Words and terms, when used in this subchapter, shall have
the meanings as set forth at
N.J.S.A. 17B:27A-17 and
N.J.A.C. 11:21-1.2, unless defined below or
the context indicates otherwise.
"Benefits coverage" means the services and supplies covered
by a health benefits plan and certain general provisions, definitions and
covered charges with special limitations (as specified in the Checklist and
Certification set forth in Part 5 of Exhibit BB of the Appendix to N.J.A.C.
11:21, incorporated herein as part of this subchapter) governing the health
benefits plan.
"Closed nonstandard health benefits plan" means a health
benefits plan issued prior to January 1, 1994 that was in effect on February
28, 1994 and was reinstated, renewed or continued at the option of the small
employer(s) pursuant to N.J.S.A. 17B:27A-19j, but under which contracts or
certificates have not been issued or offered on or after January 1, 1994 to a
small employer group that was not covered under the health benefits plan prior
to January 1, 1994, and which the carrier has certified shall not be offered or
issued to any small employer that was not covered under the health benefits
plan on December 31, 1993.
The term "closed nonstandard health benefits plan" also means
a health benefits plan issued prior to January 1, 1994 that was in effect on
February 28, 1994 and reinstated, renewed or continued at the option of a small
employer pursuant to N.J.S.A. 17B:27A-19j under which contracts or certificates
have been issued subsequent to January 1, 1994 to small employers who were not
covered under the health benefits plan prior to January 1, 1994, but under
which no such small employers remain covered as of the effective date of this
subchapter and which the carrier has certified shall not be offered or issued
to any small employer that was not covered under the health benefits plan on
December 31, 1993.
"Market," when used as a verb, means to offer or advertise as
available a nonstandard health benefits plan for initial purchase by small
employers or to a small employer who formerly purchased the nonstandard health
benefits plan but who is not currently covered under the nonstandard health
benefits plan. The term does not include continuation or renewal of a contract,
policy or certificate under a nonstandard health benefits plan by a carrier for
a small employer currently covered under the nonstandard health benefits
plan.
"Nonstandard health benefits plan" means a health benefits
plan policy or contract form under which policies or contracts were issued on
or before December 31, 1993 to small employers or to one or more employees of a
small employer by virtue of the employment arrangement, or a policy or contract
form under which policies or contracts were issued on or before December 31,
1993 to an association, out-of-State trust or multiple employer arrangement and
offered to small employers or to one or more employees of a small
employer.
"Open nonstandard health benefits plan" means a nonstandard
health benefits plan which has been issued or offered to a small employer group
that was not covered under the health benefits plan on or before December 31,
1993, or which would otherwise meet the requirements for a closed nonstandard
health benefits plan except that the carrier has not certified that the
nonstandard health benefits plan shall not be offered for issue to any small
employer that was not covered under the health benefits plan on December 31,
1993.
