§ 26:2J-1 Short title
§ 26:2J-2 Definitions
§ 26:2J-3 Establishment of health maintenance organizations
§ 26:2J-4 Issuance of certificate of authority
§ 26:2J-4.1 Health maintenance organization to pay benefits for treatment of Wilm’s tumor
§ 26:2J-4.4 Health maintenance organization, mammogram examination benefits
§ 26:2J-4.5 Health maintenance organization, benefits for “off-label” drugs required
§ 26:2J-4.6 Health maintenance organization, benefits for health promotion
§ 26:2J-4.7 Requirements for health maintenance organization providing benefits for pharmacy services
§ 26:2J-4.8 Benefits for certain cancer treatments
§ 26:2J-4.9 Coverage for birth and natal care; HMO
§ 26:2J-4.10 Health maintenance organization, child screening, blood lead, hearing loss; immunizations
§ 26:2J-4.11 Coverage, diabetes treatment by HMO contracts
§ 26:2J-4.12 HMO contracts, Pap smear benefits
§ 26:2J-4.13 HMO certificate of authority, prostate cancer testing
§ 26:2J-4.14 HMO to provide benefits for reconstructive breast surgery
§ 26:2J-4.15 Coverage for minimum inpatient care following mastectomy by HMO
§ 26:2J-4.16 Applicability of Health Care Quality Act
§ 26:2J-4.17 Coverage for treatment of inherited metabolic diseases by health maintenance organization
§ 26:2J-4.18 Coverage for treatment of domestic violence injuries by health maintenance organization
§ 26:2J-4.19 Coverage for certain dental procedures for the severely disabled or child age five or under by HMO
§ 26:2J-4.20 HMO to provide coverage for mental health conditions, substance use disorders; collaborative care model
§ 26:2J-4.21 HMO to provide continuing nursing home care, certain
§ 26:2J-4.22 Coverage for hemophilia services by HMO
§ 26:2J-4.23 Health maintenance organization to provide coverage for treatment of infertility
§ 26:2J-4.24 HMO agreement to provide coverage for colorectal cancer screening
§ 26:2J-4.25 Health maintenance organization prescription drug plans to cover certain infant formulas
§ 26:2J-4.26 HMO required to cover certain out-of-network services
§ 26:2J-4.27 HMO to offer coverage for domestic partner
§ 26:2J-4.28 HMO, high deductible, coverage for preventive care
§ 26:2J-4.29 Health service corporation, coverage for prescription female contraceptives
§ 26:2J-4.30 Health maintenance organization, coverage for contraceptives
§ 26:2J-4.31 HMOs to provide benefits for orthotic and prosthetic appliances
§ 26:2J-4.32 Health maintenance organization to provide coverage for hearing aids for certain persons aged 15 or younger
§ 26:2J-4.33 Health maintenance organization to provide installment payments to obstetrical provider for maternity services
§ 26:2J-4.34 Health maintenance organization to provide benefits for treatment of autism or other developmental disability
§ 26:2J-4.35 HMO to provide coverage for oral anticancer medications
§ 26:2J-4.36 HMO to provide coverage for sickle cell anemia
§ 26:2J-4.37 Health maintenance organization to provide coverage for prescription eye drops
§ 26:2J-4.38 Health maintenance organization, coverage for synchronization of prescribed medications
§ 26:2J-4.39 Health maintenance organization contract to provide benefits for substance use disorder
§ 26:2J-4.40 Health maintenance organization to provide coverage regardless of gender identity, expression
§ 26:2J-4.41 HMO to cover digital tomosynthesis of the breast
§ 26:2J-4.42 HMO to provide coverage for donated human breast milk
§ 26:2J-4.43 Health maintenance organization to provide coverage for standard fertility preservation services
§ 26:2J-4.44 Health maintenance organization to provide coverage for breastfeeding support
§ 26:2J-4.45 Health maintenance organization to cover preventive services
§ 26:2J-4.46 Health maintenance organization to provide certain coverage for prescription drugs
§ 26:2J-4.47 Health maintenance organization to cover adolescent depression screenings
§ 26:2J-4.48 HMO to cover newborn home nurse visitation
§ 26:2J-4.49 Contract, health care services, coverage, epinephrine auto-injector device
§ 26:2J-4.50 Contract, health care services, coverage, prescription asthma inhaler
§ 26:2J-5 Powers of health maintenance organizations
§ 26:2J-6 Governing body
§ 26:2J-7 Protection against wrongful acts
§ 26:2J-8 Evidence of coverage
§ 26:2J-8.1 Health maintenance organization to receive, transmit transactions electronically; standards
§ 26:2J-9 Annual report
§ 26:2J-10 Information to enrollees
§ 26:2J-10.1 Coverage provided by health maintenance organization for subscriber’s child
§ 26:2J-10.2 Requirements applicable to State Medicaid
§ 26:2J-10.3 Coverage for certain dependents until age 31 by health maintenance organization
§ 26:2J-11 Annual open enrollment period
§ 26:2J-11.1 Failure to agree on terms; four-month extension; notification of options
§ 26:2J-12 Complaint system
§ 26:2J-13 Investments
§ 26:2J-14 Protection against insolvency
§ 26:2J-15 Prohibited practices for health maintenance organization
§ 26:2J-15.1 Health care services contract, exclusion, rates, terms based on genetic information prohibited
§ 26:2J-16 Regulation of agents
§ 26:2J-17 Powers of insurers and hospital and medical service corporations
