N.J. Admin. Code § 11:23-2.1

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

Section 11:23-2.1 - License or registration required

(a) No person shall act as, offer to act as, or hold himself or herself out to be, a third party administrator in this State unless licensed or registered by the Commissioner as set forth in N.J.A.C. 11:23-2.2.

(b) Every third party administrator that is either not licensed in New Jersey as an insurer or an organized delivery system and is not an affiliate or subsidiary of an insurer licensed in New Jersey, or an affiliate or a subsidiary of a New Jersey licensed insurer and only processes or pays claims on behalf of benefits payers other than insurers shall be licensed by the Commissioner pursuant to the provisions of the Act.

(c) Every third party administrator that is a subsidiary or affiliate of an insurer licensed in New Jersey and processes claims on behalf of both that insurer and benefits payers other than that insurer shall be required to register with the Commissioner pursuant to the provisions of the Act.

N.J. Admin. Code § 11:23-2.1