reglab/statecodes huggingface dataset:
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.36b - Limitation on participation of private sector employees.

52:14-17.36b Limitation on participation of private sector employees.
2. Notwithstanding the provisions of subsection a. of section 1 of this act, P.L.2005, c.135 (C.52:14-17.36a), the total number of private sector employees who participate under the provisions of that section shall not be permitted to exceed a de minimis percentage of the total number of employees participating in the State Health Benefits Program. For purposes of this act, any employee who is on a leave of absence from employment with the State and who is an employee of an affiliate of a majority representative of State employees for collective negotiation purposes, which affiliate represents State employees, shall not be considered a private sector employee.
L.2005,c.135,s.2.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.36c - Determination letter confirming status of SHBP.

52:14-17.36c Determination letter confirming status of SHBP.
3. a. On the effective date of this act,P.L.2005, c.135 (C.52:14-17.36a et seq.), the Division of Pensions and Benefits in the Department of the Treasury shall seek a determination letter from the United States Department of Labor confirming the status of the State Health Benefits Program, P.L.1961, c.49 (C.52:14-17.25 et seq.), as amended by this act, as a qualified and exempt governmental plan under Title I of the federal Employee Retirement Income Security Act of 1974 (ERISA).
b. In the event the division receives a determination letter from the United States Department of Labor stating that P.L.2005, c.135 (C.52:14-17.36a et seq.) changes the status of the State Health Benefits Program so that it is no longer a qualified and exempt governmental plan under Title I of the federal Employee Retirement Income Security Act of 1974,P.L.2005, c.135 (C.52:14-17.36a et seq.) shall be void and expire immediately and no employees of an affiliate of a majority representative of State employees for collective negotiation purposes shall be permitted to enroll or continue to participate in the State Health Benefits Program.
L.2005,c.135,s.3.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.37 - Election to participate, plan availability.

52:14-17.37 Election to participate, plan availability.
6. a. Any employer eligible for participation in the program may elect such participation by the adoption of a resolution by its governing body, which would include the name and title of a certifying agent, and a certified copy of the resolution shall be filed with the commission. Any employer making such election shall become a participating employer under the program, subject to and in accordance with the rules and regulations of the commission relating thereto.
b. Notwithstanding the provisions of any other law to the contrary, the availability of plans within the program may be limited for employees of a participating employer other than the State pursuant to a binding collective negotiations agreement between the employer and its employees or pursuant to the application by the employer, in its sole discretion, of the terms of any collective negotiations agreement binding on the employer to employees for whom there is no majority representative for collective negotiations purpose. The commission shall implement the terms of such an agreement, and the application of such terms, with regard to plan availability for employees of the employer. The commission may impose such restrictions on the terms as the commission may deem necessary to ensure the effective and efficient operation of the program. This subsection shall apply to the State Health Benefits Program and the School Employees' Health Benefits Program.
L.1964, c.125, s.6; amended 2010, c.2, s.7.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.37a - Claims experience information provided by SHBP.

52:14-17.37a Claims experience information provided by SHBP.
1. The State Health Benefits Program shall provide at no cost to the requestor, and not more than once in a 24-month period, complete claims experience data to a public employer other than the State that participates in the State Health Benefits Program and makes a written request for its claims experience information, including loss reports and large claims data. The State Health Benefits Program shall provide the information in an electronic and manual format to the participating public employer who has made a written request for its information, within 60 days of the receipt of the written request made by the public employer. Notwithstanding the above, the State Health Benefits Program shall issue claims experience data only in a manner that complies with the privacy requirements of the federal Health Insurance Portability and Accountability Act of 1996, Pub. L.104-191, and related regulations.
L.2013, c.189, s.1.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.38a - Continuation of coverage

52:14-17.38a. Continuation of coverage
Notwithstanding any other law to the contrary, the employer of a member of the Police and Firemen's Retirement System of New Jersey who retires under the provisions of special disability retirement pursuant to section 1 of P.L.1989, c.103 (C.43:16A-6.1) shall pay the premium or periodic charges for a continuation of all coverages provided to the member and any dependent of the member under section 5 of P.L.1961, c.49 (C.52:14-17.29) which are in effect at the time of retirement.
L.1989,c.103,s.2.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.38b - Participation in State Health Benefits Program by local board of education, limitation.

