reglab/statecodes huggingface dataset:
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27-46.1xx - Group health insurance policy, coverage, prescription asthma inhaler.

17B:27-46.1xx Group health insurance policy, coverage, prescription asthma inhaler.
15. A group health insurance policy providing hospital or medical expense benefits that is delivered, issued, executed, or renewed in this State pursuant to Chapter 27 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 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. The provisions of this section shall apply to a high-deductible health plan to the maximum extent permitted by federal law, except if the plan is used to establish a medical savings account pursuant to section 220 of the federal Internal Revenue Code of 1986 (26 U.S.C. s.220) or a health savings account pursuant to section 223 of the federal Internal Revenue Code of 1986 (26 U.S.C. s.223). The provisions of this section shall apply to the plan to the maximum extent that is permitted by federal law and does not disqualify the account for the deduction allowed under section 220 or 223, as applicable. 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 a group health insurer from reducing a covered person's cost-sharing requirement by an amount greater than the amount specified in this section.
L.2023, c.105, s.15.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27-46.2 - Second surgical opinions; definitions

17B:27-46.2. Second surgical opinions; definitions
As used in this act:
a. "Elective surgical procedure" means any nonemergency surgical procedure which may be scheduled at the convenience of the patient or the surgeon without jeopardizing the patient's life or causing serious impairment to the patient's bodily functions.
b. "Second surgical opinion" means an opinion of an eligible physician based on that physician's examination of a person for the purpose of evaluating the medical advisability of that person undergoing an elective surgical procedure. The examination must be performed after another physician licensed to practice medicine and surgery has proposed to perform such surgical procedure on the person but prior to the performance of such surgical procedure.
c. "Eligible physician" means a physician licensed to practice medicine and surgery who holds the rank of Diplomate of an American Board (M.D.) or Certified Specialist (D.O.) in the surgical or medical specialty for which surgery is proposed.
L.1979, c. 329, s. 1.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27-46.3 - Group insurance policies; provision of program on request

17B:27-46.3. Group insurance policies; provision of program on request
Any insurer issuing a group insurance policy in accordance with chapter 27 of Title 17B of the New Jersey Statutes which provides coverage of surgical operations performed on a person while confined in a hospital as an inpatient shall make available, and if requested by the group policyholder, provide a second surgical opinion program for elective surgical procedures which would require inpatient admission to a hospital for persons insured under the group policy for such surgical coverage.
L.1979, c. 329, s. 2.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27-46.4 - Payment for second surgical opinion services

17B:27-46.4. Payment for second surgical opinion services
A second surgical opinion program shall provide for payment for the second surgical opinion services of an eligible physician and for essential laboratory and X-ray services incidental thereto, either as a benefit under the group policy or, at the insurer's option, by a separate arrangement with the group policyholder. The program may be limited to eligible physicians who have agreed to participate in the insurer's second surgical opinion program. If the benefits are provided by the group insurance policy, the amount shall be reasonably related to amounts payable under the group policy for covered surgical procedures.
L.1979, c. 329, s. 3.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27-46.5 - Third surgical opinion

17B:27-46.5. Third surgical opinion
If a second surgical opinion does not confirm that a proposed elective surgical procedure is medically advisable, the program must cover a third surgical opinion in the same manner as the second opinion.
L.1979, c. 329, s. 4.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27-46.6 - Reduction of benefits where no second opinion obtained

17B:27-46.6. Reduction of benefits where no second opinion obtained
Where a second surgical opinion program is operative in connection with surgical coverage under a group insurance policy, and provides second and third surgical opinion services at no cost to the insured or patient, the group policy may, as an incentive to encourage utilization of the program when elective surgery is proposed, provide reduced benefits for the surgeon's charges for such elective surgery if it is performed without first obtaining a second or third opinion confirming that the proposed elective surgery was advisable.
L.1979, c. 329, s. 5.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27-46.7 - Permissible benefit exclusions

