reglab/statecodes huggingface dataset:
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:26-3.2 - Individual health insurance policy, exclusion, rates, terms based on genetic information prohibited

17B:26-3.2. Individual health insurance policy, exclusion, rates, terms based on genetic information prohibited
14. Every individual health insurance policy providing hospital and medical expense benefits that is delivered, issued, executed or renewed in this State pursuant to Chapter 26 of Title 17B of the New Jersey Statutes 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 not exclude any person or eligible dependent and shall not establish any rates or terms therefor on the basis of an actual or expected health condition or on the basis of any genetic characteristic. For the purposes of this section, "genetic characteristic" means any inherited gene or chromosome, or alteration thereof, that is scientifically or medically believed to predispose an individual to a disease, disorder or syndrome, or to be associated with statistically increased risk of development of a disease, disorder or syndrome.
L.1996,c.126,s.14.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:26-4 - Entire contract; changes

17B:26-4. Entire contract; changes
There shall be a provision as follows:
Entire contract; changes: This policy, including the endorsements and the attached papers, if any, constitutes the entire contract of insurance. No change in this policy shall be valid until approved by an executive officer of the insurer and unless such approval be endorsed hereon or attached hereto. No agent has authority to change this policy or to waive any of its provisions.
L.1971, c. 144, s. 17B:26-4.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:26-5 - Time limit on certain defenses

17B:26-5. Time limit on certain defenses
There shall be a provision as follows:
Time limit on certain defenses:
a. After 2 years from the date of issue of this policy no misstatements, except fraudulent misstatements, made by the applicant in the application for such policy shall be used to void the policy or to deny a claim for loss incurred or disability (as defined in the policy) commencing after the expiration of such 2-year period.
(1) The foregoing policy provision shall not be so construed as to affect any legal requirement for avoidance of a policy or denial of a claim during such initial 2-year period, nor to limit the application of sections 17B:26-17 to 17B:26-21, inclusive, in the event of misstatement with respect to age or occupation or other insurance.
(2) A policy which the insured has the right to continue in force subject to its terms by the timely payment of premium (a) until at least age 50 or, (b) in the case of a policy issued after age 44, for at least 5 years from its date of issue, may contain in lieu of the foregoing the following provision (from which the clause in parentheses may be omitted at the insurer's option) under the caption " Incontestable " :
After this policy has been in force for a period of 2 years during the lifetime of the insured, (excluding any period during which the insured is disabled) it shall become incontestable as to the statements contained in the application.
b. No claim for loss incurred or disability (as defined in the policy) commencing after 2 years from the date of issue of this policy shall be reduced or denied on the ground that a disease or physical condition not excluded from coverage by name or specific description effective on the date of loss and existed prior to the effective date of coverage of this policy.
L.1971, c. 144, s. 17B:26-5.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:26-6 - Grace period

17B:26-6. Grace period
There shall be a provision as follows:
Grace period: A grace period of (insert a number not less than "7" for weekly premium policies, "10" for monthly premium policies and "31" for all other policies) days will be granted for the payment of each premium falling due after the first premium, during which grace period the policy shall continue in force.
a. A policy which contains a cancellation provision may add, at the end of the above provision:
Subject to the right of the insurer to cancel in accordance with the cancellation provision hereof.
b. A policy in which the insurer reserves the right to refuse any renewal shall have, at the beginning of the above provision:
Unless not less than 5 days prior to the premium due date the insurer has delivered to the insured or has mailed to his last address as shown by the records of the insurer written notice of its intention not to renew this policy beyond the period for which the premium has been accepted.
L.1971, c. 144, s. 17B:26-6.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:26-7 - Reinstatement

17B:26-7. Reinstatement
There shall be a provision as follows:
Reinstatement: If any renewal premium be not paid within the time granted the insured for payment, a subsequent acceptance of premium by the insurer or by any agent duly authorized by the insurer to accept such premium, without requiring in connection therewith an application for reinstatement, shall reinstate the policy; provided, however, that if the insurer or such agent requires an application for reinstatement and issues a conditional receipt for the premium tendered, the policy will be reinstated upon approval of such application by the insurer or, lacking such approval, upon the forty-fifth day following the date of such conditional receipt unless the insurer has previously notified the insured in writing of its disapproval of such application. The reinstated policy shall cover only loss resulting from such accidental injury as may be sustained after the date of reinstatement and loss due to such sickness as may begin more than 10 days after such date. In all other respects the insured and insurer shall have the same rights thereunder as they had under the policy immediately before the due date of the defaulted premium, subject to any provisions endorsed hereon or attached hereto in connection with the reinstatement. Any premium accepted in connection with a reinstatement shall be applied to a period for which premium has not been previously paid, but not to any period more than 60 days prior to the date of reinstatement.
(The last sentence of the above provision may be omitted from any policy which the insured has the right to continue in force subject to its terms by the timely payment of premiums a. until at least age 50 or, b. in the case of a policy issued after age 44, for at least 5 years from its date of issue.)
L.1971, c. 144, s. 17B:26-7.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:26-8 - Notice of claim