52:14-17.38b Participation in State Health Benefits Program by local board of education, limitation.
5. Notwithstanding the provisions of any other law, rule, or regulation to the contrary, any local board of education may elect to participate in the State Health Benefits Program upon the termination of any contract in effect on the effective date of this amendatory and supplementary act, P.L.1993, c.8 (C.52:14-17.38b et al.), between the board of education and an insurance company writing insurance pursuant to Title 17B of the New Jersey Statutes, hospital service corporation, medical service corporation, health service corporation, or health maintenance organization to provide hospital and medical expense benefits. Such election shall be in accordance with the laws and regulations otherwise applicable to participation by employers other than the State in the program. If the board does not elect to participate in the State Health Benefits Program at that time, its eligibility to elect such participation thereafter shall be subject to the time period specified by the State Health Benefits Commission for participating again in the State Health Benefits Program after a participant's withdrawal from the program. No such election shall be permitted after June 30, 2008.
L.1993, c.8, s.5; amended 2007, c.103, s.30.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.39 - Establishment of rates

52:14-17.39. Establishment of rates
The rates charged for any contract purchased under the authority of the New Jersey State Health Benefits Program Act shall be established in accordance with the provisions of subsection (C) of section 5 of P.L.1961, c. 49; provided, however, that the commission may, in its discretion, prescribe that the rates for employee coverage and for dependents coverage be determined separately for State employees and employees of participating employers.
L.1964, c. 125, s. 8. Amended by L.1972, c. 75, s. 10.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.40 - Coverage, withholding of employee contribution, payment of remainder.

52:14-17.40 Coverage, withholding of employee contribution, payment of remainder.
9. An employee enrolling for coverage shall, at the time of enrollment, authorize the participating employer to withhold, on an advance basis, from his wages or salary the contribution required by such employer for such coverage, which shall not exceed the premium or periodic charge therefor. The remainder of the premiums and periodic charges for employee and dependents coverage shall be paid by the participating employer out of its own funds.
L.1964, c.125, s.9; amended 2007, c.62, s.43.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.41 - Dependents premium fund; establishment; use

52:14-17.41. Dependents premium fund; establishment; use
There is hereby established a dependents premium fund consisting of all remittances received by the State treasury from participating employers in connection with dependents coverage and said fund shall be used to pay the portion of the premium and periodic charges under the program attributable to the dependents coverage provided for employees of participating employers.
L.1964, c. 125, s. 10.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.42 - Employer health benefits fund; establishment; use

52:14-17.42. Employer health benefits fund; establishment; use
There is hereby established an employer health benefits fund consisting of all contributions to premiums and periodic charges remitted to the State treasury by participating employers for employee coverage. All such contributions shall be deposited in the employer health benefits fund and said fund shall be used to pay the portion of the premium and periodic charges under the program attributable to employee coverage for employees of participating employers.
L.1964, c. 125, s. 11.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.43 - Duties of certifying agent of participating employer

52:14-17.43. Duties of certifying agent of participating employer
The certifying agent of each participating employer shall submit to the Division of Pensions such information and shall cause to be performed in respect to each of the employees of such employer such duties as would be performed by the State in connection with the program. The division shall have the power and authority to make such verification of the employment and other records of any participating employer as the division may deem necessary in connection with the program.
L.1964, c. 125, s. 12. Amended by L.1970, c. 231, s. 7, eff. Oct. 22, 1970.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.44 - Payment of administrative expenses

52:14-17.44. Payment of administrative expenses
Each participating employer and the State shall be required to pay its proportionate share of the expenses of administration of the program in such amounts and at such times as determined and fixed by the commission. All amounts payable by the participating employers for such expenses of administration shall be forwarded to the State treasury and shall be applied for such purposes, in order to reimburse the State for the cost of administration of the program.
L.1964, c. 125, s. 13.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.45 - Apportionment of dividend or retrospective rate credit

52:14-17.45. Apportionment of dividend or retrospective rate credit
In addition to the requirements of subsection (B) of section 6 of chapter 49 of the laws of 1961, for apportionment of any dividend or retrospective rate credit declared or allowed by a carrier under a contract, the commission shall determine, in an equitable manner, (1) the amount of any such dividend or credit attributable to employee coverage provided under the program for employees of participating employers and shall credit the employer health benefits fund with such amount, and (2) the amount of any such dividend or credit attributable to dependents coverage provided under the program for employees of participating employers and shall credit such amount to the dependents premium fund.
L.1964, c. 125, s. 14.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.46a - Funding of health care benefits for retirees from certain educational employment.