17B:27-46.7. Permissible benefit exclusions
A second surgical opinion program may exclude benefits while the patient is confined in a hospital as an inpatient, any surgical procedure not covered by the group insurance policy, and surgical procedures in the following categories: cosmetic surgery, dental surgery, and podiatric surgery.
L. 1979, c. 329, s. 6. Amended by L. 1985, c. 277, s. 1.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27-46.8 - Payment for opinion services of physician

17B:27-46.8. Payment for opinion services of physician
If a physician who furnishes a second or third surgical opinion also performs the surgical procedure, the second surgical opinion program need not provide payment for the second or third opinion services of that physician.
L.1979, c. 329, s. 7.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27-47 - Group health or blanket insurance--provisions as favorable; policies issued outside State

17B:27-47. Group health or blanket insurance--provisions as favorable; policies issued outside State
No policy of group health or blanket insurance, and no certificate thereunder shall be delivered or issued for delivery in this State if such policy or certificate contains any provision inconsistent with any of the provisions of this chapter, except that such policy may contain any provision which in the opinion of the commissioner is as favorable to policyholders or certificate holders as the provision herein required, and except that such policy issued by any insurer of this State for delivery outside of this State may contain any provision not consistent with the provisions of this chapter; provided, such policy conforms to the laws of the State or country in which it is delivered.
L.1971, c. 144, s. 17B:27-47.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27-49 - Filing of forms

17B:27-49. Filing of forms
17B:27-49. a. No group health insurance policy, or blanket insurance policy, or application, if a written application is required and is to be made a part of the policy, certificate, printed rider or endorsement for use with the policy, shall be delivered or issued for delivery in this State unless the form has been filed with the commissioner in accordance with the provisions of section 16 of P.L.1995, c.73 (C.17B:25-18.2).
b. (Deleted by amendment, P.L.1995, c.73.)
c. If a form is disapproved for filing by the commissioner during the 60-day period, it may not be delivered or issued for delivery unless it is resubmitted and approved in accordance with the provisions of subsections b., c., and d. of section 16 of P.L.1995, c.73 (C.17B:25-18.2). Such disapproval shall be subject to review in accordance with the procedure described in the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) and any rules adopted thereunder. Any such form which is filed by the commissioner or deemed filed may be so delivered or issued for delivery until such time as any subsequent withdrawal of the filing by the commissioner, following an opportunity for a hearing held in accordance with the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) and any rules adopted thereunder, becomes final in accordance therewith
d. (Deleted by amendment, P.L.1995, c.73.)
e. (Deleted by amendment, P.L.1995, c.73.)
f. This section shall not apply to documents which relate only to the manner of distribution of benefits or to the reservation of rights and benefits under such policies and which are used at the request of the individual insured or policyholder.
g. The disapproval by the commissioner of any such form may be on the ground that such form contains provisions which are unjust, unfair, inequitable, misleading, contrary to law or to the public policy of this State.
L.1971, c.144; amended 1995,c.73,s.21.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27-50.1 - Severability

17B:27-50.1. Severability
If any section, subsection, paragraph, sentence, clause, phrase or word contained in this act shall be declared invalid for any reason whatsoever, such invalidity shall not effect the remaining portions of this act which shall remain in full force and effect, and, to this end, the provisions of this act are hereby declared to be severable.
L.1973, c. 340, s. 2, eff. Dec. 27, 1973.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27-51 - Reimbursement for optometric service

17B:27-51. Reimbursement for optometric service
Notwithstanding any provision of a policy or contract of group health insurance, hereafter delivered or issued for delivery in this State, whenever such a policy or contract provides for reimbursement for any optometric service which is within the lawful scope of practice of a duly licensed optometrist, a person covered under such group health policy or contract shall be entitled to reimbursement for such service, whether the said service is performed by a physician or duly licensed optometrist.
L.1971, c. 144, s. 17B:27-51.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27-51.1 - Reimbursement for service of chiropractor