17B:26-8. Notice of claim
There shall be a provision as follows:
Notice of claim: Written notice of claim must be given to the insurer within 20 days after the occurrence or commencement of any loss covered by the policy, or as soon thereafter as is reasonably possible. Notice given by or on behalf of the insured or the beneficiary to the insurer at (insert the location of such office as the insurer may designate for the purpose), or to any authorized agent of the insurer, with information sufficient to identify the insured, shall be deemed notice to the insurer.
(In a policy providing a loss-of-time benefit which may be payable for at least 2 years, an insurer may at its option insert the following between the first and second sentences of the above provision:
Subject to the qualifications set forth below, if the insured suffers loss of time on account of disability for which indemnity may be payable for at least 2 years, he shall, at least once in every 6 months after having given notice of claim, give to the insurer notice of continuance of said disability, except in the event of legal incapacity. The period of 6 months following any filing of proof by the insured or any payment by the insurer on account of such claim or any denial of liability in whole or in part by the insurer shall be excluded in applying this provision. Delay in the giving of such notice shall not impair the insured's right to any indemnity which would otherwise have accrued during the period of 6 months preceding the date on which such notice is actually given.)
L.1971, c. 144, s. 17B:26-8.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:26-9 - Claim forms

17B:26-9. Claim forms
There shall be a provision as follows:
Claim forms: The insurer, upon receipt of a notice of claim, will furnish to the claimant such forms as are usually furnished by it for filing proofs of loss. If such forms are not furnished within 15 days after the giving of such notice the claimant shall be deemed to have complied with the requirements of this policy as to proof of loss upon submitting, within the time fixed in the policy for filing proofs of loss, written proof covering the occurrence, the character and the extent of the loss for which claim is made.
L.1971, c. 144, s. 17B:26-9.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:26-10 - Proofs of loss

17B:26-10. Proofs of loss
There shall be a provision as follows:
Proofs of loss: Written proof of loss must be furnished to the insurer at its said office in case of claim for loss for which this policy provides any periodic payment contingent upon continuing loss within 90 days after the termination of the period for which the insurer is liable and in case of claim for any other loss within 90 days after the date of such loss. Failure to furnish such proof within the time required shall not invalidate nor reduce any claim if it was not reasonably possible to give proof within such time, provided such proof is furnished as soon as reasonably possible and in no event, except in the absence of legal capacity, later than 1 year from the time proof is otherwise required.
L.1971, c. 144, s. 17B:26-10.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:26-11 - Time of payment of claims

17B:26-11. Time of payment of claims
There shall be a provision as follows:
Time of payment of claims: Indemnities payable under this policy for any loss other than loss for which this policy provides any periodic payment will be paid immediately upon receipt of due written proof of such loss. Subject to due written proof of loss, all accrued indemnities for loss for which this policy provides periodic payment will be paid (insert period for payment which must not be less frequently than monthly) and any balance remaining unpaid upon the termination of liability will be paid immediately upon receipt of due written proof.
L.1971, c. 144, s. 17B:26-11.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:26-12 - Payment of claims

17B:26-12. Payment of claims
There shall be a provision as follows:
Payment of claims: Indemnity for loss of life will be payable in accordance with the beneficiary designation and the provisions respecting such payment which may be prescribed herein and effective at the time of payment. If no such designation or provision is then effective, such indemnity shall be payable to the estate of the insured. Any other accrued indemnities unpaid at the insured's death may, at the option of the insurer, be paid either to such beneficiary or to such estate. All other indemnities will be payable to the insured.
(The following provisions, or either of them, may be included with the foregoing provision at the option of the insurer:
a. If any indemnity of this policy shall be payable to the estate of the insured, or to an insured or beneficiary who is a minor or otherwise not competent to give a valid release, the insurer may pay such indemnity, up to an amount not exceeding $ (insert an amount which shall not exceed $1,000.00) to any relative by blood or connection by marriage of the insured or beneficiary who is deemed by the insurer to be equitably entitled thereto. Any payment made by the insurer in good faith pursuant to this provision shall fully discharge the insurer to the extent of such payment.
b. Subject to any written direction of the insured in the application or otherwise all or a portion of any indemnities provided by this policy on account of hospital, nursing, medical, or surgical services may, at the insurer's option and unless the insured requests otherwise in writing not later than the time of filing proofs of such loss, be paid directly to the hospital or person rendering such services; but it is not required that the service be rendered by a particular hospital or person.)
L.1971, c. 144, s. 17B:26-12.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:26-13 - Physical examinations and autopsy