52:14-17.46a Funding of health care benefits for retirees from certain educational employment.
49. Effective July 1, 2007, health care benefits for qualified retirees and their dependents as provided by section 3 of P.L.1987, c.384 (C.52:14-17.32f), section 2 of P.L.1992, c.126 (C.52:14-17.32f1) and section 1 of P.L.1995, c.357 (C.52:14-17.32f2) shall be funded and paid by the State through a separate fund established in the Department of the Treasury. Beginning with the valuation period ending June 30, 2007, the Director of the Division of Pensions and Benefits shall annually compute a contribution to fund these health care benefits which shall be the amount necessary to pay the anticipated premiums or periodic charges for the benefits for the following valuation period and to provide that the balance in the fund as of the end of the following valuation period shall be increased by 3/5 of 1% of the salary of the active members for the valuation period. If the assets in the fund are insufficient to pay the premiums or periodic charges for the benefits, such premiums or periodic charges shall be paid directly by the State. Nothing hereinabove shall alter health care benefits for qualified retirees and their dependents or relieve the State from its acknowledged obligation to fund the benefits.
L.2007, c.103, s.49.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.46.1 - Short title.

52:14-17.46.1 Short title.
31. Sections 31 through 41 of P.L.2007, c.103 (C.52:14-17.46.1 through C.52:14-17.46.11) shall be known and may be cited as the "School Employees' Health Benefits Program Act."
L.2007, c.103, s.31.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.46.4 - Administration of School Employees' Health Benefits Program.

52:14-17.46.4 Administration of School Employees' Health Benefits Program.
34. The School Employees' Health Benefits Program, authorized by sections 31 through 41 of P.L.2007, c.103 (C.52:14-17.46.1 through C.52:14-17.46.11), shall be administered in the Department of the Treasury. Administrative services required by the commission shall be provided through the Division of Pensions and Benefits, and the Director of the Division of Pensions and Benefits shall be the secretary of the commission. The commission and the committee shall establish a health benefits program for the school employees of the State, the cost of which shall be paid as specified in this act. The commission shall, by a majority vote of its full authorized membership, establish and change rules and regulations as may be deemed reasonable and necessary for the administration of this act by the commission and committee. Until such rules and regulations are established, the rules and regulations of the State Health Benefits Commission shall be deemed to apply to the School Employees' Health Benefits Program.
The Attorney General shall be the legal advisor of the commission and committee.
The members of the commission and committee shall serve without compensation but shall be reimbursed for any necessary expenditure.
The commission shall ensure that audits and reviews are performed as required by section 40 of P.L.2007, c.103 (C.52:14-17.46.10). Actions of the commission related to such audits and reviews shall require a majority vote of the full authorized membership of the commission to be approved.
Except as otherwise specified in this act, actions of the commission shall require the affirmative vote of a majority of the members present at a meeting at which a majority of the full authorized membership is present.
L.2007, c.103, s.34; amended 2011, c.78, s.36.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.46.6a - School Employees' Health Benefits Commission to provide for installment payments to obstetrical provider for maternity services.

52:14-17.46.6a School Employees' Health Benefits Commission to provide for installment payments to obstetrical provider for maternity services.
10. Within 30 days of the effective date of this act, the School Employees' Health Benefits Commission shall provide, in every health benefits plan that provides for maternity services, for reimbursement in installments to an obstetrical provider licensed in New Jersey for maternity services rendered during the term of a covered person's pregnancy.
b. For the purposes of this section, "obstetrical provider licensed in New Jersey" means:
(1) an obstetrician/gynecologist licensed by the State Board of Medical Examiners; or
(2) a midwife licensed by the State Board of Medical Examiners as a certified midwife or a certified nurse midwife.
L.2009, c.113, s.10.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.46.6c - School Employees' Health Benefits Commission to provide coverage for oral anticancer medications.