17B:27-51.1. Reimbursement for service of chiropractor
Notwithstanding any provision of a policy or contract of group health insurance, hereafter delivered or issued for delivery 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 chiropractor, a person covered under such group health policy or contract or the chiropractor rendering such service shall be entitled to reimbursement for such service when the said service is performed by a chiropractor. The foregoing provision shall be liberally construed in favor of reimbursement of chiropractors.
L.1975, c. 125, s. 1, eff. June 5, 1975.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27-51.1a - Group health insurance benefits for certain nursing services

17B:27-51.1a. Group health insurance benefits for certain nursing services
2. a. Notwithstanding any provision of a policy of group health insurance, whenever such a policy provides for reimbursement for any service which is within the lawful scope of practice of a duly registered professional nurse who is not being paid a salary by a health care provider for the services so performed, a person covered under that group health insurance policy or the registered professional nurse rendering the service shall be entitled to reimbursement for the service.
b. This act shall exclude salaried services which are already reimbursed and shall not be construed to affect or impair hospital procedures for billing in-hospital nursing care. The practice of nursing shall be deemed to be within the provisions of chapter 27 of Title 17B of the New Jersey Statutes and duly registered professional nurses shall have those privileges and benefits in the scope of their practice as are afforded thereunder to licensed physicians and surgeons in the scope of their practice.
c. This section shall apply to any group health insurance policy: (1) delivered or issued for delivery in this State on or after the effective date of this act; or (2) under which the insurer reserves the right to change the premium.
L.1992,c.128,s.2.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27-51.2 - Legislative findings and declarations

17B:27-51.2. 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. 99, s. 1.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27-51.3 - Definitions

17B:27-51.3. 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 c. 136 and 138, P.L.1971, home health care providers shall be licensed agencies.
L.1977, c. 99, s. 2.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27-51.4 - Home health care; requirement for coverage

17B:27-51.4. Home health care; requirement for coverage
Notwithstanding any provision of a policy of group 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. 99, s. 3.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27-51.5 - Benefits

17B:27-51.5. 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. 99, s. 4.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27-51.6 - Direct reimbursement to home health care providers

17B:27-51.6. 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. 99, s. 5.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27-51.8 - Policy provision for reimbursement of dental services; payment regardless of discipline of provider

17B:27-51.8. Policy provision for reimbursement of dental services; payment regardless of discipline of provider
Notwithstanding any provision of a policy or contract of group health insurance 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 group health 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. 158, s. 1, eff. July 19, 1979.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27-51.9 - Application to policy or contract not limited to reimbursement of specific types of duly licensed health care professionals other than dentists

17B:27-51.9. 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 group 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. 158, s. 2, eff. July 19, 1979.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27-51.10 - Renewal date; policy with reservation of right to change premium

17B:27-51.10. 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. 158, s. 3, eff. July 19, 1979.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27-51.10a - Alternative dental coverage; original coverage restricted to limited number of providers

17B:27-51.10a. 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 which contributes to a group 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 or their eligible dependents or members or 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. 145, s. 1, eff. April 20, 1983.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27-51.10b - Employer contribution

17B:27-51.10b. Employer contribution
An employer or other organization shall be required to pay or contribute towards the provision of alternative coverage an amount equal to the premium or cost which it pays or contributes to the group health insurance contract for dental services which limits the number of providers of dental services.
L.1983, c. 145, s. 2, eff. April 20, 1983.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27-51.10c - Rules and regulations

17B:27-51.10c. 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. 145, s. 3, eff. April 20, 1983.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27-51.11 - Definitions

17B:27-51.11. Definitions
As used in this act:
a. "Group policy" means a group health insurance policy issued by an insurer pursuant to Title 17B of the New Jersey Statutes.
b. "Insurer" means the entity issuing a group policy or an individual policy or converted policy.
c. "Insurance" , "Insures" and "Insured" refer to coverage under a group policy on a premium-paying basis.
d. "Premium" includes any premium or other consideration payable for coverage under a group or individual policy.
e. "Medicare" means Title XVIII of the United States Social Security Act as amended or superseded.
f. "Total disability of the employee or member" exists only while the employee or member (1) is not engaged in any gainful occupation, and (2) is completely unable, due to sickness or injury or both, to engage in any and every gainful occupation for which the person is reasonably fitted by education, training or experience.
L.1981, c. 422, s. 1.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27-51.13 - Inapplicability to policy without right of insurer to terminate without consent of insured