17B:26-13. Physical examinations and autopsy
There shall be a provision as follows:
Physical examinations and autopsy: The insurer at its own expense shall have the right and opportunity to examine the person of the insured when and as often as it may reasonably require during the pendency of a claim hereunder and to make an autopsy in case of death where it is not forbidden by law.
L.1971, c. 144, s. 17B:26-13.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:26-14 - Legal actions

17B:26-14. Legal actions
There shall be a provision as follows:
Legal actions: No action at law or in equity shall be brought to recover on this policy prior to the expiration of 60 days after written proof of loss has been furnished in accordance with the requirements of this policy. No such action shall be brought after the expiration of 3 years after the time written proof of loss is required to be furnished.
L.1971, c. 144, s. 17B:26-14.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:26-15 - Change of beneficiary

17B:26-15. Change of beneficiary
There shall be a provision as follows:
Change of beneficiary: Unless the insured makes an irrevocable designation of beneficiary, the right to change of beneficiary is reserved to the insured and the consent of the beneficiary or beneficiaries shall not be requisite to surrender or assignment of this policy or to any change of beneficiary or beneficiaries, or to any other changes in this policy.
(The first clause of this provision, relating to the irrevocable designation of beneficiary, may be omitted at the insurer's option.)
L.1971, c. 144, s. 17B:26-15.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:26-16 - Optional policy provisions

17B:26-16. Optional policy provisions
Except as provided in section 17B:26-28, no policy of health insurance delivered or issued for delivery to any person in this State shall contain provisions respecting the matters set forth in sections 17B:26-17 to 17B:26-27 inclusive, unless such provisions are in the words in which the same appear in the applicable section; provided, however, that the insurer may, at its option, use in lieu of any such provision a corresponding provision of different wording approved by the commissioner which is not less favorable in any respect to the insured or the owner, if other than the insured. Any such provision contained in the policy shall be preceded individually by the caption appearing in the appropriate section or, at the option of the insurer, by such appropriate individual or group captions or subcaptions as the commissioner may approve.
L.1971, c. 144, s. 17B:26-16.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:26-17 - Change of occupation

17B:26-17. Change of occupation
There may be a provision as follows:
Change of occupation: If the insured be injured or contract sickness after having changed his occupation to one classified by the insurer as more hazardous than that stated in this policy or while doing for compensation anything pertaining to an occupation so classified, the insurer will pay only such portion of the indemnities provided in this policy as the premium paid would have purchased at the rates and within the limits fixed by the insurer for such more hazardous occupation. If the insured changes his occupation to one classified by the insurer as less hazardous than that stated in this policy, the insurer, upon receipt of proof of such change of occupation, will reduce the premium rate accordingly, and will return the excess pro rata unearned premium from the date of change of occupation or from the policy anniversary date immediately preceding receipt of such proof, whichever is the more recent. In applying this provision, the classification of occupational risk and the premium rates shall be such as have been last filed by the insurer prior to the occurrence of the loss for which the insurer is liable or prior to date of proof of change in occupation with the State official having supervision of insurance in the State where the insured resided at the time this policy was issued; but if such filing was not required, then the classification of occupational risk and the premium rates shall be those last made effective by the insurer in such State prior to the occurrence of the loss or prior to the date of proof of change in occupation.
L.1971, c. 144, s. 17B:26-17.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:26-18 - Misstatement of age

17B:26-18. Misstatement of age
There may be a provision as follows:
Misstatement of age: If the age of the insured has been misstated, all amounts payable under this policy shall be such as the premium paid would have purchased at the correct age.
L.1971, c. 144, s. 17B:26-18.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:26-19 - Other insurance in this insurer

