N.J. Admin. Code § 11:4-14.4

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

Section 11:4-14.4 - Exclusions

(a) This subchapter does not impose an obligation to pay benefits for physician's services in connection with home health care except for those benefits required under paragraph 9 of the definition of home health care services.

(b) Home health care services including those of home health aides need not be reimbursable to the extent they have been provided for persons in the household other than the patient.

(c) Policy exclusions relating to worker's compensation, employer's liability laws, Medicare, mandatory no-fault automobile insurance, veteran's hospitals, military service, and so forth, applicable to hospital and skilled nursing facility confinement benefits may also apply to home health care benefits.

(d) Benefits need not be payable if no charge is normally made for a home health care service.

(e) Policy provisions relating to coordination of benefits may apply to home health care services to the same extent that they apply to other benefits provided by the policy.

(f) The policy may require that home health care services will be provided only to residents of New Jersey.

N.J. Admin. Code § 11:4-14.4