17B:27-51.13. Inapplicability to policy without right of insurer to terminate without consent of insured
The provisions of this act shall not apply to any policy in which the insurer does not have the right to terminate the policy without the consent of the insured.
L.1981, c. 422, s. 3.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27-51.14 - Insurer provide health benefits plan, aggregate benefits.

17B:27-51.14 Insurer provide health benefits plan, aggregate benefits.
4. a. Beginning with the calendar year starting on January 1, 2020, and in each calendar year thereafter, an insurer providing a health benefits plan shall return, in the form of aggregate benefits for all large group health insurance policy forms offered by the insurer pursuant to N.J.S.17B:27-26 et seq., at least 85 percent of the aggregate premiums collected for all of the policy forms.
b. An insurer shall annually report to the Commissioner of Banking and Insurance, no later than August 1 of each year, the loss ratio calculated for all of the policy forms for the previous calendar year. In each case in which the loss ratio fails to substantially comply with the 85 percent loss ratio requirement, the insurer shall issue a dividend or credit against future premiums for all policyholders in an amount sufficient to assure that the aggregate benefits paid in the previous calendar year plus the amount of the dividends and credits shall equal 85 percent of the premiums collected. The insurer shall distribute all dividends and credits by December 31 of the year following the calendar year in which the loss ratio requirements were not satisfied. The insurer's annual report shall include the insurer's calculation of the dividends and credits applicable to all policy forms, as well as an explanation of the insurer's plan to issue dividends or credits.
c. The commissioner shall specify by regulation:
(1) any informational filings required to be submitted by insurers to the commissioner in order to determine whether insurers are in compliance with their loss ratio requirements;
(2) the instructions and format for calculating and reporting loss ratios and issuing dividends or credits;
(3) procedures for the distribution of a dividend or credit in the event of cancellation or termination by a policyholder; and
(4) the instructions and format for submitting annual reports.
L.2019, c.358, s.4.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27-52 - Group life and health--package policies

17B:27-52. Group life and health--package policies
Any insurer authorized to write in this State group life and group health insurance may provide such coverages in one policy or in separate policies, or in supplements or riders to such policy or policies, with or without health insurance benefits on account of families or dependents of the insured employees or members, if the provisions of any such policy, supplement or rider which treat of group life insurance, and the provisions which treat of group health insurance comply respectively with the requirements of the law of this State applicable to the respective forms of insurance.
L.1971, c. 144, s. 17B:27-52.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27-53 - Group life and health--rate reductions and application of dividends; excess over employer's cost

17B:27-53. Group life and health--rate reductions and application of dividends; excess over employer's cost
If a policy dividend is hereafter declared or a reduction in rate is hereafter made or continued under any group insurance policy heretofore or hereafter issued to an employer, or to a labor union, or to the trustees of a fund established in whole or in part by an employer or a labor union, the excess, if any, of the aggregate dividends or rate reductions under such policy and all other group insurance policies of the policyholder over the aggregate expenditure for insurance under such policies made from funds contributed by the policyholder, or by an employer of insured persons, or by a union or association to which insured persons belong, including expenditures made in connection with administration of such policies, shall be applied by the policyholder for the sole benefit of insured employees or members.
L.1971, c. 144, s. 17B:27-53.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27-60 - Written certification of creditable coverage under COBRA

