N.J. Admin. Code § 11:4-54.1

Current through Register Vol. 56, No. 8, April 15, 2024

Section 11:4-54.1 - Purpose and scope

(a) The purpose of this subchapter is to implement P.L. 2001, c. 236 by establishing uniform definitions of terms associated with infertility coverage and benefits that must be provided for infertility in this State.

(b) This subchapter shall apply to the following:

1. All policies, contracts, riders and endorsements delivered, issued, executed or renewed in this State by health service corporations, hospital service corporations, medical service corporations and health insurance companies for groups other than small employers as defined at 17B:27A-17 that provide hospital or medical benefits, including pregnancy-related benefits;

2. All contracts and evidence of coverage forms issued by health maintenance organizations for groups other than small employers as defined at 17B:27A-17 that include pregnancy-related coverage; and

3. All certificates and evidence of coverage forms delivered, issued, executed or renewed in this State where the related group policy or contract is delivered, issued, executed or renewed in this State for groups other than small employers as defined at 17B:27A-17 that provide hospital or medical benefits, including pregnancy-related benefits.

(c) This subchapter shall not apply to any policy or contract which, pursuant to a contract between a carrier and the New Jersey Department of Human Services, provides benefits to persons who are eligible for medical assistance under P.L. 1968, c.413 (30:4D-1 et seq.); the Children's Health Care Coverage program under P.L. 1997, c. 272 (30:4I-1 et seq.); the FamilyCare Health Coverage Program under P.L. 2000, c. 71 (30:4J-1 et seq.); or any other program administered by the Division of Medical Assistance and Health Services in the New Jersey Department of Human Services.

N.J. Admin. Code § 11:4-54.1