17B:26-19. Other insurance in this insurer
There may be a provision as follows:
Other insurance in this insurer: If an accident or sickness or accident and sickness policy or policies previously issued by the insurer to the insured be in force concurrently herewith, making the aggregate indemnity for (insert type of coverage or coverages) in excess of $ (insert maximum limit of indemnity or indemnities) the excess insurance shall be void and all premiums paid for such excess shall be returned to the insured or to his estate.
or, in lieu thereof:
Insurance effective at any one time on the insured under a like policy or policies in this insurer is limited to the one such policy elected by the insured, his beneficiary or his estate, as the case may be, and the insurer will return all premiums paid for all other such policies.
L.1971, c. 144, s. 17B:26-19.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:26-20 - Insurance with other insurers

17B:26-20. Insurance with other insurers
There may be a provision as follows:
Insurance with other insurers: If there be other valid coverage, not with this insurer, providing benefits for the same loss on a provision of service basis or on an expense incurred basis and of which this insurer has not been given written notice prior to the occurrence or commencement of loss, the only liability under any expense incurred coverage of this policy shall be for such proportion of the loss as the amount which would otherwise have been payable hereunder plus the total of the like amounts under all such other valid coverages for the same loss of which this insurer had notice bears to the total like amounts under all valid coverages for such loss, and for the return of such portion of the premiums paid as shall exceed the pro-rata portion for the amount so determined. For the purpose of applying this provision when other coverage is on a provision of service basis, the "like amount" of such other coverage shall be taken as the amount which the services rendered would have cost in the absence of such coverage.
(If the foregoing policy provision is included in a policy which also contains the next following policy provision there shall be added to the caption of the foregoing provision the phrase "--Expense Incurred Benefits." The insurer may, at its option, include in this provision a definition of "other valid coverage," approved as to form by the commissioner, which definition shall be limited in subject matter to coverage provided by organizations subject to regulation by insurance law or by insurance authorities of this or any other State of the United States or any province of Canada, and by hospital or medical service organizations, and to any other coverage the inclusion of which may be approved by the commissioner. In the absence of such definition such term shall not include group insurance, automobile medical payments insurance, or coverage provided by hospital or medical service organizations or by union welfare plans or employer or employee benefit organizations. For the purpose of applying the foregoing policy provision with respect to any insured, any amount of benefit provided for such insured pursuant to any compulsory benefit statute (including any workmen's compensation or employer's liability statute) whether provided by a governmental agency or otherwise shall in all cases be deemed to be "other valid coverage" of which the insurer has had notice. In applying the foregoing policy provision no third party liability coverage shall be included as "other valid coverage." )
L.1971, c. 144, s. 17B:26-20.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:26-21 - Insurance with other insurers

17B:26-21. Insurance with other insurers
There may be a provision as follows:
Insurance with other insurers: If there be other valid coverage, not with this insurer, providing benefits for the same loss on other than an expense incurred basis and of which this insurer has not been given written notice prior to the occurrence or commencement of loss, the only liability for such benefits under this policy shall be for such proportion of the indemnities otherwise provided hereunder for such loss as the like indemnities of which the insurer had notice (including the indemnities under this policy,) bear to the total amount of all like indemnities for such loss, and for the return of such portion of the premium paid as shall exceed the pro-rata portion for the indemnities thus determined.
(If the foregoing policy provision is included in a policy which also contains the next preceding policy provision there shall be added to the caption of the foregoing provision the phrase "--Other Benefits." The insurer may, at its option, include in this provision a definition of "other valid coverage," approved as to form by the commissioner, which definition shall be limited in subject matter to coverage provided by organizations subject to regulation by insurance law or by insurance authorities of this or any other State of the United States or any province of Canada, and to any other coverage the inclusion of which may be approved by the commissioner. In the absence of such definition such term shall not include group insurance, or benefits provided by union welfare plans or by employer or employee benefit organizations. For the purpose of applying the foregoing policy provision with respect to any insured, any amount of benefit provided for such insured pursuant to any compulsory benefit statute (including any workmen's compensation or employer's liability statute) whether provided by a governmental agency or otherwise shall in all cases be deemed to be "other valid coverage" of which the insurer has had notice. In applying the foregoing policy provision no third party liability coverage shall be included as "other valid coverage." )
L.1971, c. 144, s. 17B:26-21.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:26-22 - Relation of earnings to insurance

