N.J. Admin. Code § 11:4-42.9
Current through Register Vol. 56, No. 24, December 18, 2024
Section 11:4-42.9 - Provisions for pre-existing condition exclusions and limitations(a) Blanket and group policies and certificates providing life insurance or accidental death and dismemberment insurance benefits shall not subject such benefits to pre-existing condition exclusions and limitations.(b) Group policies and certificates providing health insurance benefits, other than accidental death and dismemberment and group health benefits plans, may include pre-existing condition exclusions and limitations subject to the following:1. A pre-existing condition may be defined no more restrictively than as an illness or injury for which the insured received treatment or advice from a physician or used prescription drugs within no more than a two year period prior to the effective date of coverage.2. No policy, other than a policy providing group disability income insurance shall exclude coverage for a loss due to a pre-existing condition for a period greater than 24 months following the effective date of coverage, nor shall any policy provide any exclusion or limitation applicable to new losses due to a pre-existing condition after the 24-month (or lesser) period. Policies providing group disability income insurance may exclude coverage for losses beginning during the first 24 months after the effective date of coverage due to disabilities and recurrent disabilities which result from a pre-existing condition.3. A succeeding insurer, in applying a pre-existing condition waiting period in its policy shall credit the covered person for satisfaction of the pre-existing condition waiting period under a prior policy or contract, or any portion thereof if the prior waiting period has not been satisfied in full.4. No policy shall limit benefits to illnesses or injuries which first manifest themselves while the covered person is covered under the policy. N.J. Admin. Code § 11:4-42.9
Amended by 51 N.J.R. 618(a), effective 5/6/2019