N.J. Admin. Code § 11:4-28.5

Current through Register Vol. 56, No. 17, September 3, 2024

Section 11:4-28.5 - Prohibited coordination; benefit design

(a) A group contract shall not reduce benefits on the basis that:

1. Another plan exists;

2. A person is or could have been covered under another plan, except with respect to Part B of Medicare; or

3. A person has elected an option under another plan providing a lower level of benefits than another option which could have been elected.

(b) A contract shall not contain a provision that its benefits are "excess" or "always secondary" to any plan as defined in this subchapter, except as may be permitted by this subchapter. This prohibition shall not apply to group student excess accident or health contracts where no part of the premium is paid by the student or his family.

(c) No contract delivered or issued for delivery in this State, or renewed, continued or converted on or after January 1, 1991, shall contain any provision, rider, waiver or endorsement or other instrument which restricts, limits or excludes coverage, directly or indirectly, of services or expenses otherwise eligible under the contract on the grounds that such expenses or services would be covered under an automobile no-fault medical benefits plan for which the covered member would be eligible, except as provided for by N.J.A.C. 11:3-37.

N.J. Admin. Code § 11:4-28.5

Emergency Amendment, R.1990 d.625, effective 11/26/1990 (expires January 25, 1991).
See: 22 New Jersey Register 3777(a).
Amended to effectuate the purpose and intent of Section 6 of the Fair Automobile Insurance Reform Act of 1990, P.L. 1990, c.8 ("FAIR Act"), which becomes operative January 1, 1991.
Adopted Concurrent Proposal, R.1991 d.90, effective 1/25/1991.
See: 22 New Jersey Register 3777(a), 23 New Jersey Register 597(a).
Provisions of emergency amendment R.1990 d.625 readopted without change.