N.J. Admin. Code § 10:62-1.20

Current through Register Vol. 56, No. 24, December 18, 2024

Section 10:62-1.20 - Personal contribution to care requirements for NJ FamilyCare-Plan C and copayments for NJ FamilyCare-Plan D

(a) General policies regarding the collection of personal contribution to care for NJ FamilyCare-Plan C and copayments for NJ FamilyCare-Plan D services are set forth at N.J.A.C. 10:49-9.

(b) Personal contribution to care for NJ FamilyCare-Plan C services is $ 5.00 per visit for office visits, except when the service is provided for preventive care.

1. An office visit is defined as a face-to-face contact with a vision care professional that meets the documentation requirements in this subchapter and N.J.A.C. 10:62-3.

2. Office visits include eye care professional services provided in the office, patient's home, or any other site, excluding hospital, where the child may have been examined by the vision care professional. Generally, these procedure codes are set forth in N.J.A.C. 10:62-3.2.

(c) Vision care professionals shall not charge a personal contribution to care for services provided to newborns who are covered under fee-for-service for Plan C; or for preventive services.

(d) There shall be a $ 5.00 copayment per visit required for vision care services for Plan D enrollees.

(e) Vision care professionals shall collect the copayment specified in (d) above except as provided in (f) below. Copayments shall not be waived.

(f) Vision care professionals shall not charge a copayment for services provided to newborns who are covered under fee-for-service for Plan D.

N.J. Admin. Code § 10:62-1.20

Amended by 49 N.J.R. 2279(b), effective 7/17/2017