17B:27-60. Written certification of creditable coverage under COBRA
20. a. A health insurer which offers a group health plan shall provide a written certification of creditable coverage at the time an individual ceases coverage or otherwise becomes covered under a COBRA continuation provision; at the time an individual ceases to be covered under a COBRA continuation provision; and upon request, on behalf of an individual not later than 24 months after the cessation of coverage under the plan or a COBRA continuation provision.
b. The written certification of creditable coverage shall include the period of creditable coverage of the individual under the group health plan and the coverage under any COBRA continuation provision and any waiting or affiliation period imposed with respect to the individual for coverage under the plan.
L.1997,c.146,s.20.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27-61 - Affiliation period imposed by HMO

17B:27-61. Affiliation period imposed by HMO
21. A health maintenance organization which offers a group health plan and which does not impose a preexisting condition exclusion, may impose an affiliation period if the period is applied uniformly without regard to any health status-related factors and the period does not exceed two months, or three months in the case of a late enrollee.
L.1997,c.146,s.21.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27-62 - Permission to enroll for group coverage

17B:27-62. Permission to enroll for group coverage
22. A health insurer which offers a group health plan shall permit an employee or dependent who is eligible, but not enrolled, for coverage under the terms of the plan, to enroll for coverage if:
a. the employee or dependent was covered under a group health plan or had health insurance coverage at the time coverage was previously offered to the employee or dependent, and the employee stated in writing at such time that coverage under a group health plan or health insurance coverage was the reason for declining enrollment, if the health insurer required such a statement at that time and notified the employee of the insurer s requirements;
b. the employee s or dependent s other coverage described in subsection a. of this section was under a COBRA continuation provision and coverage under that provision was exhausted or the coverage was terminated due to loss of eligibility for coverage, including legal separation, divorce, death, termination of employment and reduction in hours of employment, or to the termination of employer contributions toward that coverage; and
c. the employee requests enrollment not later than 30 days after exhaustion of coverage under a COBRA continuation provision or termination of coverage pursuant to subsection b. of this section.
L.1997,c.146,s.22.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27-63 - Dependent special enrollment period

17B:27-63. Dependent special enrollment period
23. If a group health plan makes coverage available with respect to a dependent of an individual who is a participant under the plan or has satisfied any waiting period and is eligible to be enrolled, and the dependent becomes a dependent of the individual through marriage, birth, adoption or placement for adoption, the group health plan shall provide for a dependent special enrollment period during which the dependent and individual, if necessary, may be enrolled.
The dependent special enrollment period shall be for a period of not less than 30 days and shall begin on the later of the date dependent coverage is made available or the date of marriage, birth, adoption or placement for adoption. If an individual enrolls a dependent during the first 30 days of the dependent special enrollment period, the coverage of the dependent shall become effective: in the case of a marriage, no later than the first day of the first month after the date the completed request for enrollment is received; in the case of a dependent s birth, as of the date of birth; and in the case of a dependent s adoption or placement for adoption, the date of the adoption or placement for adoption.
L.1997,c.146,s.23.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27-64 - Rules for eligibility, health status-related factors prohibited

17B:27-64. Rules for eligibility, health status-related factors prohibited
24. A health insurer which offers a group health plan may not establish rules for eligibility, including continued eligibility, of any individual to enroll under the terms of the plan based on health status-related factors in relation to the individual or a dependent of the individual.
The provisions of this section shall not be construed to require a group health plan to provide particular benefits other than those provided under the terms of its coverage or to prevent the coverage from establishing limitations or restrictions on the amount, level, extent or nature of the benefits or coverage for similarly situated individuals enrolled in the coverage.
L.1997,c.146,s.24.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27-65 - Premiums, contributions regulated

17B:27-65. Premiums, contributions regulated
25. A health insurer which offers a group health plan may not require an individual, as a condition of enrollment or continued enrollment under the plan, to pay a premium or contribution which is greater than the premium or contribution for a similarly situated enrollee in the plan on the basis of any health status-related factor in relation to the individual or to an enrollee or a dependent of the individual or enrollee. This provision shall not be construed to restrict the amount that an employer may be charged for coverage under a group health plan or to prevent a health insurer offering group health insurance coverage from establishing premium discounts or modifying otherwise applicable copayments or deductibles in return for adherence to programs of health promotion and disease prevention.
L.1997,c.146,s.25.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27-69 - Conditions for issuance, delivery of group life insurance to groups not included in C.17B:27-68.