§ 26:2J-18 Examinations
§ 26:2J-18.1 Examination of HMO by Commissioner of Banking and Insurance
§ 26:2J-18.2 Definitions relative to risk based capital requirements for HMOs
§ 26:2J-18.3 Increase of capital, surplus; methods, procedures
§ 26:2J-18.4 Factors in determining change in capital, surplus
§ 26:2J-18.5 Noncompliance, penalties
§ 26:2J-18.6 Regulations
§ 26:2J-19 Suspension or revocation of certificate of authority
§ 26:2J-21 Regulation
§ 26:2J-22 Administrative procedures
§ 26:2J-23 Fees
§ 26:2J-24 Administrative penalty; enforcement
§ 26:2J-25 Statutory construction and relationship to other laws
§ 26:2J-26 Filings and reports as public documents
§ 26:2J-27 Confidentiality of medical information
§ 26:2J-28 Commissioner of health’s authority to contract
§ 26:2J-29 Enrollment of State employees
§ 26:2J-30 Severability
§ 26:2J-31 Definitions
§ 26:2J-32 Applicability of act
§ 26:2J-33 Avoidance of duplication of benefits, regulations
§ 26:2J-34 Coverage for preexisting condition
§ 26:2J-35 Regulations
§ 26:2J-36 Authorization for health maintenance organization to offer, provide medicare supplement health care services
§ 26:2J-37 Submission of underlying plan; rate filings
§ 26:2J-38 Outline of coverage delivered to applicant
§ 26:2J-39 30-day return provision, refunds
§ 26:2J-40 Filing of copy of advertising materials, regulations
§ 26:2J-41 Additional remedies
§ 26:2J-42 Health maintenance organization contract; compliance
§ 26:2J-43 Filing of contract or related form
§ 26:2J-44 Contract forms; certification memorandum
§ 26:2J-47 Annual assessment on HMOs
§ 26:2J-48 Health maintenance organization, aggregate benefits

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Terms Used In New Jersey Statutes > Title 26 > Chapter 2J

  • Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
  • Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
  • Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
  • Baseline: Projection of the receipts, outlays, and other budget amounts that would ensue in the future without any change in existing policy. Baseline projections are used to gauge the extent to which proposed legislation, if enacted into law, would alter current spending and revenue levels.
  • Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. Source: OCC
  • Charity: An agency, institution, or organization in existence and operating for the benefit of an indefinite number of persons and conducted for educational, religious, scientific, medical, or other beneficent purposes.
  • Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
  • Continuance: Putting off of a hearing ot trial until a later time.
  • Contract: A legal written agreement that becomes binding when signed.
  • Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
  • Dependent: A person dependent for support upon another.
  • Discovery: Lawyers' examination, before trial, of facts and documents in possession of the opponents to help the lawyers prepare for trial.
  • Donor: The person who makes a gift.
  • Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
  • Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
  • Fraud: Intentional deception resulting in injury to another.
  • Lease: A contract transferring the use of property or occupancy of land, space, structures, or equipment in consideration of a payment (e.g., rent). Source: OCC
  • Liabilities: The aggregate of all debts and other legal obligations of a particular person or legal entity.
  • Litigation: A case, controversy, or lawsuit. Participants (plaintiffs and defendants) in lawsuits are called litigants.
  • month: means a calendar month, and the word "year" means a calendar year. See New Jersey Statutes 1:1-2
  • Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
  • Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
  • person: includes corporations, companies, associations, societies, firms, partnerships and joint stock companies as well as individuals, unless restricted by the context to an individual as distinguished from a corporate entity or specifically restricted to one or some of the above enumerated synonyms and, when used to designate the owner of property which may be the subject of an offense, includes this State, the United States, any other State of the United States as defined infra and any foreign country or government lawfully owning or possessing property within this State. See New Jersey Statutes 1:1-2
  • Power of attorney: A written instrument which authorizes one person to act as another's agent or attorney. The power of attorney may be for a definite, specific act, or it may be general in nature. The terms of the written power of attorney may specify when it will expire. If not, the power of attorney usually expires when the person granting it dies. Source: OCC
  • State: extends to and includes any State, territory or possession of the United States, the District of Columbia and the Canal Zone. See New Jersey Statutes 1:1-2
  • Statute: A law passed by a legislature.
  • Subpoena: A command to a witness to appear and give testimony.
  • Uphold: The decision of an appellate court not to reverse a lower court decision.