N.J. Admin. Code § 11:20-2.10
Current through Register Vol. 56, No. 11, June 3, 2024
Section 11:20-2.10 - Standard health benefits plans(a) The Board shall establish the policy and contract forms and benefit levels (standard health benefits plans) to be made available by members. 1. In designing and amending the standard health benefits plans, the Board shall give consideration to the types of coverage currently in force and/or available in the market, individuals' preferences, and the evolution of the market towards managed care.2. The Board shall discuss amendments to the standard policy forms at a meeting open to the public prior to any vote by the Board to adopt, or modify any aspect of, a standard health benefits plan design.3. The Board shall hold a public hearing on the standard health benefits plans or any amendments thereto prior to adopting or changing a standard health benefits plan. i. The Board shall provide to all members and interested parties reasonable advance notice of a public hearing in accordance with the procedures set forth in the Act as amended.ii. The Board may establish procedures for a public hearing and publish them with the notice of the public hearing.iii. The Board shall maintain a written record of any public hearing and make it available for inspection at the office of the Executive Director.4. The Board shall adopt or amend a standard health benefits plan in accordance with the procedures set forth in the Act, as amended, or in accordance with the procedures set forth in the Administrative Procedures Act.i. In accordance with the procedures for taking action set forth in the Act, as amended, the Board may adopt a standard health benefits plan or modifications thereto and thereafter shall address in writing such comments as were received within a reasonable period following the adoption of the proposed action. The Board shall give due consideration to all comments received. Pursuant to the Act as amended, the Board shall, within a reasonable period of time following submission of the comments, prepare for public distribution a report listing all parties who provided written submissions concerning the intended action, summarizing the content of the submissions and providing the Board's response to the data views and arguments contained in the submissions. A copy of the report shall be filed with the Office of Administrative Law for publication in the New Jersey Register. (1) The Board shall identify whether it made a change in the action proposed at its own initiative or in response to one or more comments.ii. Except as may be required by law, members shall implement amendments to the standard health benefits plans in the time prescribed by the Board.5. The Board shall take action as necessary to keep the standard health benefits plans in compliance with State and Federal law.6. No member shall issue or renew a standard health benefits plan until a rate filing has been filed with the Department in accordance with N.J.A.C. 11:20-6.N.J. Admin. Code § 11:20-2.10
Amended by R.1998 d.443, effective 8/7/1998.
See: 30 N.J.R. 2581(a), 30 N.J.R. 3289(a).
Rewrote the section.
Amended by R.2006 d.15, effective 1/3/2006 (operative July 1, 2006).
See: 37 N.J.R. 2994(a), 38 N.J.R. 311(a), 1005(a).
Rewrote (a) and (b).
Amended by R.2009 d.45, effective 12/29/2008.
See: 40 N.J.R. 6904(a), 41 N.J.R. 799(b).
Deleted the former introductory paragraph of (b); recodified former (b)1 as (a)6; and in (a)6, substituted "Department" for "Board".
Amended by R.2016 d.127, effective 10/17/2016 (operative January 1, 2017).
See: 48 N.J.R. 1555(a), 48 N.J.R. 2153(a).
In (a)1, substituted "individuals' " for "individual's"; and in (a)6, deleted "or the basic and essential healthcare services plan" preceding "until".
Amended by R.2018 d.197, effective 6/12/2018.
See: 50 N.J.R. 1412(a), 50 N.J.R. 2329(a).
In (a)1, substituted "market" for "marketplace" twice, and inserted a comma following "preferences".