17B:27-69 Conditions for issuance, delivery of group life insurance to groups not included in C.17B:27-68.
2. a. Group life insurance offered to a resident of this State under a group life insurance policy issued to a group other than one described in section 1 of this act shall be subject to the requirements of this section.
b. A group life insurance policy shall not be delivered or issued for delivery in this State unless the commissioner finds that:
(1) The issuance of the group policy is not contrary to the best interest of the public;
(2) The issuance of the group policy would result in economies of acquisition or administration; and
(3) The benefits are reasonable in relation to the premiums charged.
c. Group life insurance coverage may not be offered in this State by an insurer under a policy issued in another state unless this State or another state having requirements substantially similar to those included in paragraphs (1), (2) and (3) of subsection b. of this section has made a determination that those requirements have been met.
d. The premium for the policy shall be remitted by the policyholder either from the policyholder's funds or from funds contributed by the covered persons, or from both.
e. An insurer may exclude or limit the coverage on any person as to whom evidence of individual insurability is not satisfactory to the insurer.
L.2005,c.190,s.2.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27-70 - Written notice to prospective insureds of noncompliance with C.17B:27-68; definitions.

17B:27-70 Written notice to prospective insureds of noncompliance with C.17B:27-68; definitions.
3. a. With respect to a program of insurance which, if issued on a group basis, does not meet the requirements of section 1 of this act, the insurer shall cause to be distributed to prospective insureds a written notice that compensation shall or may be paid, if compensation of any kind shall or may be paid to:
(1) A policyholder or sponsoring or endorsing entity in the case of a group policy; or
(2) A sponsoring or endorsing entity in the case of individual, blanket or franchise policies marketed by means of direct response solicitation.
b. The notice shall be distributed:
(1) Whether compensation is direct or indirect; and
(2) Whether the compensation is paid to or retained by the policyholder or sponsoring or endorsing entity, or paid to or retained by a third party at the direction of the policyholder or sponsoring or endorsing entity, or an entity affiliated therewith by way of ownership, contract or employment.
c. The notice required by this section shall be placed on or accompany an application or enrollment form provided to prospective insureds.
d. For the purposes of this section:
(1) "Direct response solicitation" means a solicitation through a sponsoring or endorsing entity through the mails, telephone or other mass communications media; and
(2) "Sponsoring or endorsing entity" means an organization that has arranged for the offering of a program of insurance in a manner that communicates that eligibility for participation in the program is dependent upon affiliation with the organization or that it encourages participation in the program.
L.2005,c.190,s.3.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27-71 - Extension to dependents of group life insurance policy.

17B:27-71 Extension to dependents of group life insurance policy.
4. Except for a policy issued under subsection b. of section 1 of this act, a group life insurance policy may be extended to insure the employees or members against loss due to the death of their spouses, domestic partners and dependent children, and any other persons dependent upon the insured employees or members, or any class thereof, subject to the following:
a. The premium for the insurance shall be remitted by the policyholder either from funds contributed by the employer, union, association or other person to whom the policy has been issued, or from funds contributed by the covered persons, or from both. Except as provided in subsection b. of section 1 of this act, a policy on which no part of the premium for the spouse's, domestic partner's, dependent child's and other dependent's coverage is to be derived from funds contributed by the covered persons shall insure all eligible employees or members with respect to their spouses, domestic partners, dependent children and other dependents, or any class thereof.
b. An insurer may exclude or limit the coverage on any spouse, domestic partner, dependent child or any other person dependent upon the insured employee or member as to whom evidence of individual insurability is not satisfactory to the insurer.
c. The amounts of insurance for any covered spouse, domestic partner, dependent child or any other person dependent upon the insured employee or member under the policy may not exceed 100% of the amount of insurance for which the employee or member is insured.
L.2005,c.190,s.4.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27-73 - Issuance, delivery of individual policy of life insurance.

