N.J. Admin. Code § 11:4-57.1 - Purpose and scope

Current through Register Vol. 54, No. 7, April 4, 2022

(a) The purpose of this subchapter is to implement P.L. 1999, c. 106 by specifying that certain exclusions may not be applied to treatment of biologically-based mental illness, and that benefit limits in health insurance policies and health maintenance organization contracts may not be applied to deny medically necessary benefits or services for the treatment of biologically-based mental illness when those benefit limits are not applied in the same manner to treatments for other illnesses.
(b) This subchapter shall apply to all policies and contracts providing hospital or medical services or benefits that are delivered, issued, executed or renewed in this State in the individual, small group and large group markets as follows: all hospital service corporation contracts issued pursuant to 17:48-1 et seq.; all medical service corporation contracts issued pursuant to 17:48A-1 et seq.; all health service corporation contracts issued pursuant to 17:48E-1 et seq.; all health insurance policies issued pursuant to 17B:26-1 et seq., 17B:27-26 et seq., 17B:27A-2 et seq. and 17B:27A-17 et seq.; and all health maintenance organization contracts issued pursuant to 26:2J-1 et seq.


N.J. Admin. Code § 11:4-57.1

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