N.J. Admin. Code § 11:4-37.1

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

Section 11:4-37.1 - Purpose and scope

(a) The purpose of this subchapter is to set forth standards and procedures whereby a carrier shall obtain approval from the Commissioner of its offering of health benefits plans utilizing selective contracting arrangements that promote health care cost containment while adequately preserving quality of care.

(b) This subchapter applies to all carriers operating pursuant to Title 17B of the New Jersey statutes, and issuing health benefits plans utilizing selective contracting arrangements in this State. This subchapter shall not apply to the following: hospital service corporations operating pursuant to N.J.S.A. 17:48-1 et seq.; medical service corporations operating pursuant to N.J.S.A. 17:48A-1 et seq.; hospital and medical service corporations operating pursuant to N.J.S.A. 17:48B-1 et seq.; dental service corporations operating pursuant to N.J.S.A. 17:48C-1 et seq.; dental plan organizations operating pursuant to N.J.S.A. 17:48D-1 et seq.; or health service corporations operating pursuant to N.J.S.A. 17:48E-1 et seq.

(c) The provisions of these rules shall apply except where in conflict with any policy or contract issued pursuant to the New Jersey Individual Health Coverage Act at N.J.S.A. 17B:27A-1 et seq. or the New Jersey Small Employer Health Coverage Act at N.J.S.A. 17B:27A-17 et seq. If such a conflict exists, all remaining provisions of these rules determined not to be in conflict shall remain in effect.

N.J. Admin. Code § 11:4-37.1

Amended by R.1998 d.302, effective 6/15/1998.
See: 30 New Jersey Register 267(a), 30 New Jersey Register 2214(a).
Added (c).
Amended by R.2001 d.7, effective 1/2/2001.
See: 32 New Jersey Register 3546(a), 33 New Jersey Register 101(a).
In (b), deleted "or which cover New Jersey residents" following "arrangements in this State".