N.J. Admin. Code Tit. 11, ch. 24 - HEALTH MAINTENANCE ORGANIZATIONS

  1. Subchapter 1 - SCOPE AND DEFINITIONS (§ 11:24-1.1 to 11:24-1.2)
  2. Subchapter 2 - ESTABLISHMENT OF HEALTH MAINTENANCE ORGANIZATIONS (§ 11:24-2.1 to 11:24-2.15)
  3. Subchapter 3 - GENERAL REQUIREMENTS (§ 11:24-3.1 to 11:24-3.9)
  4. Subchapter 4 - MEDICAL DIRECTOR (§ 11:24-4.1 to 11:24-4.2)
  5. Subchapter 5 - HEALTH CARE SERVICES (§ 11:24-5.1 to 11:24-5.7)
  6. Subchapter 5A - COVERAGE FOR TERMINATION OF PREGNANCY (§ 11:24-5A.1 to 11:24-5A.3)
  7. Subchapter 6 - PROVIDER NETWORK (§ 11:24-6.1 to 11:24-6.3)
  8. Subchapter 7 - CONTINUOUS QUALITY IMPROVEMENT (§ 11:24-7.1 to 11:24-7.4)
  9. Subchapter 8 - UTILIZATION MANAGEMENT (§ 11:24-8.1 to 11:24-8.9)
  10. Subchapter 9 - MEMBER RIGHTS AND RESPONSIBILITIES; DISCLOSURES TO CONSUMERS (§ 11:24-9.1)
  11. Subchapter 10 - MEDICAL RECORDS (§ 11:24-10.1 to 11:24-10.5)
  12. Subchapter 11 - FINANCIAL STANDARDS AND REPORTING (§ 11:24-11.1 to 11:24-11.9)
  13. Subchapter 12 - REHABILITATION, CONSERVATION AND LIQUIDATION (§ 11:24-12.1 to 11:24-12.2)
  14. Subchapter 13 - LICENSING OF REPRESENTATIVES AND ADVERTISING (§ 11:24-13.1 to 11:24-13.6)
  15. Subchapter 14 - INDEMNITY BENEFITS OFFERED BY A HEALTH MAINTENANCE ORGANIZATION (§ 11:24-14.1 to 11:24-14.9)
  16. Subchapter 15 - PROVIDER AGREEMENTS AND RISK TRANSFERENCE (§ 11:24-15.1 to 11:24-15.4)
  17. Subchapter 16 - RESERVED
  18. Subchapter 17 - PLAN DOCUMENTS FOR GROUP CONTRACTS (§ 11:24-17.1 to 11:24-17.6)
  19. Subchapter 18 - DRUG FORMULARIES (§ 11:24-18.1 to 11:24-18.4)

Notes

N.J. Admin. Code Tit. 11, ch. 24
CHAPTER SOURCE AND EFFECTIVE DATE:
Effective: 11/30/2021.
See: 54 N.J.R. 73(a).
CHAPTER HISTORICAL NOTE:
Chapter 38, Health Maintenance Organizations, was adopted as R.1974. d.320, effective 11/20/1974. See: 6 N.J.R. 8(b), 6 N.J.R. 473(a).
Pursuant to Executive Order No. 66(1978), Chapter 38 expired on 4/3/1994.
Chapter 38, Health Maintenance Organizations, was adopted as R.1994 d.365, effective 7/18/1994. See: 26 N.J.R. 1624(a), 26 N.J.R. 2896(a).
Subchapter 14, Indemnity Benefits Offered by a Health Maintenance Organization, was adopted as R.1996 d.194, effective 4/15/1996. See: 27 N.J.R. 4981(a), 28 N.J.R. 1981(c).
Pursuant to Executive Order No. 66(1978), Subchapter 14, Indemnity Benefits Offered by a Health Maintenance Organization, of Chapter 38, was readopted as R.1997 d.68, effective 1/17/1997. As a part of R.1997 d.68, effective 2/18/1997, Subchapter 1, General Provisions, was repealed and a new Subchapter 1, Scope and Definitions, was adopted; Subchapter 2, Establishment of Health Maintenance Organizations, was repealed and a new Subchapter 2, Establishment of Health Maintenance Organizations, was adopted; Subchapter 3, Issuance of Certificate of Authority, was repealed and a new Subchapter 3, General Requirements, was adopted; and Subchapter 4, Medical Director, Subchapter 5, Health Care Services, Subchapter 6, Provider Network, Subchapter 7, Continuous Quality Improvement, Subchapter 8, Utilization Management, Subchapter 9, Member Rights and Responsibilities, Subchapter 10, Medical Records, Subchapter 11, Financial Standards and Reporting, Subchapter 12, Rehabilitation, Conservation and Liquidation, Subchapter 13, Licensing of Representatives and Advertising, and Subchapter 15, Provider Agreements and Risk Transference, were adopted as new rules. All repeals, amendments, and other new rules became operative July 1, 1997. See: 28 N.J.R. 2456(a), 28 N.J.R. 3118(b), 29 N.J.R. 625(a).
Subchapter 17, Plan Documents for Group Contracts, was adopted as new rules by R.2000 d.183, effective 5/1/2000. See 31 N.J.R. 953(a), 32 N.J.R. 1544(a).
Subchapter 18, Drug Formularies, was adopted as new rules by R.2001 d.8, effective 1/2/2001, (operative July 1, 2001). See: 32 N.J.R. 211(a), 33 N.J.R. 46(a).
Chapter 38, Health Maintenance Organizations, expired on 7/16/2002.
Chapter 38, Health Maintenance Organizations, was adopted as new rules by R.2002 d.265, effective 8/19/2002. See: 34 N.J.R. 885(a), 34 N.J.R. 3014(a).
Pursuant to Reorganization Plan No. 005-2005, Chapter 38 of Title 8, Health Maintenance Organizations, was recodified as Chapter 24 of Title 11, effective 10/6/2006. See: 37 N.J.R. 2737(a), 38 N.J.R. 4721(a).
Chapter 24, Health Maintenance Organizations, was readopted as R.2008 d.60, effective 2/15/2008. See: 39 N.J.R. 3466(a), 40 N.J.R. 1668(a).
In accordance with N.J.S.A. 52:14B-5.1b, Chapter 24, Health Maintenance Organizations, was scheduled to expire on 2/15/2015. See: 43 N.J.R. 1203(a).
Chapter 24, Health Maintenance Organizations, was readopted, effective 1/14/2015. See: 47 N.J.R. 488(a).
Chapter 24, Health Maintenance Organizations, was readopted with technical changes, effective 11/30/2021. See: Source and Effective Date. See, also, section annotations.

CHAPTER AUTHORITY:

N.J.S.A. 17:1-8.1, 17:1-15.e, 17B:30-54, 26:2J-21, and 26:2S-18.

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