17B:27-73 Issuance, delivery of individual policy of life insurance.
6. If an individual insured under a group insurance policy hereafter delivered or issued for delivery in this State becomes entitled under the terms of the policy to have an individual policy of life insurance issued without evidence of insurability, subject to making application and payment of the first premium within the period specified in the policy, and if the individual is not given notice of the existence of the right at least 15 days prior to the expiration date of the period, then the individual shall have an additional period within which to exercise the right, but nothing herein contained shall be construed to continue any insurance beyond the period provided in the policy. This additional period shall expire 15 days after the individual is given notice but in no event shall the additional period extend beyond 60 days after the expiration date of the period provided in the policy. Written notice presented to the individual or mailed by the policyholder to the last known address of the individual or mailed by the insurer to the last known address of the individual as furnished by the policyholder shall constitute notice for the purpose of this section.
L.2005,c.190,s.6.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27-74 - Filing of form required for delivery, issuance of group life insurance.

17B:27-74 Filing of form required for delivery, issuance of group life insurance.
7. a. No group life insurance policy, or application, if a written application is required and is to be made a part of the policy, certificate, printed rider or endorsement for use with the policy, shall be delivered or issued for delivery in this State unless the form has been filed with the Commissioner of Banking and Insurance for approval in accordance with the provisions of section 16 of P.L.1995, c.73 (C.17B:25-18.2).
b. If a form is disapproved for filing by the commissioner during the 60-day period provided in section 16 of P.L.1995, c.73 (C.17B:25-18.2), it may not be delivered or issued for delivery unless it is resubmitted and approved in accordance with the provisions of subsections b., c., and d., of section 16 of P.L.1995, c.73 (C.17B:25-18.2). Such disapproval shall be subject to review in accordance with the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.).
c. Any form which is filed by the commissioner or deemed filed may be so delivered or issued for delivery until such time as any subsequent withdrawal of the filing by the commissioner, following an opportunity for a hearing held in accordance with the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), becomes final in accordance therewith.
d. This section shall not apply to documents which relate only to the manner of distribution of benefits or to the reservation of rights and benefits under group life insurance policies and which are used at the request of the individual insured or policyholder.
e. The disapproval by the commissioner of any form may be on the grounds that the form contains provisions which are unjust, unfair, inequitable, misleading, or contrary to law or to the public policy of this State.
L.2005,c.190,s.7.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27-75 - Payment of benefits.

17B:27-75 Payment of benefits.
8. a. Notwithstanding any policy provision to the contrary, benefits under a group life insurance policy subject to this act shall become payable by reason of the death of the insured within 60 days after the receipt of due proof of death and, at the insurer's option, proof of the interest of the claimant.
b. If a claim or a portion of a claim for benefits under a policy requires additional investigation or is denied by the insurer, the claimant shall be notified in writing no later than 45 days following receipt by the insurer of due proof of death, proof of the interest of the claimant, or any other document or information requested by the insurer under the terms of the policy, that the claim, or a portion thereof, is subject to additional investigation or denied, and the reason the claim is being investigated or denied. Notwithstanding the provisions of this subsection b. to the contrary, the notice to the claimant for any claim which the insurer concludes, based upon its investigation and which conclusion is reasonably based upon the contents of the insurer's claim file, constitutes probable cause for fraud shall not be required to contain the specific reasons for the investigation. A conclusion of fraud that is not reasonably based upon the contents of the insurer's claim file shall be a violation of section 1 of P.L.1975, c.101 (C.17B:30-13.1), notwithstanding that the violation did not occur with such frequency as to indicate a general business practice. Any uncontested portion of a claim shall be paid no later than 60 days following receipt of due proof of death, proof of the interest of the claimant, or any other document or information requested by the insurer under the terms of the policy.
c. The insurer, upon receipt of any document or information requested relating to a claim or portion of a claim under investigation, shall pay the benefits for which the claim is made, or deny the claim no later than 90 days following the receipt of the document or information.
d. Payment of a claim or a portion thereof that is not under investigation by the insurer shall be overdue if not remitted to the claimant by the insurer on or before 60 days following receipt of due proof of death, proof of the interest of the claimant, or any other document or information requested by the insurer pursuant to the policy. Payment of a claim, or a portion of a claim under investigation, or denied, that becomes eligible for payment shall be overdue if not remitted to the claimant by the insurer on or before 90 days following receipt of due proof of death, proof of the interest of the claimant, or any other document or information requested by the insurer. Overdue payments shall bear an annual rate of interest equal to the average rate of return of the State of New Jersey Cash Management Fund, established pursuant to section 1 of P.L.1977, c.281 (C.52:18A-90.4), for the preceding fiscal year, rounded to the nearest one-half percent.
L.2005,c.190,s.8.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27A-2.1 - Regulations.