52:14-17.46.6c School Employees' Health Benefits Commission to provide coverage for oral anticancer medications.
10. a. The School Employees' Health Benefits Commission shall ensure that every contract purchased on or after the effective date of this act that provides hospital or medical expense benefits shall provide coverage for expenses for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells on a basis no less favorable than the contract provides for intravenously administered or injected anticancer medications.
b. Pursuant to subsection a. of this section, coverage for expenses for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells shall not be subject to any prior authorization, dollar limit, copayment, deductible or coinsurance provision that does not apply to intravenously administered or injected anticancer medications.
c. A School Employees' Health Benefits Commission contract shall not achieve compliance with the provisions of this section by imposing an increase in patient cost sharing, including any copayment, deductible or coinsurance, for anticancer medications, whether intravenously administered or injected or orally administered, that are covered under the contract as of the effective date of this act.
L.2011, c.188, s.10.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.46.6d - School Employees' Health Benefits Commission to provide coverage for prescription eye drops.

52:14-17.46.6d School Employees' Health Benefits Commission to provide coverage for prescription eye drops.
10. The School Employees' Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital or medical expense benefits that include coverage for prescription eye drops, shall provide coverage for expenses incurred for refills of prescription eye drops in accordance with the Guidance for Early Refill Edits of Topical Ophthalmic Products provided to Medicare Part D plan sponsors by the Centers for Medicare & Medicaid Services of the U.S. Department of Health and Human Services, provided that:
(1) the prescribing health care practitioner indicates on the original prescription that additional quantities of the prescription eye drops are needed; and
(2) the refill requested by the covered person does not exceed the number of additional quantities indicated on the original prescription by the prescribing health care practitioner.
L.2013, c.50, s.10.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.46.6e - School Employees' Health Benefits Commission, coverage for synchronization of prescribed medications.

52:14-17.46.6e School Employees' Health Benefits Commission, coverage for synchronization of prescribed medications.
10. The School Employees' Health Benefits Commission shall ensure that every contract under the School Employees' Health Benefits Program purchased on or after the effective date of this act, which provides benefits for pharmacy services, prescription drugs, or for participation in a prescription drug plan, shall, on at least one occasion per year for each covered person:
(1) apply a prorated daily cost-sharing rate to prescriptions that are dispensed by a network pharmacy for less than a 30 days' supply if the prescriber or pharmacist indicates the fill or refill is in the best interest of the covered person or is for the purpose of synchronizing the covered person's chronic medications;
(2) provide coverage for a drug prescribed for the treatment of a chronic illness dispensed in accordance with a plan among the covered person, the prescriber and the pharmacist to synchronize the refilling of multiple prescriptions for the covered person; and
(3) determine dispensing fees based exclusively on the total number of prescriptions dispensed; dispensing fees shall not be prorated or based on the number of the days' supply of medication prescribed or dispensed.
This section shall not apply to prescriptions for opioid analgesics. "Opioid analgesic" means a drug in the opioid analgesic drug class prescribed to treat moderate to severe pain or other conditions, whether in immediate release or extended release form, and whether or not combined with other drug substances to form a single drug product or dosage form.
L.2015, c.206, s.10.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.46.6j - School Employees' Health Benefits Commission to cover digital tomosynthesis of the breast.

52:14-17.46.6j School Employees' Health Benefits Commission to cover digital tomosynthesis of the breast.
10. a. The School Employees' Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital and medical expense benefits shall provide coverage for expenses incurred in conducting digital tomosynthesis to detect or screen for breast cancer in women 40 years of age and over; and for diagnostic purposes in women of any age.
b. In the case of digital tomosynthesis conducted to detect or screen for breast cancer in women 40 years of age and over, no deductible, coinsurance or other cost sharing shall be applied; and in the case of digital tomosynthesis conducted for diagnostic purposes in women of any age, the same deductibles, coinsurance, and other cost sharing as apply to similar services under the contract shall be applied.
L.2017, c.305, s.10.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.46.6k - School Employees' Health Benefits Commission to provide coverage for donated human breast milk.