17B:26-22. Relation of earnings to insurance
There may be a provision as follows:
Relation of earnings to insurance: If the total monthly amount of loss of time benefits promised for the same loss under all valid loss of time coverage upon the insured, whether payable on a weekly or monthly basis, shall exceed the monthly earnings of the insured at the time disability commenced or his average monthly earnings for the period of two years immediately preceding a disability for which claim is made, whichever is the greater, the insurer will be liable only for such proportionate amount of such benefits under this policy as the amount of such monthly earnings or such average monthly earnings of the insured bears to the total amount of monthly benefits for the same loss under all such coverage upon the insured at the time such disability commences and for the return of such part of the premiums paid during such two years as shall exceed the pro-rata amount of the premiums for the benefits actually paid hereunder; but this shall not operate to reduce the total monthly amount of benefits payable under all such coverage upon the insured below the sum of two hundred dollars or the sum of the monthly benefit specified in such coverages, whichever is the lesser, nor shall it operate to reduce benefits other than those payable for loss of time.
(The foregoing policy provision may be inserted only in a policy which the insured has the right to continue in force subject to its terms by the timely payment of premiums a. until at least age 50, or b. in the case of a policy issued after age 44, for at least five years from its date of issue. The insurer may, at its option, include in this provision a definition of "valid loss of time coverage," approved as to form by the commissioner, which definition shall be limited in subject matter to coverage provided by governmental agencies or by organizations subject to regulation by insurance law or by insurance authorities of this or any other State of the United States or any province of Canada, or to any other coverage the inclusion of which may be approved by the commissioner or any combination of such coverages. In the absence of such definition such terms shall not include any coverage provided for such insured pursuant to any compulsory benefit statute (including any workmen's compensation or employer's liability statute), or benefits provided by union welfare plans or by employer or employee benefit organizations.)
L.1971, c. 144, s. 17B:26-22.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:26-23 - Unpaid premium

17B:26-23. Unpaid premium
There may be a provision as follows:
Unpaid premium: Upon the payment of a claim under this policy, any premium then due and unpaid or covered by any note or written order may be deducted therefrom.
L.1971, c. 144, s. 17B:26-23.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:26-24 - Cancellation

17B:26-24. Cancellation
There may be a provision as follows:
Cancellation: The insurer may cancel this policy at any time by written notice delivered to the insured, or mailed to his last address as shown by the records of the insurer, stating when, not less than five days thereafter, such cancellation shall be effective; and after the policy has been continued beyond its original term the insured may cancel this policy at any time by written notice delivered or mailed to the insurer, effective upon receipt or on such later date as may be specified in such notice.
In the event of cancellation, the insurer will return promptly the unearned portion of any premium paid. If the insured cancels, the earned premium shall be computed by the use of the short-rate table last filed with the State official having supervision of insurance in the State where the insured resided when the policy was issued. If the insurer cancels, the earned premium shall be computed pro-rata. Cancellation shall be without prejudice to any claim originating prior to the effective date of cancellation.
L.1971, c. 144, s. 17B:26-24.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:26-25 - Conformity with State statutes

17B:26-25. Conformity with State statutes
There may be a provision as follows:
Conformity with State statutes: Any provision of this policy which, on its effective date, is in conflict with the statutes of the State in which the insured resides on such date is hereby amended to conform to the minimum requirements of such statutes.
L.1971, c. 144, s. 17B:26-25.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:26-26 - Illegal occupation

17B:26-26. Illegal occupation
There may be a provision as follows:
Illegal occupation: The insurer shall not be liable for any loss to which a contributing cause was the insured's commission of or attempt to commit a felony or to which a contributing cause was the insured's being engaged in an illegal occupation.
L.1971, c. 144, s. 17B:26-26.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:26-27 - Intoxicants and narcotics

17B:26-27. Intoxicants and narcotics
There may be a provision as follows:
Intoxicants and narcotics: The insurer shall not be liable for any loss sustained or contracted in consequence of the insured's being intoxicated or under the influence of any narcotic unless administered on the advice of a physician.
L.1971, c. 144, s. 17B:26-27.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:26-28 - Inapplicable or inconsistent provisions

17B:26-28. Inapplicable or inconsistent provisions
If any provision of sections 17B:26-3 to 17B:26-31, inclusive, is in whole or in part inapplicable to or inconsistent with the coverage provided by a particular form of policy the insurer, with the approval of the commissioner, shall omit from such policy any inapplicable provision or part of a provision, and shall modify any inconsistent provision or part of the provision in such manner as to make the provision as contained in the policy consistent with the coverage provided by the policy.
L.1971, c. 144, s. 17B:26-28.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:26-29 - Order of certain policy provisions

