N.J. Admin. Code § 11:1-4.3

Current through Register Vol. 57, No. 1, January 6, 2025

Section 11:1-4.3 - Complications of pregnancy

(a) This regulation is applicable to all persons engaged in the business of life and health insurance in the State of New Jersey.

(b) "Complications of pregnancy" shall mean:

1. Conditions (when the pregnancy is not terminated) whose diagnoses are distinct from pregnancy but are adversely affected by pregnancy or are caused by pregnancy, such as, acute nephritis, nephrosis, cardiac decompensation, missed abortion, and similar medical and surgical conditions of comparable severity, but shall not include false labor, occasional spotting, physician-prescribed rest during the period of pregnancy, morning sickness, hyperemesis gravidarum, preeclampsia, and similar conditions associated with the management of a difficult pregnancy not constituting a nosologically distinct complication of pregnancy; and

2. Nonelective caesarean section, ectopic pregnancy, which is terminated, and spontaneous termination of pregnancy, which occurs during a period of gestation in which a viable birth is not possible.

(c) General provisions include the following:

1. No person engaged in the business of life and health insurance in this State shall treat complications of pregnancy more restrictively than any other sickness or illness under any contract of insurance issued for delivery in New Jersey.

2. A contravention of the preceding paragraph shall be deemed evidence of an unfair trade practice in the conduct of business of insurance in this State in violation of N.J.S.A. 17B:30-1 et seq.

N.J. Admin. Code § 11:1-4.3

New Rule, R.1976 d.161, effective 9/1/1976.
See: 8 N.J.R. 196(b), 8 N.J.R. 300(b).