52:14-17.46.6k School Employees' Health Benefits Commission to provide coverage for donated human breast milk.
10. a. The School Employees' Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital or medical expense benefits shall provide coverage for expenses incurred in the provision of pasteurized donated human breast milk, which may include human milk fortifiers if indicated by the prescribing licensed medical practitioner, provided that:
(1) the covered person is an infant under the age of six months;
(2) the milk is obtained from a human milk bank that meets quality guidelines established by the Department of Health ; and
(3) a licensed medical practitioner has issued an order for an infant who is medically or physically unable to receive maternal breast milk or participate in breast feeding or whose mother is medically or physically unable to produce maternal breast milk in sufficient quantities or participate in breast feeding despite optimal lactation support; or
(4) a licensed medical practitioner has issued an order for an infant who meets any of the following conditions:
(a) a body weight below healthy levels determined by the licensed medical practitioner;
(b) a congenital or acquired condition that places the infant at a high risk for development of necrotizing enterocolitis; or
(c) a congenital or acquired condition that may benefit from the use of donor breast milk as determined by the Department of Health.
b. Nothing in this section shall preclude the carrier from performing utilization review, including periodic review of the medical necessity of a particular service.
c. The benefits shall be provided to the same extent as for any other prescribed items under the contract.
d. If there is no supply of human breast milk that meets the requirements of paragraph (2) of subsection a. of this section, the carrier shall not be required to provide coverage of expenses pursuant to this section.
L.2017, c.309, s.10.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.46.6l - School Employees' Health Benefits Commission not to provide coverage for certain early elective deliveries.

52:14-17.46.6l School Employees' Health Benefits Commission not to provide coverage for certain early elective deliveries.
5. a. Notwithstanding any other law or regulation to the contrary, the School Employees' Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital and medical expense benefits shall not provide coverage for a non-medically indicated early elective delivery performed at a hospital on a pregnant woman earlier than the 39th week of gestation.
b. As used in this section, "non-medically indicated early elective delivery" means the artificial start of the birth process through medical interventions or other methods, also known as labor induction, or the surgical delivery of a baby via a cesarean section for purposes or reasons that are not fully consistent with established standards of clinical care as provided by the American College of Obstetricians and Gynecologists.
L.2019, c.87, s.5.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.46.6m - School Employees' Health Benefits Commission to provide coverage for standard fertility preservation services.

52:14-17.46.6m School Employees' Health Benefits Commission to provide coverage for standard fertility preservation services.
7. a. The School Employees' Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital or medical expense benefits shall provide coverage for standard fertility preservation services when a medically necessary treatment may directly or indirectly cause iatrogenic infertility.
For the purposes of this section:
"Iatrogenic infertility" means an impairment of fertility caused by surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or processes.
"May directly or indirectly cause" means a medical treatment with a likely side effect of iatrogenic infertility as established by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or as defined by the New Jersey Department of Health.
"Standard fertility preservation services" means procedures consistent with established medical practices and professional guidelines published by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or as defined by the New Jersey Department of Health. "Standard fertility preservation services" shall not include the storage of sperm or oocytes.
The benefits shall be provided to the same extent as for any other medical condition under the contract. The same copayments, deductibles, and benefit limits shall apply to the provision of standard fertility preservation services pursuant to this section as those applied to other medical or surgical benefits under the contract.
b. The School Employees' Health Benefits Program shall not purchase a contract that determines the provision of standard fertility preservation services based on a covered person's expected length of life, present or predicted disability, degree of medical dependency, perceived quality of life, or other health conditions, or based on personal characteristics, including age, sex, sexual orientation, marital status, or gender identity.
L.2019, c.306, s.7.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.46.6o - School Employee's Health Benefits Commission to cover preventive services.