17B:26-29. Order of certain policy provisions
The provisions which are the subject of sections 17B:26-3 to 17B:26-27, inclusive, or any corresponding provisions which are used in lieu thereof in accordance with such sections, shall be printed in the consecutive order of the provisions in such sections or, at the option of the insurer, any such provision may appear as a unit in any part of the policy, with other provisions to which it may be logically related, provided the resulting policy shall not be in whole or in part unintelligible, uncertain, ambiguous, abstruse, or likely to mislead a person to whom the policy is offered, delivered or issued.
L.1971, c. 144, s. 17B:26-29.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:26-30 - Third party ownership

17B:26-30. Third party ownership
The word "insured," as used in this chapter, shall not be construed as preventing a person other than the insured with a proper insurable interest from making application for and owning a policy covering the insured or from being entitled under such a policy to any indemnities, benefits and rights provided therein.
L.1971, c. 144, s. 17B:26-30.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:26-31 - Requirements of other jurisdictions

17B:26-31. Requirements of other jurisdictions
a. Any policy of a foreign or alien insurer, when delivered or issued for delivery to any person in this State, may contain any provision which is not less favorable to the insured or the owner, if other than the insured, than the provisions of this chapter and which is prescribed or required by the law of the State under which the insurer is organized.
b. Any policy of a domestic insurer may, when issued for delivery in any other State or country, contain any provision permitted or required by the laws of such other State or country.
L.1971, c. 144, s. 17B:26-31.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:26-32 - Other policy provisions

17B:26-32. Other policy provisions
No policy provision which is not subject to sections 17B:26-3 to 17B:26-31, inclusive, of this chapter shall make a policy, or any portion thereof, less favorable in any respect to the insured or the owner, if other than the insured, than the provisions thereof which are subject to this chapter.
L.1971, c. 144, s. 17B:26-32.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:26-33 - Policy conflicting with this chapter

17B:26-33. Policy conflicting with this chapter
A policy delivered or issued for delivery to any person in this State in violation of this chapter shall be held valid but shall be construed as provided in this chapter. When any provision in a policy subject to this chapter is in conflict with any provision of this chapter, the rights, duties and obligations of the insurer, the insured or the owner, if other than the insured, shall be governed by the provisions of this chapter.
L.1971, c. 144, s. 17B:26-33.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:26-34 - Time limit on certain defenses with respect to reinstatement

17B:26-34. Time limit on certain defenses with respect to reinstatement
A policy provision complying with the requirements of section 17B:26-5, relating to a time limit on certain defenses, shall also apply to any reinstatement of the policy except that the period of time established by such provision shall commence with the date of the reinstatement instead of the date of issue of the policy.
L.1971, c. 144, s. 17B:26-34.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:26-35 - Waiver of rights of insurer

17B:26-35. Waiver of rights of insurer
The acknowledgment by any insurer of the receipt of notice given under any policy covered by this chapter, or the furnishing of forms for filing proofs of loss, or the acceptance of such proofs, or the investigation of any claim thereunder shall not operate as a waiver of any of the rights of the insurer in defense of any claim arising under such policy.
L.1971, c. 144, s. 17B:26-35.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:26-36 - Age limit

17B:26-36. Age limit
If any policy contains a provision establishing, as an age limit or otherwise, a date after which the coverage provided by the policy will not be effective, and if such date falls within a period for which premium is accepted by the insurer or if the insurer accepts a premium after such date, the coverage provided by the policy will continue in force subject to any right of cancellation until the end of the period for which premium has been accepted. In the event the age of the insured has been misstated and if, according to the correct age of the insured, the coverage provided by the policy would not have become effective, or would have ceased prior to the acceptance of such premium or premiums, then the liability of the insurer shall be limited to the refund, upon request, of all premiums paid for the period not covered by the policy.
L.1971, c. 144, s. 17B:26-36.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:26-37 - Scope of chapter

17B:26-37. Scope of chapter
Nothing in this chapter shall apply to or affect a. any policy of workmen's compensation insurance or any policy of liability insurance with or without supplementary coverage therein as authorized by section 17:28-1; or b. any policy or contract of reinsurance; or c. any blanket or group policy of insurance; or d. life insurance or annuity contracts, or contracts supplemental thereto, which contain only such provisions relating to health insurance as (1) providing for additional benefits in event of death by accident or accidental means or in event of dismemberment or loss of sight, or (2) safeguarding such insurance or annuity against lapse or giving a special surrender value or special benefit or an annuity in the event that the insured or the annuitant shall become totally and permanently disabled.
L.1971, c. 144, s. 17B:26-37.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:26-38 - Penalty

