human Services, the Commissioner of Labor and Workforce Development, and the State Treasurer may enter into agreements, adopt regulations and guidelines, establish accounts, conduct trainings, provide public information, educate tax preparers, and take any other steps as may be necessary to accomplish the purpose of the program.
d. Notwithstanding the provisions of subsection a. of R.S.54:50-8 to the contrary, the State Treasurer shall share with the Commissioner of Banking and Insurance the taxpayer information that is necessary for the purposes of this act and P.L.2018, c.31 (C.54A:11-1 et seq.).
e. The Commissioners of Human Services and Banking and Insurance shall apply and secure any State plan amendments or necessary waivers from the federal Department of Health and Human Services in order to implement the provisions of this act.
L.2022, c.39, s.2.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27A-59.3 - Assistance eligibility, Department of Banking and Insurance.

17B:27A-59.3 Assistance eligibility, Department of Banking and Insurance.
3. a. The Department of Banking and Insurance may assess or determine, as appropriate, eligibility for insurance affordability assistance as soon as possible after an individual files a State income tax return on which the individual indicates pursuant to paragraph (3) of subsection c. of section 6 of this act, that the individual or another individual indicated on the tax return is seeking coverage.
b. (1) To the extent practicable, the department may verify an individual's eligibility for insurance affordability assistance with information on a State income tax return and other data from third-party data sources, including data described in section 1413 of the Affordable Care Act or available pursuant to section 6 of this act, without requesting additional information from the individual.
(2) If additional documentation from an individual is required to establish eligibility for insurance affordability assistance, the department shall take steps to obtain such information while limiting the burden on the individual.
c. The Department of Banking and Insurance may make, or refer to the Department of Human Services to make, an assessment or determination, as appropriate, of eligibility for the State Medicaid program or the NJ FamilyCare Program. The Department of Banking and Insurance may utilize and share with the Department of Human Services any information provided to the Department of Banking and Insurance in making assessments or determinations pursuant to this subsection.
L.2022, c.39, s.3.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27A-59.4 - Special enrollment period, New Jersey individual health insurance market, established.

17B:27A-59.4 Special enrollment period, New Jersey individual health insurance market, established.
4. a. The Department of Banking and Insurance shall establish a special enrollment period for the New Jersey individual health insurance market to facilitate the objectives of the program.
The enrollment period described in this section shall last for a period of time, to be determined by the Department of Banking and Insurance, that shall not be shorter than 30 days.
b. Information about the enrollment period described in subsection a. of this section shall be communicated to the public and affected individuals through measures that may include language in the instructions for the State individual income tax return, if inclusion of the language is approved by the State Treasurer.
c. The Department of Banking and Insurance shall conduct outreach to individuals described in subsection b. of this section, using methods that may include written notices and the provision of individualized assistance by insurance agents and brokers, navigators, tax preparers, and contractors and staff.
Notwithstanding any other provision of this act, the Department of Banking and Insurance may compensate an entity for outreach described in this subsection in a manner that reflects, in whole or in part, the number of individuals enrolled under this section and section 3 of this act by that entity or any other reasonable manner.
L.2022, c.39, s.4.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27A-59.5 - Data privacy, security safeguards.

17B:27A-59.5 Data privacy, security safeguards.
5. a. The Department of Banking and Insurance shall develop data privacy and data security safeguards to govern the conveyance, storage, and utilization of data under the program.
b. The safeguards developed under subsection a. of this section shall ensure that the conveyance, storage, and utilization of data under the program comply with applicable requirements of federal and State law.
L.2022, c.39, s.5.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27A-59.7 - Consenting to information sharing, system established.

17B:27A-59.7 Consenting to information sharing, system established.
7. a. An individual that consents to share information through the system established pursuant to section 8 of this act shall be eligible for a special enrollment period pursuant to subsection b. of this section. The Department of Banking and Insurance shall determine, in accordance with sections 3 and 4 of this act, whether the individual is eligible for the State Medicaid program or the NJ FamilyCare Program, premium tax credits, or cost-sharing reductions.
b. (1) The Department of Banking and Insurance shall establish a special enrollment period for the New Jersey individual health insurance market.
(2) The enrollment period described in this section shall last for a period of time, to be determined by the Department of Banking and Insurance, that shall not be shorter than 30 days.
c. The Department of Banking and Insurance shall conduct outreach to affected individuals, using methods that may include written notices and the provision of individualized assistance by insurance agents and brokers, navigators, tax preparers, and contractors and staff.
L.2022, c.39, s.7.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27A-59.8 - Unemployment claim, indication of interest in obtaining minimum coverage, information sharing, consent.

