N.J. Admin. Code § 11:24-3.4

Current through Register Vol. 56, No. 11, June 3, 2024

Section 11:24-3.4 - Member contract termination

(a) A member shall not have his or her membership in an HMO cancelled except for the following reasons:

1. Failure to pay the premiums and other applicable charges for such coverage, including copayment coinsurance and deductibles;

2. Failure to abide by the rules and/or policies and procedures of the HMO;

3. Fraud or material misrepresentation affecting coverage, including misuse of a member identification card; or

4. The group of which the individual is a member is not renewed in accordance with the HMO's underwriting guidelines or is cancelled for failure to pay premiums.

(b) Before a member's coverage can be terminated for (a)1 and 2 above, the member shall be given written notice of the violation and a reasonable opportunity to come into compliance. Following any decision to terminate a member's coverage, the HMO shall notify the member of his or her right to appeal such decision as set forth in 11:24-3.7.

N.J. Admin. Code § 11:24-3.4

Amended by R.2002 d.265, effective 8/19/2002.
See: 34 N.J.R. 885(a), 34 N.J.R. 3014(a).
In (b), neutralized gender reference and revised N.J.A.C. reference.