N.J. Admin. Code § 11:15-5.22

Current through Register Vol. 56, No. 21, November 4, 2024

Section 11:15-5.22 - Confidentiality of claims

(a) Employee claims information is privileged and confidential and shall not be included as a part of any open public record.

(b) The trustees and the officials of the member shall not have access to any employee claim information which reveals the identity of any individual plan participant.

(c) All claims are to be filed, and all inquiries are to be handled, directly by the designated claims' administrator. All employees of the administrator shall execute a non-disclosure statement to protect the identity of the plan participants.

(d) Only trustees and necessary fund professionals shall participate in any closed session discussion of claims. These claims discussions, whether general or specific to a coverage dispute, shall at all times be confidential and anonymous so that the identity of the school board and claimant cannot be ascertained. The anonymity of the claimant shall be accomplished by assigning a blind claim number and deleting all references to the individual's name and place of employment. Only the claimant may demand, by written notice, that the matter be handled with disclosure of his or her identity.

(e) Documents identifying the employee, or from which the employee's identity might be deduced, shall not be accessible to any persons other than the administrator, program manager, fund attorney, or appointed claim auditors when such records are needed to verify the accuracy of claim data as part of an audit.

(f) Any person having access to claim information must sign a written non-disclosure statement.

N.J. Admin. Code § 11:15-5.22