52:14-17.46.6o School Employee's Health Benefits Commission to cover preventive services.
10. a. The School Employees' Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital or medical expense benefits shall provide coverage, without requiring any cost sharing, for the following preventive services:
(1) evidence-based items or services that have in effect a rating of "A" or "B" in the current recommendations of the United States Preventive Services Task Force;
(2) immunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention;
(3) with respect to infants, children, and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration; and
(4) with respect to women, any additional preventive care and screenings not described in paragraph (1) as provided for in the comprehensive guidelines supported by the Health Resources and Services Administration.
b. (1) Except as provided in paragraph (2) of this subsection, nothing in this section shall:
(a) require a contract which has a network of providers to provide benefits for items or services described in subsection a. of this section that are delivered by an out-of-network provider; or
(b) preclude a contract which has a network of providers from imposing cost-sharing requirements for items or services described in subsection a. of this section that are delivered by an out-of-network provider.
(2) If a contract does not have in its network a provider who can provide an item or service described in subsection a. of this section, the contract shall cover the item or service when performed by an out-of-network provider, and shall not impose cost sharing with respect to that item or service.
c. (1) A contract shall provide coverage for an item or service described in subsection a. of this section for plan years that begin on or after the date that is one year after the date the recommendation or guideline is issued.
(2) (a) Except as provided in subparagraph (b) of this paragraph, a contract that is required to provide coverage for an item or service described in subsection a. of this section on the first day of a plan year shall provide coverage for that item or service through the last day of the plan year.
(b) The commissioner may remove a coverage requirement for an item or service during a plan year if the recommendation or guideline changes or is no longer described in subsection a. of this section.
L.2019, c.360, s.10.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.46.6p - School Employees' Health Benefits Commission to cover adolescent depression screenings.

52:14-17.46.6p School Employees' Health Benefits Commission to cover adolescent depression screenings.
10. The School Employees' Health Benefits Commission shall ensure that every contract purchased by the commission, on or after the effective date of this act, that provides hospital or medical expense benefits shall provide coverage for expenses incurred in screening adolescents between the ages of 12 and 18 for major depressive disorder, so long as screening for major depressive disorder in adolescents continues to receive a rating of "A" or "B" from the United States Preventative Services Task Force. Coverage shall not be denied solely on the basis that the screening is provided in conjunction with any other health care evaluation, treatment, or service.
The benefits shall be provided to the same extent as for any other condition under the contract, except that the contract shall not impose on covered persons receiving these services any form of cost sharing, including, but not limited to, copayments, deductibles, or coinsurance.
L.2021, c.73, s.10.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.46.6q - School Employees' Health Benefits Commission, coverage for abortion, certain religious employers exemption.

52:14-17.46.6q School Employees' Health Benefits Commission, coverage for abortion, certain religious employers exemption.
5. A contract providing hospital or medical expense benefits purchased by the School Employees' Health Benefits Commission may provide coverage for abortion. A contract providing hospital or medical expense benefits purchased by the commission shall not exclude a provider from its network or otherwise restrict services from the provider solely on the basis that the provider is a religious employer, as defined in section 3 of P.L.2021, c.375 (C.26:2S-39), that refuses to provide abortion services.
L.2021, c.375, s.5.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.46.6r - The School Employees' Health Benefits Commission, contract, provide coverage for colorectal cancer screening.

52:14-17.46.6r The School Employees' Health Benefits Commission, contract, provide coverage for colorectal cancer screening.
10. a. The School Employees' Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital or medical expense benefits shall provide benefits to any person covered thereunder for expenses incurred in conducting a colorectal cancer screening in accordance with United States Preventive Services Task Force recommendations. The method and frequency of screening to be utilized shall be in accordance with the most recent published recommendations of the United States Preventive Services Task Force and as determined medically necessary by the covered person's physician, in consultation with the covered person.
b. No deductible, coinsurance, copayment, or any other cost-sharing requirement shall be imposed for a colonoscopy performed following a positive result on a non-colonoscopy, colorectal cancer screening test recommended by the United States Preventive Services Task Force.
c. The benefits shall be provided to the same extent as for any other medical condition under the contract.
L.2023, c.8, s.10.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.46.6s - School Employees' Health Benefits Commission, ensure, contract purchased, health care services, insulin for diabetes treatment.

