Chapter 20 - INDIVIDUAL HEALTH COVERAGE PROGRAM

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CHAPTER SOURCE AND EFFECTIVE DATE:
Subchapters 1, 2, 3, 8, 12, 17, 19, 20, 23, and 24, and Appendix Exhibits A through D and K, R.2018 d.197, effective June 12, 2018. See: 50 N.J.R. 1412(a), 50 N.J.R. 2329(a).
Subchapters 3A, 6, 7, 11, and 18, and Appendix Exhibits E and J, effective January 12, 2018. See: 50 N.J.R. 905(a).
CHAPTER HISTORICAL NOTE:
Chapter 20, Individual Health Coverage Program, was adopted as emergency new rules by R.1993 d.344, effective June 14, 1993 (to expire August 13, 1993). See: 25 N.J.R. 2945(a). The concurrent proposal of Chapter 20 was adopted as R.1993 d.439, effective August 13, 1993, with changes effective September 7, 1993. See: 25 N.J.R. 2945(a), 25 N.J.R. 4180(a).
Subchapter 2, Individual Health Coverage Program Temporary Plan of Operation, was adopted as R.1993 d.550, effective October 14, 1993. See: 25 N.J.R. 4707(a), 25 N.J.R. 5244(a).
Subchapter 10, Performance Standards and Reporting Requirements, was adopted as R.1994 d.142, effective February 23, 1994. See: 26 N.J.R. 1202(a), 26 N.J.R. 1351(a).
Subchapter 11, Relief from Obligations Imposed by the Individual Health Insurance Reform Act, was adopted as R.1993 d. 654, effective December 30, 1993. See: 25 N.J.R. 4459(a), 25 N.J.R. 5930(b).
Subchapter 12, Eligibility for and Replacement of Standard Health Benefits Plans, was adopted as R.1994 d.54, effective December 30, 1993. See: 26 N.J.R. 87(a), 26 N.J.R. 804(a).
Subchapter 13, Certification of Non-Member Status, was adopted as R.1994 d.177, effective March 10, 1994. See: 26 N.J.R. 1294(a), 26 N.J.R. 1509(a).
Subchapter 17, Enrollment Status Report, was adopted as R.1994 d.53, effective December 30, 1993. See: 26 N.J.R. 90(a), 26 N.J.R. 806(a).
Subchapter 18, Withdrawal of Carriers from the Individual Market and Withdrawal of Plan, Plan Option, or Deductible/Copayment Option, was adopted as R.1998 d. 339, effective July 6, 1998. See: 29 N.J.R. 2615(a), 30 N.J.R. 2502(a).
Pursuant to Executive Order No. 66(1978), Chapter 20, Individual Health Coverage Program, Subchapters 1 through 10, 12, 13, 17, 18 and Appendix Exhibits A through T, were readopted as R.1998 d.443, effective August 7, 1998, and Subchapter 11 was readopted as R.1998 d.454, effective August 13, 1998. Subchapter 19, Petitions for Rulemaking, and Subchapter 20, Appeals from Actions of the Board, were adopted as new rules by R.1998 d.443, effective August 7, 1998. See: 30 N.J.R. 2581(a), 30 N.J.R. 3289(a); 30 N.J.R. 2192(a), 30 N.J.R. 3308(a).
In accordance with N.J.S.A. 52:14B-5.1d, the expiration date of Chapter 20, Individual Health Coverage Program, was extended by gubernatorial directive from August 7, 2003 to 270 days following Supreme Court decision in In re Health Coverage Program's Readoption of N.J.A.C. 11:20-1.1 et seq. See: 35 N.J.R. 2898(a).
Subchapter 22, Basic and Essential Health Care Services Plan, was adopted as R.2003 d.91, effective January 28, 2003. See: 34 N.J.R. 73(a), 35 N.J.R. 1290(a).
In accordance with N.J.S.A. 52:14B-5.1d, Chapter 20, Individual Health Coverage Program, expiration date was extended by gubernatorial directive from February 4, 2005 to July 4, 2005. See: 37 N.J.R. 778(a).
Subchapter 4, Standard Application Form; Subchapter 5, Standard Claim Form and Appendix Exhibits G, H, and I, expired effective July 4, 2005. See: 37 N.J.R. 2994(a).
