N.J. Admin. Code § 11:4-1.3

Current through Register Vol. 56, No. 24, December 18, 2024

Section 11:4-1.3 - Establishment of Association and Fund

(a) Pursuant to N.J.S.A. 17B:32B-1 et seq., the Association is created to administer the Fund established pursuant to N.J.S.A. 17B:32B-6 for purposes of providing payment for eligible claims under a covered health maintenance organization contract on an equitable basis to any covered individual or provider that remains unpaid.

(b) Pursuant to N.J.S.A. 17B:32B-6, the Fund shall consist of an aggregate amount of not more than $ 100,000,000 consisting of:

1. $ 50,000,000 to be deposited in the Fund pursuant to N.J.S.A. 17B:32B-17; and

2. An aggregate sum of not more than $ 50,000,000 collected through assessments on member organizations pursuant to N.J.S.A. 17B:32B-9.

(c) In addition to assessments made as described in (b)2 above, pursuant to N.J.S.A. 17B:32B-8h(3), assessments may be made on member organizations in the aggregate amount of $ 2,000,000 to cover costs for the services of a consulting organization to audit the adjudicated claims of the insolvent organizations, if the Commissioner determines the need for such an audit pursuant to N.J.S.A. 17B:32B-8h(1).

N.J. Admin. Code § 11:4-1.3