52:14-17.46.6s School Employees' Health Benefits Commission, ensure, contract purchased, health care services, insulin for diabetes treatment.
28. The School Employees' Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of P.L.2023, c.105 (C.17:48-6xx et al.) that provides hospital and medical expense benefits shall provide health care services to a person covered thereunder for insulin for the treatment of diabetes, if recommended or prescribed by a participating physician or participating nurse practitioner/clinical nurse specialist. Coverage for the purchase of a short-acting, intermediate-acting, rapid-acting, long-acting, and pre-mixed insulin product shall not be subject to any deductible, and no copayment or coinsurance for the purchase of insulin shall exceed $35 per 30-day supply, except a contract provided by the School Employees' Health Benefits Commission that qualifies as a high-deductible health plan shall provide coverage for the purchase of insulin at the lowest deductible and other cost-sharing requirement permitted for a high-deductible health plan under section 223(c)(2)(A) of the Internal Revenue Code (26 U.S.C. s.223 (c)(2)(A)). The provisions of this section shall apply to a plan that meets the requirements of a catastrophic plan, as defined in 45 C.F.R. s.156.155, to the maximum extent permitted by federal law.
Nothing in this section shall prevent the School Employees' Health Benefits Commission from reducing an enrollee's cost-sharing requirement by an amount greater than the amount specified in this section or prevent the commission from utilizing formulary management, including a mandatory generic policy, to promote the use of lower-cost alternative generic drugs that are the therapeutic equivalent of the brand-name drug, which could result in the member's copay being higher than set forth in this section.
L.2023, c.105, s.28.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.46.6t - School Employees' Health Benefits Commission, ensure, contract purchased, renewed, coverage, epinephrine auto-injector device.

52:14-17.46.6t School Employees' Health Benefits Commission, ensure, contract purchased, renewed, coverage, epinephrine auto-injector device.
29. The School Employees' Health Benefits Commission shall ensure that every contract purchased or renewed by the commission on or after the effective date of P.L.2023, c.105 (C.17:48-6xx et al.), shall provide coverage for at least one epinephrine auto-injector device, if recommended or prescribed by a participating physician or participating nurse practitioner/clinical nurse specialist. Coverage for the purchase of an epinephrine auto-injector device shall not be subject to any deductible, and no copayment or coinsurance for the purchase of an epinephrine auto-injector device shall exceed $25 per 30-day supply, except a contract provided by the School Employees' Health Benefits Commission that qualifies as a high-deductible health plan shall provide coverage for the purchase of an epinephrine auto-injector device at the lowest deductible and other cost-sharing requirement permitted for a high-deductible health plan under section 223(c)(2)(A) of the Internal Revenue Code (26 U.S.C. s.223 (c)(2)(A)). The provisions of this section shall apply to a plan that meets the requirements of a catastrophic plan, as defined in 45 C.F.R. s.156.155, to the maximum extent permitted by federal law.
Nothing in this section shall prevent the School Employees' Health Benefits Commission from reducing an enrollee's cost-sharing requirement by an amount greater than the amount specified in this section or prevent the commission from utilizing formulary management, including a mandatory generic policy, to promote the use of lower-cost alternative generic drugs that are the therapeutic equivalent of the brand-name drug, which could result in the member's copay being higher than set forth in this section.
L.2023, c.105, s.29.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.46.6u - School Employees' Health Benefits Commission, ensure, contract purchased, renewed, benefits, covered, expenses, prescription asthma inhaler.

52:14-17.46.6u School Employees' Health Benefits Commission, ensure, contract purchased, renewed, benefits, covered, expenses, prescription asthma inhaler.
30. The School Employees' Health Benefits Commission shall ensure that every contract purchased or renewed by the commission on or after the effective date of P.L.2023, c.105 (C.17:48-6xx et al.), shall provide benefits to a person covered thereunder for expenses incurred for a prescription asthma inhaler, if recommended or prescribed by a participating physician or participating nurse practitioner/clinical nurse specialist. Coverage for the purchase of a covered prescription asthma inhaler shall not be subject to any deductible, and no copayment or coinsurance for the purchase of a covered prescription asthma inhaler shall exceed $50 per 30-day supply, except a contract provided by the School Employees' Health Benefits Commission that qualifies as a high-deductible health plan shall provide coverage for the purchase of a covered prescription asthma inhaler at the lowest deductible and other cost-sharing requirement permitted for a high-deductible health plan under section 223(c)(2)(A) of the Internal Revenue Code (26 U.S.C. s.223 (c)(2)(A)). The provisions of this section shall apply to a plan that meets the requirements of a catastrophic plan, as defined in 45 C.F.R. s.156.155, to the maximum extent permitted by federal law.
Nothing in this section shall prevent the School Employees' Health Benefits Commission from reducing a covered person's cost-sharing requirement by an amount greater than the amount specified in this section or prevent the commission from utilizing formulary management, including a mandatory generic policy, to promote the use of lower-cost alternative generic drugs that are the therapeutic equivalent of the brand-name drug, which could result in the member's copay being higher than set forth in this section.
L.2023, c.105, s.30.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.46.8 - Participation in School Retiree Prescription Drug Plan, terms.

