N.J. Admin. Code § 11:24-17.5 - Standards for optional provisions

(a) If an HMO intends to coordinate benefits under the health benefits plan, the plan documents shall include a statement specifying that coordination may occur, and an explanation of how coordination will be achieved.

1. Coordination of benefits shall be accomplished in accordance with N.J.A.C. 11:4-28, and the explanation of coordination of benefits shall not be inconsistent with those rules.

2. If an HMO fails to include a provision regarding coordination of benefits consistent with N.J.A.C. 11:4-28, the health benefits plan shall be primary coverage for all members.

(b) If an HMO will allow reinstatement of the group health benefits plan, and/or coverage for a member, the plan documents shall include any terms and conditions for reinstatement.

Notes

N.J. Admin. Code § 11:24-17.5

Amended by R.2002 d.265, effective 8/19/2002.
See: 34 N.J.R. 885(a), 34 N.J.R. 3014(a).
Deleted (c).