Chapter 20, Individual Health Coverage Program, Subchapters 1 through 3, 6 through 10, 12, 17 through 20, 22 and Appendix Exhibits A through F, J through L, and Q through V, were readopted as R.2006 d.15, effective December 7, 2005, and Subchapter 11 was readopted as R.2006 d.16, effective December 7, 2005. Subchapter 12, Eligibility for and Replacement of Standard Health Benefits Plans and the Basic and Essential Health Care Services Plan, was repealed, and Subchapter 12, Purchase of a Standard Individual Health Benefits Plan or a Basic and Essential Healthcare Services Plan by a Person Covered under an Individual Plan or Eligible for or Covered under a Group Plan, was adopted as new rules by R.2006 d.15, effective January 3, 2006. Appendix Exhibit R, was repealed, by R.2006 d. 15, effective January 3, 2006. Subchapter 23, Rulemaking; Interested Parties; Public Notices; Interested Parties Mailing List, and Subchapter 24, Program Compliance, were adopted as new rules by R.2006 d.15, effective January 3, 2006. Appendix Exhibits A, C, E and U were repealed by R.2006 d.15, effective January 3, 2006 (operative July 1, 2006). Exhibits A, C and E were adopted as new rules. See: 37 N.J.R. 2994(a), 38 N.J.R. 311(a), 38 N.J.R. 1005(a); 37 N.J.R. 3022(a), 38 N.J.R. 332(a).
Exhibit H of the Appendix was adopted as new rules by R.2009 d.45, effective December 29, 2008. See: 40 N.J.R. 6904(a), 41 N.J.R. 799(b).
Subchapter 6, Individual Health Benefits Carriers Informational Rate Filing Requirement; Subchapter 7, Loss Ratio and Refund Reporting Requirements; and Subchapter 18, Withdrawal of Carriers from the Individual Market and Withdrawal of Plan, Plan Option, or Deductible/Copayment Option, were repealed by R.2009 d.45, effective December 29, 2008 (operative April 20, 2009). See: 40 N.J.R. 6904(a), 41 N.J.R. 799(b), 41 N.J.R. 1875(a).
Subchapter 3A, Policy Forms; Subchapter 6, Individual Health Benefits Carriers Informational Rate Filing Requirements; Subchapter 7, Loss Ratio And Refund Reporting Requirements; and Subchapter 18, Withdrawals of Carriers from the Individual Market and the Withdrawal of Plan, Plan Option, or Deductible/Copayment Option, were adopted as new rules by R.2009 d.128, effective April 20, 2009. See: 41 N.J.R. 73(a), 41 N.J.R. 1866(c).
Subchapter 9, Exemptions, and Subchapter 10, Performance Standards and Reporting Requirements, expired on December 7, 2010.
In accordance with N.J.S.A. 52:14B-5.1b, Subchapters 1, 2, 3, 3A, 6, 7, 8, 11, 12, 17, 18, 19, 20, 22, 23 and 24, and Appendix Exhibits A through H and J through L were scheduled to expire on June 5, 2013. See: 43 N.J.R. 1203(a).
Chapter 20, Individual Health Coverage Program, Subchapters 1, 2, 3, 8, 12, 17, 19, 20, 22, 23 and 24, and Appendix Exhibits A through D, F, G, H, K and L, were readopted as R.2011 d.163, effective May 12, 2011. See: 43 N.J.R. 131(a), 43 N.J.R. 1353(a).
Chapter 20, Individual Health Coverage Program, Subchapters 3A, 6, 7, 11 and 18, and Appendix Exhibits E and J, were readopted as R.2011 d.167, effective May 12, 2011. See: 43 N.J.R. 143(a), 43 N.J.R. 1359(a).
Subchapter 12, Purchase of a Standard Individual Health Benefits Plan or a Basic and Essential Healthcare Services Plan by a Person Covered Under an Individual Plan or Eligible for or Covered Under a Group Plan, was renamed Purchase of a Standard Health Benefits Plan by a Person Covered Under an Individual Plan or Covered Under a Group Plan by R.2013 d.130, effective October 1, 2013 (operative January 1, 2014). See: 45 N.J.R. 2310(a), 45 N.J.R. 2385(a).
Subchapter 22, Basic and Essential Healthcare Services Plan, was repealed by R.2016 d.127, effective October 17, 2016 (operative January 1, 2016). See: 48 N.J.R. 1555(a), 48 N.J.R. 2153(a).
Chapter 20, Individual Health Coverage Program, Subchapters 3A, 6, 7, 11 and 18, and Appendix Exhibits E and J, were readopted with technical changes, effective January 12, 2018. See: Source and Effective Date. See, also, section annotations.
Chapter 20, Individual Health Coverage Program, Subchapters 1, 2, 3, 8, 12, 17, 19, 20, 23, and 24, and Appendix Exhibits A through D and K, were readopted; and Appendix Exhibits F, G, and H were repealed by R.2018 d.197, effective June 12, 2018. See: Source and Effective Date. See, also, section annotations.

CHAPTER AUTHORITY:

N.J.S.A. 17:1-8.1, 17:1-15.e, and 17B:27A-2 et seq.; and P.L. 2008, c. 38.

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