52:14-17.46.8 Participation in School Retiree Prescription Drug Plan, terms.
38. a. Retirees and eligible dependents who participate in the School Employees' Health Benefits Program shall be eligible to participate in the School Retiree Prescription Drug Plan. The definitions in subsection f. of section 36 of P.L.2007, c.103 (C.52:14-17.46.6) shall apply to the School Retiree Prescription Drug Plan.
b. There shall be no annual deductible amount that retirees or their eligible dependents shall be required to satisfy before eligibility for payment of prescription drug expenses under the School Retiree Prescription Drug Plan.
c. Eligibility of prescription drug expenses for coverage under the School Retiree Prescription Drug Plan shall be determined on the same basis as reasonable and necessary medical expenses under the School Employees' Health Benefits Program.
d. A co-payment shall be required for each prescription drug expense until a retiree or eligible dependent satisfies the maximum annual out-of-pocket expense for a calendar year prescribed in subsection f. of this section. The amounts of the co-payments shall be the same as those in effect as of July 1, 2007 for retiree prescription drug coverage under the State Health Benefits Program. The commission shall promulgate rules that shall establish a formula for a reasonable annual escalator to the amount of co-payment.
e. The supply of a drug product eligible for coverage under the School Retiree Prescription Drug Plan for each prescription drug expense shall be limited to 30 days if the prescription is filled at a retail pharmacy, and 90 days if the prescription is filled through the mail-order pharmacy.
f. The amount of out-of-pocket expense that a retiree or eligible dependent shall pay in a calendar year for eligible prescription drug expenses under the School Retiree Prescription Drug Plan shall be limited in the first year of the plan to the amount in effect on July 1, 2007 for retiree prescription drug coverage under the State Health Benefits Program. The commission shall promulgate rules that shall establish a formula for a reasonable annual escalator to the amount of out-of-pocket expense.
g. In the fifth year following the initial appointment of all of its members, the commission shall, as part of the fifth year audit and review undertaken pursuant to section 40 of P.L.2007, c.103 (C.52:14-17.46.10), review the amounts established in this section and make any changes that it deems appropriate pursuant to section 40 of P.L.2007, c.103 (C.52:14-17.46.10) by majority vote of the full authorized membership of the commission.
L.2007, c.103, s.38.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.46.11 - Applicability of State Health Benefits Program Act.

52:14-17.46.11 Applicability of State Health Benefits Program Act.
41. All provisions of P.L.1961, c.49 (C.52:14-17.25 et seq.) applicable to the State Health Benefits Program shall, except as expressly stated in the School Employees' Health Benefits Program Act, be construed as applicable to participating employers and to their employees and to dependents of such employees, and to retirees and to dependents of such retirees, in the School Employees' Health Benefits Program.
L.2007, c.103, s.41.
2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.46.12 - School Employees' Health Benefits Commission to establish audit program.

52:14-17.46.12 School Employees' Health Benefits Commission to establish audit program.
2. The School Employees' Health Benefits Commission shall establish and contract for a Medicare Primary Assignment and Audit Program through which it shall conduct a continuous review of the School Employees' Health Benefits Program for the purposes of ensuring that all persons who are participants and their dependents of the School Employees' Health Benefits Program and who are eligible for Medicare under federal law are properly enrolled in Medicare with Medicare as the primary provider of their health care benefits coverage and with the School Employees' Health Benefits Program as their secondary provider of their health care benefits coverage.
L.2018, c.88, s.2.