17B:26-38. Penalty
Any person who delivers or issues for delivery to any person in this State any policy in willful violation of the provisions of this chapter shall be liable to a penalty not exceeding $500.00 for each offense to 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.1971, c. 144, s. 17B:26-38.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:26-39 - Legislative findings and declarations

17B:26-39. Legislative findings and declarations
The Legislature hereby finds and declares that the high cost of hospital care necessitates the establishment of alternative means of caring for patients who need some professional health care, but who do not need to remain hospitalized. Home health care, therefore, is a necessary and desirable means of providing professional services to patients, consistent with the following objectives:
a. Rehabilitation of the patient in order to assist in the development of independent living capabilities;
b. Rehabilitation of the patient in order to attain reduction of physical or mental disability.
L.1977, c. 98, s. 1.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:26-40 - Definitions

17B:26-40. Definitions
As used in this act:
a. "Home health care" means those nursing and other home health care services rendered to a person in his place of residence, under the following conditions:
(1) On a part-time and intermittent basis, except when full-time or 24-hour services are needed on a short-term basis;
(2) If continuing hospitalization would otherwise have been required if home health care were not provided;
(3) Pursuant to a physician's order and under a plan of care established by the responsible physician in collaboration with a home health care provider, which plan shall be periodically reviewed and approved by said physician. All care plans shall be established within 14 days following the commencement of home health care.
b. "Home health care services" means any of the following services necessary for achievement of the care plan set forth for the patient:
(1) Nursing care;
(2) Physical therapy;
(3) Occupational therapy;
(4) Medical social work;
(5) Nutrition services;
(6) Speech therapy;
(7) Home health aide services;
(8) Medical appliances and equipment, drugs, and medications, laboratory services and special meals, to the extent such items and services would have been covered under the policy if the covered person had been in a hospital;
(9) Any diagnostic or therapeutic service, including surgical services, performed in a hospital outpatient department, a doctor's office or any other licensed health care facility, provided such service would have been covered under the policy if performed as inpatient hospital services.
C. "Home health care provider" means a home health care agency which is certified to participate as a home health agency under Title XVIII of the Social Security Act or a proprietary agency licensed by the Commissioner of Health. At such time as home health agency licensure standards are promulgated pursuant to P.L.1971, c. 136 and 138, home health care providers shall be licensed agencies.
L.1977, c. 98, s. 2.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:26-41 - Home health care; requirement for provisions for coverage

17B:26-41. Home health care; requirement for provisions for coverage
Notwithstanding any provision of a policy of health insurance, hereafter delivered or issued for delivery in this State, whenever such policy provides coverage for inpatient hospital care or skilled nursing facility care, it shall also provide coverage for home health care.
L.1977, c.98, s. 3.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:26-42 - Benefits

17B:26-42. Benefits
Every policy shall provide benefits required by section 3 without a separate deductible or coinsurance provision for the home health care benefit. For the purpose of determining the benefits for home health care, each visit by a member of a home health care team shall be considered as one home health care visit. The policy may contain a limitation on the number of home health care visits, but no policy may provide for less than 60 home health care visits in any calendar year or in any continuous period of 12 months.
L.1977, c. 98, s. 4.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:26-43 - Direct reimbursement to home health care providers

17B:26-43. Direct reimbursement to home health care providers
The State Commissioner of Insurance, after consultation with the State Commissioner of Health, shall provide for a system of direct reimbursement to home health care providers for services rendered pursuant to this act.
L.1977, c. 98, s. 5.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:26-44.1 - Policy provision for reimbursement of dental services; payment regardless of discipline of provider

17B:26-44.1. Policy provision for reimbursement of dental services; payment regardless of discipline of provider
Notwithstanding any provision of a policy or individual health insurance contract hereafter delivered, issued for delivery, amended, renewed or ratified in this State, whenever such a policy or contract provides for reimbursement for any service which is within the lawful scope of practice of a duly licensed dentist, the following provisions shall apply:
a. A person covered under such policy or contract shall be entitled to reimbursement for such service regardless of whether the service is performed by a duly licensed physician or duly licensed dentist.
b. Equal reimbursement rates shall be paid for services performed, regardless of the discipline of the provider of the service.
L.1979, c. 161, s. 1, eff. July 19, 1979.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:26-44.2 - Application to policy or contract not limited to reimbursement of specific types of duly licensed health care professionals other than dentists

17B:26-44.2. Application to policy or contract not limited to reimbursement of specific types of duly licensed health care professionals other than dentists
The provisions of section 1 of this act shall also apply to any policy or contract of individual health insurance already delivered or issued for delivery in this State, if such policy or contract does not limit reimbursement to specific types of duly licensed health care professionals other than dentists.
L.1979, c. 161, s. 2, eff. July 19, 1979.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:26-44.3 - Renewal date; policy with reservation of right to change premium

