N.J. Admin. Code § 11:3-37.10

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

Section 11:3-37.10 - Explanation of benefits

(a) Automobile insurers shall develop and utilize an explanation of benefits form to be provided with the payment of benefits for expenses incurred for treatment of injuries which clearly identifies and explains the following:

1. Each procedure for which a claim has been made;

2. Eligible expense related to each procedure with an indication of whether the eligible expense is based on the medical fee schedules or is the reasonable charge as determined by the automobile insurer;

3. Actual benefits paid;

4. Any deductible or copayment applied;

5. A concise explanation why any item of expense is considered an ineligible expense, when this occurs; and

6. A statement to insureds that no health care provider may demand or request any payment from any person in excess of those permitted by N.J.A.C. 11:3-29, and that no person is liable to any health care provider for any amount of money which results from the charging of fees in excess of those permitted by N.J.A.C. 11:3-29 pursuant to 39:6A-4.6.

N.J. Admin. Code § 11:3-37.10

Amended by R.1994 d.564, effective 11/21/1994 (operative January 1, 1995).
See: 25 New Jersey Register 4706(a), 26 New Jersey Register 4616(b).