17B:27A-59.8 Unemployment claim, indication of interest in obtaining minimum coverage, information sharing, consent.
8. a. The Department of Labor and Workforce Development shall implement a system through which an individual who has filed a claim for unemployment insurance benefits may, as part of the claim filing application, indicate that the individual is interested in obtaining minimum essential coverage and consent to the sharing of relevant information collected by the Department of Labor and Workforce Development with the Department of Banking and Insurance and the Department of Human Services to determine whether the individual qualifies for the State Medicaid program or the NJ FamilyCare Program, or any other insurance affordability assistance and to support minimum essential coverage outreach and enrollment efforts. If an individual indicates that the individual is interested in obtaining minimum essential coverage and consents to share information pursuant to this subsection, then the Department of Labor and Workforce Development shall notify the Department of Banking and Insurance, which may assess or determine, as appropriate, eligibility for insurance affordability assistance or make, or refer to the Department of Human Services to make, an assessment or determination, as appropriate, of eligibility for the State Medicaid program or the NJ FamilyCare Program.
b. The Department of Labor and Workforce Development shall enter into an agreement with the Department of Banking and Insurance and the Department of Human Services, before the system described in subsection a. of this section begins to operate, that enables the system to operate in compliance with all applicable State and federal requirements related to privacy, data security, and funding.
c. The consent request described in subsection a. of this section shall be prominently placed on the claim filing application in clear and understandable language that is easy to read.
d. The Department of Labor and Workforce Development shall cooperate with the Department of Banking and Insurance and the Department of Human Services to claim the maximum amount of available federal funding for the establishment and operation of the system established pursuant to this section.
e. To facilitate the most efficient implementation of the system, the Commissioner of Banking and Insurance, the Commissioner of Human Services, and the Commissioner of Labor and Workforce Development may enter into agreements, adopt regulations and guidelines, establish accounts, conduct trainings, provide public information, educate tax preparers, and take any other steps as may be necessary to accomplish the purpose of the system.
L.2022, c.39, s.8.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27A-61 - Carrier seeking rate increase.

17B:27A-61 Carrier seeking rate increase.
1. In addition to any other applicable laws or regulations, a carrier that seeks a rate increase as part of an informational filing for an individual or small employer health benefits plan shall comply with all of the provisions of this act. The Department of Banking and Insurance shall review informational filings that are subject to this act in the manner set forth in the provisions of this act.
L.2019, c.355, s.1.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27A-62 - Information to support, justify rate requests.

17B:27A-62 Information to support, justify rate requests.
2. a. An informational rate filing by a carrier for an individual or small employer health benefits plan offered in this State shall contain information to support and justify rate requests. A rate increase shall be subject to expanded review by the department pursuant to the provisions of this act if the informational rate filing requests a rate increase of 10 percent or more annually.
b. A rate increase meets or exceeds 10 percent annually if the average increase for all enrollees weighted by premium volume for any plan within the product meets or exceeds the 10 percent threshold.
c. With respect to small employer plans, rate increases submitted on a quarterly basis shall be considered both for each specific quarter and in combination with any previous quarterly rate increase or increases applicable to the same calendar year when determining whether the rate increase meets or exceeds the 10 percent threshold for expanded review.
d. For the purposes of this act, "informational filing" means a submission, by a carrier to the department, of rate-filings which specify the plans offered, premium rates, all factors to be used in the calculation of premium rates, and a detailed actuarial memorandum supporting the calculation of the rates including a certification by a qualified member of the American Academy of Actuaries, the Society of Actuaries, or the Casualty Actuarial Society, all supporting data for the premium rates and such other information as required by the department.
L.2019, c.355, s.2.