N.J. Admin. Code § 11:4-53.4

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

Section 11:4-53.4 - Standards for specified disease coverage

(a) Specified disease policies shall provide the following minimum benefits:

1. A fixed-sum benefit of at least $ 100.00 for each day of hospital confinement for at least 365 days; and

2. A fixed-sum benefit equal to at least one-half of the benefit for hospital confinement, for each day of hospital or non-hospital outpatient surgery or other medically appropriate outpatient treatment, including but not limited to chemotherapy and radiation therapy, for at least 365 days.

(b) Benefits for confinement in a skilled nursing home or for home health care are optional. If a policy provides these benefits, the policy shall provide a fixed sum benefit of at least one-fourth of the daily benefit amount payable for hospital confinement for each day of skilled nursing home confinement for at least 100 days, and for each day of home health care for at least 100 days.

(c) A lump sum payment at least equal to $ 1,000 may be made to cover non-medical costs such as travel, lodging, household costs, and other living expenses.

(d) Benefit payments shall begin with the first day of care or confinement after the effective date of coverage if the care or confinement is for a covered disease even though the diagnosis of the covered disease is made at some later date.

(e) No policy shall contain any requirement that the covered person under the policy must incur an expense in order for benefits to be paid.

N.J. Admin. Code § 11:4-53.4