17B:27A-2.1 Regulations.
36. The Commissioner of Banking and Insurance shall, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), adopt regulations necessary to implement sections 9 through 25 and sections 29 through 34 of this act.
L.2008, c.38, s.36.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27A-2.2 - Effective date.

17B:27A-2.2 Effective date.
37. Sections 1 through 8, 26 through 28, 36 and this section of this act shall take effect immediately and sections 9 through 25 and 29 through 35 of this act shall take effect on the 180th day after enactment, except that the 80 percent minimum loss ratio requirements in sections 16, 19, and 24 of this act shall take effect on January 1 next following the date of enactment. Sections 9 through 25 and 29 through 35 shall apply to all contracts and policies that are delivered, issued, executed or renewed or approved for issuance or renewal in this State on or after the effective date provided herein, but the Commissioner of Banking and Insurance may take such anticipatory administrative action in advance thereof as shall be necessary for the implementation of this act. L.2008, c.28, s.37.
2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:27A-4 - Offering of individual health benefits required by issuer of small employer health benefits plans.

17B:27A-4 Offering of individual health benefits required by issuer of small employer health benefits plans.
3. a. Every carrier that offers individual health benefits plans shall make a good faith effort to market the individual health benefits plans. The department may impose fines against any carrier that violates the provisions of this subsection.
b. A carrier shall offer to an eligible person a choice of at least three individual health benefits plans established by the board pursuant to section 6 of P.L.1992, c.161 (C.17B:27A-7).
c. (1) (Deleted by amendment, P.L.2019, c.359).
(2) (Deleted by amendment, P.L.2019, c.359).
(3) (Deleted by amendment, P.L.2019, c.359).
(4) (Deleted by amendment, P.L.2019, c.359).
(5) The provisions of section 13 of P.L.1985, c.236 (C.17:48E-13), N.J.S.17B:26-1, and section 8 of P.L.1973, c.337 (C.26:2J-8) with respect to the filing of policy forms shall not apply to health plans issued on or after the effective date of P.L.1992, c.161 (C.17B:27A-2 et al.).
(6) The provisions of section 27 of P.L.1985, c.236 (C.17:48E-27) and section 7 of P.L.1988, c.71 (C.17:48E-27.1) with respect to rate filings shall not apply to individual health plans issued on or after the effective date of P.L.1992, c.161 (C.17B:27A-2 et al.).
d. Every group conversion contract or policy issued after the effective date of P.L.1992, c.161 (C.17B:27A-2 et al.) shall be issued pursuant to this section; except that this requirement shall not apply to any group conversion contract or policy in which a portion of the premium is chargeable to, or subsidized by, the group policy from which the conversion is made.
e. (Deleted by amendment, P.L.2008, c.38).
f. (Deleted by amendment, P.L.2019, c.359).
L.1992, c.161, s.3; amended 1993, c.164, s.3; 1994, c.102, s.1; 2008, c.38, s.11; 2019, c.359, s.2; 2023, c.194, s.1.