17B:26-44.3. Renewal date; policy with reservation of right to change premium
For the purposes of this act, a policy or contract in which the company has reserved the right to change the premium shall be considered renewed as of the date on which the premium is changed or is subject to change.
L.1979, c. 161, s. 3, eff. July 19, 1979.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:26-44.4 - Alternative dental coverage; original coverage restricted to limited number of providers

17B:26-44.4. Alternative dental coverage; original coverage restricted to limited number of providers
Each employer or other organization which employs or has 25 or more employees or members during the full preceding calendar year and which contributes to a health insurance contract which restricts the covered persons in selecting the providers of dental services to a single provider or limited number of providers, shall also offer its employees and their eligible dependents and members and members' eligible dependents at the time a dental benefits plan is offered or renewed the option of selecting alternative coverage which permits covered persons to obtain dental services from any licensed dentist.
L.1983, c. 142, s. 1, eff. April 20, 1983.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:26-44.5 - Employer contribution

17B:26-44.5. Employer contribution
An employer or other organization shall be required to pay for or contribute towards the provision of alternative coverage an amount equal to the premium or cost which it pays or contributes to the health insurance contract for dental services which limits the number of providers of dental services.
L.1983, c. 142, s. 2, eff. April 20, 1983.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:26-44.6 - Rules and regulations

17B:26-44.6. Rules and regulations
Within 120 days of the effective date of this act, the Commissioner of the Department of Insurance shall promulgate rules and regulations necessary to effectuate the purpose of this act, including procedures for notice to covered persons, employers and other organizations of the provisions of this act.
L.1983, c. 142, s. 3, eff. April 20, 1983.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:26-45 - Minimum standards for form, content and sale of individual health insurance; regulations

17B:26-45. Minimum standards for form, content and sale of individual health insurance; regulations
a. The commissioner of insurance shall issue such regulations as he shall deem necessary or desirable to establish minimum standards, including standards for full and fair disclosure, for the form, content and sale of individual health insurance issued pursuant to chapter 26 of Title 17B of the New Jersey Statutes. Such regulations shall apply to all, any portion, or reasonable classifications of such insurance, other than conversion policies pursuant to a contractual conversion privilege.
b. The purposes of such minimum standards shall include any or all of the following: (1) reasonable standardization and simplification of language, terms and coverages to facilitate understanding and comparisons; (2) elimination of provisions which may be misleading or unreasonably confusing in connection with either the purchase of such insurance or the settlement of claims; (3) elimination of deceptive practices in connection with the sale of such insurance; (4) elimination of provisions which may be contrary to the health care needs of the public; (5) elimination of coverages which are so limited in scope as to be of no substantial economic value to the holders thereof; and (6) elimination of unfair renewal practices which are contrary to the health care needs and economic well-being of the public.
c. Any such regulations shall be promulgated in accordance with the Administrative Procedure Act (P.L.1968, c. 410, C. 52:14B-1 et seq.).
d. The department shall transmit copies of all rules and regulations adopted pursuant to this act to the Senate and General Assembly on a day on which both houses shall be meeting in the course of a regular or special session. The provisions of the "Administrative Procedure Act" or any other law to the contrary notwithstanding no such rule or regulation shall take effect if, within 60 days of the date of its transmittal to the Senate and General Assembly, the legislature shall pass a concurrent resolution stating in substance that the Legislature does not favor such proposed rule or regulation.
e. 120 days after the effective date of a regulation which has been adopted pursuant to this section, all policies of insurance previously filed with the commissioner which are not in compliance with the regulation shall be deemed to be withdrawn from filing and disapproved. No new policy of insurance shall be delivered or issued for delivery in this State until such new policy has been filed with the commissioner.
L.1979, c. 78, s. 1, eff. April 15, 1979.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:26-46 - Violations; penalty; collection and enforcement

17B:26-46. Violations; penalty; collection and enforcement
If, after notice and hearing, the commissioner finds that an insurance company, agent or broker or any other person has violated the provisions of this act or any regulation promulgated pursuant to this act, he may, in addition to any other penalty, impose a penalty not exceeding $2,000.00 for each such violation, which penalty shall be collected and enforced pursuant to the law (N.J.S. 2A:58-1 et seq.).
L.1979, c. 78, s. 2, eff. April 15, 1979.